Can we Monitor a Patient with Inflammatory Bowel Disease and Adapt Treatment without Endoscopy?
BACKGROUND
While predictors of disease course in inflammatory bowel diseases (IBD) are not accurate, we adapt therapies reactively, after objective demonstration of the presence of active disease, complications, or an inadequate response to a therapeutic intervention. In this context, adequate monitoring is essential to make timely management decisions.


OBJECTIVE
To review the role of clinical assessment, biomarkers, radiology and endoscopy in monitoring patients with IBD.


RESULTS
Assessment of clinical symptoms is the cornerstone of monitoring in IBD; in ulcerative colitis (UC) there is acceptable correspondence between mucosal lesions and presence of symptoms, but in Crohn's disease (CD) there is a considerable disconnection between these two, and monitoring requires complementary tests. Blood and stool markers such as C-reactive protein and fecal calprotectin are increasingly used. However, the operating properties of these biomarkers are different according to disease type (UC vs. CD), age (pediatric or adult), and disease location (small bowel vs. colonic disease). Cross-sectional imaging has a similar accuracy to endoscopy to detect inflammation in CD, and a higher accuracy to detect stenosing and penetrating complications. It has also been shown that magnetic resonance imaging is accurate for measuring response to therapeutic interventions.


CONCLUSION
Cross-sectional imaging is one of the preferred monitoring options in patients with CD. Endoscopy continues to be the preferred examination for assessing UC, and should still be considered in patients with CD who have symptoms or altered biomarkers and cross-sectional imaging is negative.
['Panes|Julian|J|', 'Ricart|Elena|E|']
D000328:Adult D015415:Biomarkers D002097:C-Reactive Protein D002648:Child D003093:Colitis, Ulcerative D003424:Crohn Disease D016099:Endoscopy, Gastrointestinal D005243:Feces D006801:Humans D039841:Leukocyte L1 Antigen Complex D008279:Magnetic Resonance Imaging
endoscopy Biomarker ulcerative colitis Crohn's disease imaging magnetic resonance imaging ultrasonography.