ISLAMABAD, Nov 20 (Online): New guidelines from the American Gastroenterological Association could mean people living with Crohn\u2019s disease will need fewer invasive procedures.<\/p>\n
The guidelines published today recommend using the C-reactive protein (CRP) biomarker in blood and the fecal calprotectin (FCP) biomarker in stool to measure inflammation levels and assess whether Crohn\u2019s disease is in remission or active.<\/p>\n
\u201cPatients\u2019 symptoms do not always match endoscopic findings, so biomarkers are a useful tool to understand and monitor the status of inflammation and guide decision making in patients with Crohn\u2019s disease,\u201d Dr. Siddarth Singh, a co-author of the guidelines and an associate professor of clinical medicine at The University of California San Diego, said in a press statement.<\/p>\n
The guidelines recommend biomarkers be used alongside imaging studies and colonoscopies, and at different intervals depending on the patient.
\nUnder the guidelines, patients in remission would have their biomarkers checked every 6 to 12 months. People with active symptoms would have their biomarkers checked every 2 to 4 months.<\/p>\n
The authors of the guidelines say it would be good news for patients who would not require as many invasive procedures, like colonoscopy.
\n\u201cBased on this guideline, biomarkers are no longer considered experimental and should be an integral part of inflammatory bowel disease care,\u201d Dr. Ashwin Ananthakrishnan, a co-author of the guidelines and a gastroenterologist at Massachusetts General Hospital, said in a press statement.<\/p>\n
\u201cThis is a win for Crohn\u2019s disease patients. Biomarkers are usually easier to obtain, less invasive, more cost-effective than frequent colonoscopies and can be assessed more frequently for tighter disease control and better long-term outcomes in Crohn\u2019s disease,\u201d he added.<\/p>\n
What is Crohn\u2019s disease?
\nCrohn\u2019s disease is a type of inflammatory bowel disease (IBD) that causes irritation and inflammation throughout the digestive tract.<\/p>\n
Typically, Crohn\u2019s impacts the small intestine as well as the beginning of the large intestine, although it is possible for inflammation to occur anywhere in the digestive tract, which spans from the mouth to the anus.
\nResearch suggests more than 500,000Trusted Source people in the United States have Crohn\u2019s disease. Rates of Crohn\u2019s disease have been on the rise in recent years, with the condition becoming more common in the United States. Researchers are unsure why this is.<\/p>\n
People living with Crohn\u2019s can experience symptoms such as abdominal cramping, diarrhea, and weight loss.
\nThe goal of treatment is to keep patients in symptom-free remission, prevent flare-ups, and decrease levels of inflammation in the intestine.
\nBiomarkers can be used to detect inflammation
\nThe biomarkers suggested in the guidelines are one way of determining levels of inflammation.<\/p>\n
\u201cCRP, that\u2019s a simple blood test, it\u2019s drawn routinely for many different disorders. It\u2019s a very general marker for any source of inflammation in the body. So, if there\u2019s anything in your body that\u2019s inflamed, it could result in an increase in that CRP blood test. It is somewhat useful, but definitely flawed. It\u2019s not a perfect biomarker,\u201d Dr Jesse Stondell, a gastroenterologist at UC Davis Health, told Medical News Today.<\/p>\n
The other biomarker used in the guidelines is a fecal calprotectin, taken from a stool test.
\n\u201cIt\u2019s much more specific for inflammation in the gastrointestinal tract. If you have an increased fecal calprotectin greater than 150, which is the cutoff for use in the guideline, which I agree with, that indicates there may be significant inflammation in either the colon or the small intestine,\u201d Stondell said.<\/p>\n
A shift in approach to Crohn\u2019s management
\nThe experts who spoke with Medical News Today say the use of biomarkers in the guidelines are reflective of a shift in approach to the management of Crohn\u2019s disease.<\/p>\n
\u201cIn the past, we were really okay with clinical remission. As long as patient symptoms were to the level that we call the clinical remission, that was good enough. Nowadays, we understand that many of these instances that we think the patient is in clinical remission, they are not in deep mucosal remission,\u201d Dr. Ashkan Farhadi a gastroenterologist at MemorialCare Orange Coast Medical Center in California, told Medical News Today.<\/p>\n
\u201cWhen the inflammation is going on, basically the disease is actually going on at a subclinical level. The long term consequences of this is long term damage to mucosa,\u201d he added.<\/p>\n
One of the benefits of utilizing biomarkers in Crohn\u2019s management is that physicians can change treatments without the need for an invasive colonoscopy.<\/p>\n
\u201cIn a general sense, it\u2019s kind of allowing us to decide to change therapy in some symptomatic patients without colonoscopy like we used to do,\u201d Stondell said. \u201cIf we start a patient on therapy, they\u2019re not responding appropriately, they\u2019re still having a lot of symptoms, we can check that fecal calprotectin tests and get a very quick sense of if things are working or not. If the calprotectin is normal, it could be reassuring that there may be other reasons for their symptoms, and that the medicines working. But if they have symptoms, and a calprotectin is elevated, that\u2019s a signal that we have to worry the medicine is not working. And that we need to change therapy in that patient.\u201d<\/p>\n
Another benefit of using biomarkers is that medications can be adjusted based on levels of inflammation detected.
\nA 2017 studyTrusted Source examined this approach and found that patient outcomes improved.<\/p>\n
\u201cThey titrated the medications based on biomarkers, ie they adjusted\/escalated the dose of biologics if the biomarkers were elevated. The results showed that the group of patients where we adjusted the dose of medications based on biomarkers did much better in the long run as compared to patients for where treatment was based on symptoms only,\u201d Dr. Saurabh Kapur, a gastroenterologist at The University of Kansas Health System, told Medical News Today.<\/p>\n
He is hopeful the guidelines will result in better outcomes for patients.
\n\u201cThis hopefully will standardize management across GI practices, decrease steroid use, and decrease the complications of Crohn\u2019s like flares, hospitalization, and even the need for surgery and bowel resections,\u201d he explained. \u201cSo early, effective treatment based on guidelines would lead to better outcomes and decrease the tremendous burden of disease for these patients,\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
ISLAMABAD, Nov 20 (Online): New guidelines from the American Gastroenterological Association could mean people living with Crohn\u2019s disease will need fewer invasive procedures. The guidelines published today recommend using the C-reactive protein (CRP) biomarker in blood and the fecal calprotectin (FCP) biomarker in stool to […]<\/p>\n
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