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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2015; 21(40): 11246-11259
Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11246
Disease monitoring in inflammatory bowel disease
Shannon Chang, Lisa Malter, David Hudesman
Shannon Chang, Lisa Malter, David Hudesman, Division of Gastroenterology, New York University, New York City, NY 10016, United States
Author contributions: Chang S, Malter L and Hudesman D each contributed meaningfully to the manuscript; Chang S and Hudesman D were partners in writing the manuscript; and Malter L edited the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. David Hudesman, Director of the Inflammatory Bowel Disease Program, Division of Gastroenterology, NYU Langone Medical Center, 240 East 38th Street, Floor 23, New York University, New York City, NY 10016, United States. david.hudesman@nyumc.org
Telephone: +1-212-2633095 Fax: +1-212-2633096
Received: June 6, 2015
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
Abstract

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.

Keywords: Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Fecal calprotectin; C-reactive protein; Fecal immunochemical test; Biomarkers; Remission; Postoperative recurrence

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.