AGA Guideline Advises Fecal Calprotectin, CRP Monitoring in Crohn’s Disease

Fecal calprotectin and serum C-reactive protein (CRP) levels can help guide disease management in patients with asymptomatic and symptomatic Crohn’s disease (CD), according to a new clinical practice guideline from the American Gastroenterological Association (AGA). Published in the December 2023 issue of Gastroenterology, the comprehensive guideline includes 11 conditional recommendations for using biomarkers in CD monitoring.

For patients in symptomatic remission, the guidance suggests checking CRP and fecal calprotectin every 6 to 12 months. Monitoring these biomarkers is particularly helpful for patients whose levels have previously correlated with endoscopic disease activity, the document advises.

“In patients in symptomatic remission, a fecal calprotectin <150 μg/g and normal CRP rules out active inflammation, avoiding endoscopic evaluation for assessment of disease activity,” wrote first authors Ashwin N. Ananthakrishnan, MBBS, MPH, of Massachusetts General Hospital in Boston, Massachusetts, and Jeremy Adler, MD, of C.S. Mott Children’s Hospital in Ann Arbor, Michigan, and coauthors. “However, elevated biomarkers in this setting merit confirmation with endoscopy before treatment adjustment.”

For patients with active symptoms, the recommendations advise checking CRP and fecal calprotectin in patients with increasing symptoms every 2 to 4 months to guide treatment adjustments. In all patients with active symptoms, providers should consider endoscopic or radiological assessment before making major changes to treatment plans, the guideline states.

For patients after surgery, fecal calprotectin monitoring can be helpful when the risk of disease recurrence is low.

“In patients with CD in surgically induced remission in low-risk patients on pharmacologic prophylaxis, a normal fecal calprotectin reliably rules out endoscopic recurrence,” the authors wrote. “In other postoperative settings, the panel suggests endoscopic assessment for establishing postoperative recurrence.”

References

Ananthakrishnan AN, Adler J, Chachu KA, et al. AGA Clinical practice guideline on the role of biomarkers for the management of Crohn’s disease. Gastroenterology. 2023;165(6):1367-1399. doi:10.1053/j.gastro.2023.09.029

First comprehensive guideline on using biomarkers for monitoring Crohn’s disease. News release. American Gastroenterological Association; November 17, 2023. Accessed December 1, 2023.