Gastroenterology

Gastroenterology

Volume 140, Issue 6, May 2011, Pages 1817-1826.e2
Gastroenterology

The Utility of Biomarkers in the Diagnosis and Therapy of Inflammatory Bowel Disease

https://doi.org/10.1053/j.gastro.2010.11.058Get rights and content

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.

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.

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