The Utility of Biomarkers in the Diagnosis and Therapy of Inflammatory Bowel Disease
Section snippets
Tests Used to Evaluate Patients With Symptoms of IBD
Numerous fecal markers can potentially be used to determine the likelihood that a patient has IBD.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 The 2 most commonly utilized are calprotectin and lactoferrin. Calprotectin is a 36-kilodalton calcium- and zinc-binding protein that represents 60% of cytosolic proteins in granulocytes.19 It is stable in feces when stored at room temperature for up to 1 week.20 The concentration of calprotectin in feces is an indirect measure of
Differentiating Between CD and UC
ASCA is associated with CD, whereas increased levels of pANCA are more common among patients with UC.35 In a meta-analysis, combinations of tests for ASCA and pANCA distinguished patients with CD from those with UC with 40%–50% sensitivity and specificity of > 90%.36 However, when the population was limited to those with colonic disease, for whom the diagnostic question is most relevant, the ASCA test was less sensitive for CD and discriminated less well between CD and UC.36
The need for such a
Conclusions
Biomarkers could have a role at nearly every point in the disease management. When patients present with symptoms suggestive of IBD, combinations of fecal and serologic markers might be used to identify patients who should undergo invasive testing and to help distinguish CD from UC. Tests for serologic biomarkers have been developed to identify patients who are most likely to have a severe course of disease progression but require further evaluation in prospective studies that also assess
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Conflicts of interest The author discloses the following: Dr. Lewis reports having previously served as an expert witness on behalf of Prometheus; received research funding from Centocor and Shire; and served as a consultant to Centocor, Shire, and Procter & Gamble.
Funding Supported in part by NIH grant K24-DK078228.