Research Summary

AGA Releases First Guidelines on Using Biomarkers for Monitoring Crohn Disease in Patients

Jessica Ganga

A panel representing the American Gastroenterological Association (AGA) released a set of guidelines that, for the first time, details the use of biomarkers for monitoring and managing Crohn disease (CD) in patients.

The panel, which was made up of content experts and guideline methodologists, used the Grading of Recommendations Assessment, Development and Evaluation framework to create patient-centered clinical questions. Further, the framework helped them review evidence on the performance of fecal calprotectin, serum C-reactive protein (CRP), and Endoscopic Healing Index on patients with varying degrees of CD (asymptomatic, varying severity of symptoms, or surgically induced remission).

In total, 11 conditional recommendations were made by the panel.  

For patients with CD that is in remission:

  • Use of a biomarker- and symptom monitoring strategy.
  • A fecal calprotectin less than 150 μg/g and normal CRP rules out active inflammation, thus avoiding endoscopic evaluation to assess disease activity.

For patients with CD and mild symptoms:

  • Normal or elevated biomarkers alone are not accurate enough to determine endoscopic activity.

For patients with CD and moderate to severe symptoms:

  • Elevated fecal calprotectin or serum CRP suggests endoscopic activity.

For those with CD in surgically induced remission who are also low-risk patients on pharmacologic prophylaxis:

  • A normal fecal calprotectin reliably rules out endoscopic recurrence.

“…Fecal protectin and serum CRP can inform disease management in both asymptomatic and symptomatic disease,” the authors concluded. “Discordance between symptom assessment and biomarker value may merit endoscopic evaluation for confirmation of status of disease activity.”


Ananthakrishan 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