Current Approaches for Monitoring of Patients with Inflammatory Bowel Diseases: A Narrative Review

Abstract

Background: Patients with inflammatory bowel diseases (IBD) require proactive monitoring both during the active phase to evaluate therapeutic response and during the remission phase to evaluate relapse or colorectal cancer surveillance. However, monitoring may vary between patients with ulcerative colitis (UC) and Crohn's disease (CD), with distinct tools and intervals.

Methods: This narrative review aims to focus on modern approaches to IBD monitoring, considering international guidelines and expert consensus.

Results: The most recent European diagnostic guidelines advocate a combination of clinical, laboratory, endoscopic, and radiological parameters to evaluate the disease course of patients with IBD. Unfortunately, the conventional symptom-based therapeutic approach does not improve long-term outcomes and there is no single ideal biomarker available. Endoscopy plays a key role in evaluating response to therapy as well as monitoring disease activity. Recently, bedside intestinal ultrasound (IUS) has gained increasing interest and diffusion as it appears to offer several advantages including the monitoring of therapeutic response.

Conclusion: In light of growing clinical advances, we present a schematic evidence-based monitoring algorithm that can be easily applied in clinical practice which combines all major monitoring modalities, including noninvasive tools such as IUS and video-capsule endoscopy.

Keywords: Crohn’s disease; IBD; biomarkers; endoscopy; intestinal ultrasound; monitoring; surveillance; ulcerative colitis; video-capsule endoscopy.

Figure 1

Monitoring therapeutic success scheme according to ECCO-ESGAR diagnostic guidelines. Abbreviations. CD: Crohn’s disease; UC: ulcerative colitis; ASUC: acute severe ulcerative colitis; PRO2: patient-reported outcome; AP: abdominal pain; SF: stool frequency; HBI: Harvey-Bradshaw index; pMAYO: partial Mayo score; eMAYO: endoscopic Mayo score; FC: fecal calprotectin; CRP: C-reactive protein; IUS: intestinal ultrasound; MRE: magnetic resonance enterography; CTE: computed tomography enterography; AXR: abdominal X-ray; CT: computed tomography; SES-CD: simple endoscopic score for Crohn’s disease; CECDAI: capsule endoscopy Crohn’s disease activity index; CS: colonoscopy; SG: sigmoidoscopy.