Abstract
Mucosal healing (MH) is the key therapeutic target of inflammatory bowel disease (IBD). The evaluation of MH remains challenging, with endoscopy being the golden standard. We performed a comprehensive overview of the performance of fecal-, serum-, and urine-based biochemical markers in colonic IBD to find out whether we are ready to replace endoscopy with a non-invasive but equally accurate instrument. A Pubmed, Web of Knowledge, and Scopus search of original articles as potential MH markers in adults, published between January 2009 and March 2020, was conducted. Finally, 84 eligible studies were identified. The most frequently studied fecal marker was calprotectin (44 studies), with areas under the curves (AUCs) ranging from 0.70 to 0.99 in ulcerative colitis (UC) and from 0.70 to 0.94 in Crohn`s disease (CD), followed by lactoferrin (4 studies), matrix metalloproteinase-9 (3 studies), and lipocalin-2 (3 studies). The most frequently studied serum marker was C-reactive protein (30 studies), with AUCs ranging from 0.60 to 0.96 in UC and from 0.64 to 0.93 in CD. Fecal calprotectin is an accurate MH marker in IBD in adults; however, it cannot replace endoscopy and the application of calprotectin is hampered by the lack of standardization concerning the cut-off value. Other markers are either not sufficiently accurate or have not been studied extensively enough.
Highlights
Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), are lifelong, potentially devastating conditions of the gastrointestinal tract, and are characterized by a relapsing–remitting course and heterogeneous clinical presentation with extraintestinal manifestations. their pathogenesis remains not fully elucidated, a crucial role seems to be played by an interaction of genetic, epigenetic, immunological, and environmental factors
In CD, mucosal healing (MH) has been significantly associated with less severe inflammation after
Our goal was to provide an overview of MH markers in colonic IBD that have emerged during the last decade, as well as a summary of their performance to address the question of whether they are ready to replace endoscopy in MH evaluation
Summary
Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), are lifelong, potentially devastating conditions of the gastrointestinal tract, and are characterized by a relapsing–remitting course and heterogeneous clinical presentation with extraintestinal manifestations. Their pathogenesis remains not fully elucidated, a crucial role seems to be played by an interaction of genetic, epigenetic, immunological, and environmental factors. This, in turn, drives the search for better therapeutic goals, and in parallel, the dynamic development of new therapeutic agents. In this respect, mucosal healing (MH) in IBD is gaining increasing attention. In CD, MH has been significantly associated with less severe inflammation after
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