Gut 62:1806-1816 doi:10.1136/gutjnl-2012-303957
  • Recent advances in clinical practice

Role of endoscopy, cross-sectional imaging and biomarkers in Crohn's disease monitoring

  1. Edouard Louis1,3
  1. 1Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium
  2. 2Department of Gastroenterology, University Hospital of Cordoba, Cordoba, Spain
  3. 3Gastroenterology Translational Research-GIGA Research, University of Liège, Liège Belgium
  4. 4Department of Abdominal Medical Imaging, University Hospital CHU of Liège, Liège Belgium
  1. Correspondence to Dr Edouard Louis, Service de Gastroentérologie, CHU de Liège, Liège 4000, Belgium; edouard.louis{at}
  • Received 2 January 2013
  • Revised 26 February 2013
  • Accepted 7 March 2013


Crohn's disease is characterised by recurrent and/or chronic inflammation of the gastrointestinal tract leading to cumulative intestinal tissue damage. Treatment tailoring to try to prevent this tissue damage as well as achieve optimal benefit/risk ratio over the whole disease course is becoming an important aspect of Crohn's disease management. For decades, clinical symptoms have been the main trigger for diagnostic procedures and treatment strategy adaptations. However, the correlation between symptoms and intestinal lesions is only weak. Furthermore, preliminary evidence suggests that a state of remission beyond the simple control of clinical symptoms, and including mucosal healing, may be associated with better disease outcome. Therefore monitoring the disease through the use of endoscopy and cross-sectional imaging is proposed. However, the degree of mucosal or bowel wall healing that needs to be reached to improve disease outcome has not been appropriately studied. Furthermore, owing to their invasive nature and cost, endoscopy and cross-sectional imaging are not optimal tools for the patients or the payers. The use of biomarkers as surrogate markers of intestinal and systemic inflammation might help. Two biomarkers have been most broadly assessed in Crohn's disease: C-reactive protein and faecal calprotectin. These markers correlate significantly with endoscopic lesions, with the risk of relapse and with response to therapy. They could be used to help make decisions about diagnostic procedures and treatment. In particular, with the use of appropriate threshold values, they could determine the need for endoscopic or medical imaging procedures to confirm the disease activity state.