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Measuring disease activity in Crohn's disease: what is currently available to the clinician

Authors D'Incà R, Caccaro R

Received 27 January 2014

Accepted for publication 31 March 2014

Published 20 May 2014 Volume 2014:7 Pages 151—161

DOI https://doi.org/10.2147/CEG.S41413

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Renata D'Incà, Roberta Caccaro

Department of Surgical, Oncological and Gastroenterological Sciences, Gastroenterology Section, University of Padua, Padua, Italy

Abstract: Crohn's disease (CD) is a chronic inflammatory bowel disease characterized by a relapsing-remitting clinical behavior and dominated by intestinal inflammation. Being a chronic disorder that with time develops into a disabling disease, it is important to monitor the severity of inflammation to assess the efficacy of medication, rule out complications, and prevent progression. This is particularly true now that the goals of treatment are mucosal healing and deep remission. Endoscopy has always been the gold standard for assessing mucosal activity in CD, but its use is limited by its invasiveness and its inability to examine the small intestine, proximal to the terminal ileum. Enteroscopy and the less invasive small bowel capsule endoscopy enable the small bowel to be thoroughly explored and scores are emerging for classifying small bowel disease activity. Cross-sectional imaging techniques (ultrasound, magnetic resonance, computed tomography) are emerging as valid tools for monitoring CD patients, assessing inflammatory activity in the mucosa and the transmucosal extent of the disease, and for excluding extra-intestinal complications. Neither endoscopy nor imaging are suitable for assessing patients frequently, however. Noninvasive markers such as C-reactive protein, and fecal biomarkers such as calprotectin and lactoferrin, are therefore useful to confirm the inflammatory burden of the disease and to identify patients requiring further investigations.

Keywords: activity, biomarkers, Crohn, endoscopy, imaging, monitoring


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