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Review
. 2024 May 9:17:17562848241251600.
doi: 10.1177/17562848241251600. eCollection 2024.

Biomarkers in inflammatory bowel disease: a practical guide

Jennie Clough  1   2 , Michael Colwill  1 , Andrew Poullis  1 , Richard Pollok  3   4 , Kamal Patel  1 , Sailish Honap  1   2   5
Affiliations
Review

Biomarkers in inflammatory bowel disease: a practical guide

Jennie Clough et al. Therap Adv Gastroenterol. .

Abstract

Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn's disease (CD), is a costly condition in terms of morbidity and healthcare utilization, with an increasing prevalence now approaching 1% in the Western world. Endoscopic assessment of IBD remains the gold standard for diagnosis, evaluation of treatment response and determination of post-operative recurrence, but is expensive and invasive. Biomarkers can facilitate non-invasive disease assessment, with C-reactive protein and faecal calprotectin as the most widely available biomarkers in current clinical practice. This narrative review summarizes the evidence for their use in both UC and CD and offers practical guidance for healthcare providers taking into account the limitations of biomarker interpretation. We present evidence for the future use of novel biomarkers in IBD and discuss how biomarker discovery could deliver the goal of precision medicine in IBD.

Keywords: C-reactive protein; Crohn’s disease; biomarker; disease monitoring; faecal calprotectin; precision medicine; ulcerative colitis.

Plain language summary

Biomarkers in inflammatory bowel disease: a practical guide Inflammatory bowel disease (IBD) is a term used to describe two conditions, ulcerative colitis (UC) and Crohn’s disease (CD). These two diseases cause inflammation of the bowel, which can lead to diarrhoea, abdominal pain and bleeding from the back passage. The best way of assessing how active a patient’s IBD is, is by performing a camera test called a colonoscopy. However, having a colonoscopy is inconvenient, comes with some risks to the patient, and uses a lot of healthcare resources. ‘Biomarkers’ are proteins detectable in body fluids (such as blood, poo and urine) which can give information to medical staff about how active a patient’s disease is, without the need for colonoscopy. In this article, we give guidance about how best to use these tests, and when they might not be so useful. We also discuss new biomarkers and ways in which they could be used in the future to predict which treatments patients might respond to best.

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Conflict of interest statement

JC has received a travel grant from Galapagos and has contributed to an advisory board for AbbVie. MC has received a travel grant from Celltrion. AP has no competing interests. RP has contributed to an advisory board for Galapagos. KVP reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, DrFalk, Janssen, PreddictImmune and Takeda; support for attending meetings or travel from AbbVie, Ferring, Janssen and Tillotts; and participation on a data safety monitoring board or advisory board for AbbVie, Galapagos and Janssen. SH has received speaker, consultant, advisory board member fees and/or has received travel grants from Pfizer, Janssen, AbbVie, Takeda, Ferring, Galapagos, Lilly and Pharmacosmos.

Figures

Figure 1.
Figure 1.
A guide to use and interpretation of FCP testing in clinical practice. Source: Image created in BioRender. IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; FCP, faecal calprotectin; MRI, magnetic resonance imaging; NSAID, non-steroidal anti-inflammatory; PPI, proton pump inhibitor; SES-CD, simple endoscopic score in Crohn’s disease; US, ultrasound.
Figure 2.
Figure 2.
The potential role of biomarkers in the course of IBD, and examples of existing or novel biomarkers which could perform these roles. Source: Figure created in BioRender. CRP, C-reactive protein; DPP-4, dipeptidyl peptidase-4; FCP, faecal calprotectin; LRG, leucine-rich alpha-2 glycoprotein.
See this image and copyright information in PMC

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