Predicting IBD Relapses Gets Easier

Symptomatic relapse and remission are very characteristic of Crohn’s disease and ulcerative colitis, and disease flares are often unpredictable, significantly affecting the patient’s quality of life. So far, diagnosis of IBD has been based on clinical evaluation, radiology, endoscopy, etc. Now, thanks to researchers in Canada, stool markers such as calprotectin have emerged as new diagnostic tools to detect intestinal inflammation.

The study showed that elevated levels of fecal calprotectin in the absence of endoscopically visible inflammatory bowel disease (IBD) can predict relapses requiring the escalation of therapy or even the development of future IBD in patients with irritable bowel syndrome. Patients were followed up for a year, during which time they were monitored for any change in symptoms, escalation of therapy or development of IBD. According to Dr. Jamie Gregor, MD, professor of medicine at the University of Western Ontario, in London, “It turned out that among patients with known IBD, if fecal calprotectin was normal [below 100 mcg/g], there was only an 18% chance they would require an increase in therapy. Whereas if fecal calprotectin was elevated, there was a 66% chance they would need to have increased therapy or new therapy for IBD.”

David P. Hudesman, MD, director of inflammatory bowel diseases at NYU Langone Medical Center, in New York City, said he was encouraged by the move toward proactive monitoring of patients’ disease states. “In the past, we would start patients on medication for Crohn’s or ulcerative colitis, and would adjust our therapy only when their symptoms flared, Now it is possible to proactively monitor patients to a different target, not only symptoms, but biomarkers and endoscopy as well. And hopefully that will help us prevent many clinical flares.”

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