Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11246
Peer-review started: June 8, 2015
First decision: July 13, 2015
Revised: July 26, 2015
Accepted: September 13, 2015
Article in press: September 14, 2015
Published online: October 28, 2015
Processing time: 138 Days and 16.2 Hours
The optimal method for monitoring quiescent disease in patients with Crohn’s disease (CD) and ulcerative colitis is yet to be determined. Endoscopic evaluation with ileocolonoscopy is the gold standard but is invasive, costly, and time-consuming. There are many commercially available biomarkers that may be used in clinical practice to evaluate disease status in patients with inflammatory bowel disease (IBD), but the most widely adopted biomarkers are C-reactive protein (CRP) and fecal calprotectin (FC). This review summarizes the evidence for utilizing CRP and FC for monitoring IBD during clinical remission and after surgical resection. Endoscopic correlation with CRP and FC is evaluated in each disease state. Advantages and drawbacks of each biomarker are discussed with special consideration of isolated ileal CD. Fecal immunochemical testing, traditionally used for colorectal cancer screening, is mentioned as a potential new alternative assay in the evaluation of IBD. Based on a mixture of information gleaned from biomarkers, clinical status, and endoscopic evaluation, the best treatment decisions can be made for the patient with IBD.
Core tip: C-reactive protein (CRP) is not specific for intestinal inflammation but does have modest correlation with clinical and endoscopic findings in inflammatory bowel disease patients. CRP can be falsely low despite active mucosal inflammation and is more reliable in cases of transmural inflammation. Fecal calprotectin (FC) is more specific than CRP for intestinal inflammation, except in isolated ileal disease. FC better correlates with endoscopic findings than CRP and is useful in monitoring Crohn’s patients for postoperative recurrence. Optimal FC cutoffs are still being determined.