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Evolving Endpoints in IBD Management

Ryan W Stidham, MD, Akbar K Waljee, MD, MSc, and Peter DR Higgins, MD, PhD, MSc

Assessment of disease activity in IBD has classically relied upon indices of clinical symptoms, including the Crohn’s Disease Activity Index and Mayo Index scoring systems. While improving quality of life in patients with Crohn’s disease and ulcerative colitis remains a primary therapeutic goal, apparent symptomatic control of disease activity does not predict prevention of future symptoms and complications. Biological markers of inflammation such as erythrocyte sedimentation rate, C-reactive protein levels, and fecal lactoferrin and calprotectin all show promise as objective measures of ongoing subclinical disease activity. Furthermore, assessment of mucosal healing by imaging modalities and direct endoscopic examination is a very attractive biological endpoint for disease management. While the available biological markers of inflammation appear to be good predictors of short-term risk of flare, data for long-term predictive capabilities are less compelling. Further studies are needed to determine whether directing medical treatment towards the normalization of these biomarkers improves clinical outcomes in IBD.Inflamm Bowel Dis Monit 2010;10(3):84–8.

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