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Luminal Crohn’s Disease

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Biomarkers in Inflammatory Bowel Diseases

Abstract

Crohn’s disease (CD) is a chronic inflammatory disorder which can lead to progressive intestinal damage and debilitating complications over time. Therefore, obtaining an accurate assessment of disease activity is paramount for risk-stratifying patients and initiating or escalating therapy when appropriate. Within the classic management paradigm, treatment decisions have been largely predicated on patient-reported symptoms. However, more recent evidence suggests that the correlation between clinical symptoms and endoscopically active disease is poor. A significant proportion of patients in clinical remission will have unrecognized active disease; conversely, many patients with mucosal healing will continue to have symptoms. This disconnect highlights the fact that focusing solely on clinical remission will inevitably lead to either undertreating those with clinically silent disease or overtreating those with symptoms unrelated to their CD.

Therefore, in addition to assessing clinical symptoms, there is a need to incorporate more objective markers of disease activity into the management of CD. In the pursuit of providing such information, a number of tools have been assessed in their ability to risk stratify patients, predict active disease, assess risk of relapse or recurrence, and monitor response to therapy. These include serologic, fecal, radiographic, and endoscopic modalities. When used in concert with clinical symptoms, they provide a more detailed and accurate assessment of overall disease activity, in turn allowing for more informed therapeutic decision-making.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Amanda M. Lynn & Edward V. Loftus Jr

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  1. Amanda M. Lynn
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  1. St Vincent’s Hospital, The University of Melbourne, Melbourne, VIC, Australia

    Nik Sheng Ding

  2. Austin Health, The University of Melbourne, Melbourne, VIC, Australia

    Peter De Cruz

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Lynn, A.M., Loftus, E.V. (2019). Luminal Crohn’s Disease. In: Sheng Ding, N., De Cruz, P. (eds) Biomarkers in Inflammatory Bowel Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-11446-6_6

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