The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease

Abstract

Fecal and serologic biomarkers can be used in the diagnosis and management of inflammatory bowel disease (IBD). Fecal markers such as calprotectin and lactoferrin have been studied for their ability to identify patients with IBD, assess disease activity, and predict relapse. Antibodies against Saccharomyces cerevisiae and perinuclear antineutrophil cytoplasmic proteins have been used in diagnosis of IBD, to distinguish Crohn's disease (CD) from ulcerative colitis, and to predict the risk of complications of CD. Tests for C-reactive protein and erythrocyte sedimentation rate have been used to assess inflammatory processes and predict the course of IBD progression. Levels of drug metabolites and antibodies against therapeutic agents might be measured to determine why patients do not respond to therapy and to select alternative treatments. This review addresses the potential for biomarker assays to improve treatment strategies and challenges to their use and development.

Figure 1

The potential role of biomarker assays in the care of patients with suspected or established IBD. Biomarkers might be used in all phases of the care. For patients with suspected IBD, biomarkers can be used to select which patients are unlikely to have IBD and could forgo further testing. Once patients are diagnosed, biomarkers can be used to determine which patients have CD or UC and to predict disease course. Biomarkers might be used to determine which patients are most likely to respond to therapies and determine prognosis, to identify those that require more aggressive therapies. In patients with recurrent symptoms, biomarkers can differentiate patients with active inflammation from those likely to have symptoms from other causes.