New Crohn's Disease Guidelines Should Mean Fewer Colonoscopies for Patients

In November 2023, the American Gastroenterological Association (AGA) released new guidelines for managing Crohn's disease. The new guidelines may mean that people living with Crohn's disease will need fewer colonoscopies.¹

The guidelines state that doctors can now test and detect Crohn's disease using only biomarkers. Biomarkers are blood, urine, stool, or soft-tissue-based tests that inform doctors about a disease.¹

According to the new guidelines, biomarkers are no longer considered experimental. Moving forward, biomarker testing should be a main part of IBD care.¹

What biomarkers will doctors look for?

The guidelines recommend that doctors screen for 2 specific biomarkers that have been linked to Crohn's disease:^1-3

• C-reactive protein (CRP) – This biomarker can be found in blood. CRP is made in the liver, and high levels can signal inflammation throughout the body.
• Fecal calprotectin (FCP) – This biomarker can be found in stool. High FCP levels can signal intestinal inflammation.

Crohn's biomarker testing versus colonoscopy

Compared to frequent colonoscopies, biomarkers are easier to screen for, less invasive, and more affordable. Biomarker testing can also be done more often, which can lead to better disease control.^1-3

Doctors have usually recommended an endoscopy to look inside the colon. This includes:⁴

• Colonoscopy – The doctor views the rectum using a tiny tube fixed to a camera.
• Upper endoscopy – This test helps the doctor to see the esophagus, stomach, and duodenum (the upper part of the small intestine).

Using only endoscopy to assess Crohn's disease has many challenges. This includes high cost, high resource use, invasiveness, and low acceptability.

However, researchers found that checking biomarkers often for treatment decisions improved patient outcomes over 2 years.¹

How often is biomarker testing recommended?

The AGA suggests using biomarker testing alongside other tests, including colonoscopy and imaging studies in some cases. This means people with normal biomarkers can continue their treatment plan. Those with high biomarkers should get an endoscopy to help to rule out any underlying conditions.¹

This AGA Crohn's guideline recommends that doctors check:¹

• CRP and FCP biomarkers every 4 to 6 months for people in remission
• CRP and FCP biomarkers every 2 to 4 months for those with increasing symptoms
• Endoscopy and radiology results before changing treatment or after a post-surgery flare-up

Inflammation and Crohn's disease

Crohn's disease is a long-term (chronic) condition that leads to inflammation in the gastrointestinal (GI) tract. Crohn's disease is part of a group of conditions called inflammatory bowel disease (IBD). Up to 3.1 million people in the United States have the disease.^5,6

In most cases, Crohn's disease affects the small intestine and the beginning of the large intestine. However, it can affect any part of the GI tract between the mouth and anus.^5,7

The exact cause of Crohn's disease is unknown. However, experts believe that Crohn's disease may be an autoimmune reaction. This is when the immune system mistakenly attacks healthy cells, triggering the immune system. The immune system's response causes inflammation, leading to symptoms of Crohn's disease.^5,7

While there is no cure for Crohn's disease, certain therapies can help people manage it well. The goals of treatment include:⁸

• Decreasing inflammation in the GI tract
• Preventing symptom flare-ups
• Staying in remission

If you are interested in biomarker testing as part of your Crohn's disease management and treatment plan, talk to your doctor.