Research Summary

Noninvasive Biomarkers Can Be Used For Monitoring and Managing Ulcerative Colitis

Jessica Ganga

The American Gastroenterological Association (AGA) has released new evidence-based guidelines that recommend the use of noninvasive biomarkers to monitor and treat patients with ulcerative colitis (UC), according to a recent study.1

A panel of multidisciplinary experts focused on the clinical performance of three biomarkers, which included serum C-reactive protein (CRP), fecal calprectin, and fecal lactoferrin. The researchers evaluated the use of the biomarkers as evidence of disease activity in patients with established UC in symptomatic remission or with active symptoms of the disease.

“For decades we have regarded endoscopy as the gold standard for monitoring ulcerative colitis and detecting bowel inflammation, but repeated endoscopic assessment is invasive, expensive and often impractical,” said Siddarth Singh, MD, MS, University of California, San Diego, in a press release2 “Not only are biomarkers accurate, but they provide patients with a cheaper and more convenient option of monitoring to ensure medications are working and ultimately keeping their disease well-managed.”

In total, seven conditional recommendations were made for patients. For patients in symptomatic remission, the panel recommended:

  • The use of a biomarker- and symptom-based monitoring strategy;
  • Using fecal calprotectin less than 150 μg/g, normal fecal lactoferrin, and/or normal CRP to rule out active inflammation. This will avoid the need for routine endoscopic assessment of the disease.
  • If biomarkers are elevated, endoscopic assessment should be done to assess UC.

For patients with moderate to severe symptoms of UC, the panel recommends using fecal calprotectin greater than 150 μg/g, elevated fecal lactoferrin, or elevated CRP. Further, in patients with moderate to severe symptoms and normal biomarkers, the guidelines recommend the use of endoscopic assessment of disease.

“Currently biomarkers are considered experimental by insurers,” aid guideline author Ashwin N. Ananthakrishnan, MBBS, MPH, Massachusetts General Hospital, in a press release. “This guideline is a major step in showing the value of noninvasive biomarkers and the importance of insurers covering biomarker monitoring to improve patient satisfaction and clinical outcomes.”



  1. Singh S, Ananthakrishnan AN, Nguyen NH, et al. AGA Clinical Practice Guideline on the role of biomarkers for the management of ulcerative colitis. Gastroenterology. 2023;164(3):344-372. doi:10.1053/j.gastro.2022.12.007
  2. New AGA guideline recommends blood and stool tests for monitoring ulcerative colitis. New release. EurekAlert!; February 21, 2023. Accessed March 22, 2023.