From the Guidelines
The appropriate workup for Inflammatory Bowel Disease (IBD) should include a stepwise approach to rule-out ongoing inflammatory activity, starting with measurement of fecal calprotectin, followed by endoscopy with biopsy, and cross-sectional imaging if necessary. This approach is supported by the 2019 clinical practice update on functional gastrointestinal symptoms in patients with IBD, which recommends a stepwise approach to evaluate ongoing inflammatory activity 1.
When evaluating patients with IBD, it is essential to consider the following key components:
- Measurement of fecal calprotectin to assess intestinal inflammation
- Endoscopy with biopsy to evaluate the extent and severity of disease
- Cross-sectional imaging, such as CT or MRI enterography, to evaluate small bowel involvement, particularly in Crohn's disease
- Consideration of anatomic abnormalities or structural complications in patients with obstructive symptoms
- Evaluation of alternative pathophysiologic mechanisms, such as small intestinal bacterial overgrowth, bile acid diarrhea, carbohydrate intolerance, and chronic pancreatitis, based on predominant symptom patterns 1.
In patients with indeterminate fecal calprotectin levels and mild symptoms, serial calprotectin monitoring may be considered to facilitate anticipatory management 1. Additionally, a low FODMAP diet may be offered for management of functional GI symptoms in IBD, with careful attention to nutritional adequacy 1. Psychological therapies, such as cognitive behavioral therapy, hypnotherapy, and mindfulness therapy, should also be considered in IBD patients with functional symptoms 1.
By following this stepwise approach and considering these key components, clinicians can accurately diagnose and manage IBD, while also excluding other conditions that may mimic the disease.
From the Research
Diagnostic Approach
The diagnosis of Inflammatory Bowel Disease (IBD) requires a combination of clinical manifestations, imaging, laboratory, and endoscopic results, as there are no specific diagnostic markers 2.
Role of Biomarkers
Biomarkers, such as C-reactive protein, calprotectin, and lactoferrin, can be helpful in prioritizing further examinations and in the decision to start or intensify treatment 3. However, these biomarkers are not specific for IBD and can be increased in other conditions, such as neoplasia, NSAID abuse, infections, and polyps.
Non-Invasive Biomarkers
Non-invasive biomarkers, such as fecal calprotectin, have been shown to be reliable markers of disease activity and can be used to monitor disease activity and predict relapse 4. The combination of different biomarkers has been proposed to increase the accuracy of disease activity assessment.
Endoscopic Scores
Endoscopy is currently recognized as the gold standard for assessing IBD severity, but it is invasive and not suitable for frequent monitoring 5. New biomarkers, such as platelet/albumin ratio and plateletcrit levels, have been proposed as potential non-invasive biomarkers for assessing endoscopic IBD severity 6.
Key Biomarkers
Key biomarkers that have been shown to be correlated with disease activity include:
- C-reactive protein
- Fecal calprotectin
- Platelet/albumin ratio
- Plateletcrit levels
- Highly sensitive C-reactive protein
- Erythrocyte sedimentation rate
These biomarkers can be used in combination with clinical and endoscopic examinations to assess disease activity and monitor treatment response.