Emerging role of novel biomarkers in the diagnosis of inflammatory bowel disease

Abstract

There is currently no gold standard test for the diagnosis of inflammatory bowel disease (IBD). Physicians must rely on a number of diagnostic tools including clinical and endoscopic evaluation as well as histologic, serologic and radiologic assessment. The real difficulty for physicians in both primary and secondary care is differentiating between patients suffering from functional symptoms and those with true underlying IBD. Alongside this, there is always concern regarding the possibility of a missed, or delayed diagnosis of ulcerative colitis (UC) or Crohn's disease. Even once the diagnosis of IBD has been made, there is often uncertainty in distinguishing between cases of UC or Crohn's. As a consequence, in cases of incorrect diagnosis, optimal treatment and management may be adversely affected. Endoscopic evaluation can be uncomfortable and inconvenient for patients. It carries significant risks including perforation and in terms of monetary cost, is expensive. The use of biomarkers to help in the diagnosis and differentiation of IBD has been increasing over time. However, there is not yet one biomarker, which is sensitive of specific enough to be used alone in diagnosing IBD. Current serum testing includes C-reactive protein and erythrocyte sedimentation rate, which are cheap, reliable but non-specific and thus not ideal. Stool based testing such as faecal calprotectin is a much more specific tool and is currently in widespread clinical use. Non-invasive sampling is of the greatest clinical value and with the recent advances in metabolomics, genetics and proteomics, there are now more tools available to develop sensitive and specific biomarkers to diagnose and differentiate between IBD. Many of these new advances are only in early stages of development but show great promise for future clinical use.

Treatment-Specific Composition of Gut Microbiota Is Associated with Disease Remission in a Pediatric Crohn’s Disease Cohort

“…2,3 Large efforts are being made to identify novel non-invasive biomarkers in CD patients, not only to monitor disease severity but also to predict therapeutic response. 4,5 Genome-wide association studies have identified a variety of risk loci within genes important for the maintenance of homeostasis with our commensal gut microbiota. 6 In this regard, several studies in pediatric CD patients have described a state of microbiome 'dysbiosis', with varying claims about disease-promoting or -ameliorating bacterial taxa [7][8][9] and about differences in bacterial diversity.…”

A validated risk stratification tool for detecting high‐risk small bowel Crohn's disease

“…Previous studies have assessed the risk of progression to severe disease, but currently there are no succinct guidelines for predicting a first diagnosis of ileal CD in the community setting . Whilst biomarkers such as anti‐neutrophil cytoplasmic antibodies, anti‐saccharomyces cerevisiae antibody, faecal calprotectin and lactoferrin exist for monitoring disease progression and the risk of relapse, they carry a low diagnostic sensitivity and are costly tests that are yet to be fully embraced in the primary care setting . Faecal calprotectin, for example, while a widely available and objective test, is expensive in Australia and North America, and not currently covered by government rebated health care in most settings.…”

“…that are yet to be fully embraced in the primary care setting. 8,23,24 Faecal calprotectin, for example, while a widely available and objective test, is expensive in Australia and North America, and not currently covered by government rebated health care in most settings.…”

Bio-Markers of Inflammatory Bowel Disease: Past, Present, and Future

“…Unlike CRP, ESR levels peak later and decrease at a slower rate. So, ESR is better in monitoring disease activity and response to treatment after the first 24h of onset whilst CRP may be more useful in the first 24h [46]. However, the longer half-life of ESR as well as its interference with other factors makes ESR less useful in clinical practice compared with CRP [47].…”