From symptom management to disease control with non-invasive monitoring

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Symptoms play an important role in diagnosing inflammatory bowel disease (IBD) – and they also indicate when to start therapy and signal whether a therapy is effective. Unfortunately, symptoms don't always present a complete picture, says Remo Panaccione, professor of medicine and director of the inflammatory bowel disease unit at the University of Calgary.

"We have a dilemma: patients expect that their disease is in remission when they don't have symptoms, but that is not always the case," he says. "For the two principal forms of IBD, Crohn's disease and ulcerative colitis, almost 50 per cent and 25 to 30 per cent of patients respectively have an active disease in the absence of symptoms."

Traditionally, endoscopic evaluations like colonoscopies are used to gain information about inflammation in the gastrointestinal tract, says Dr. Panaccione. "The problem is that these are invasive procedures that require unpleasant patient preparation," he says. "Advances in the field include non-invasive measures for assessing whether there is ongoing inflammation in the gut."

The most commonly used tools are a blood test known as C-reactive protein (CRP) and a stool test, fecal calprotectin, says Dr. Panaccione, who cautions that results are not always 100 per cent accurate. "For example, we know that there are patients who have inflammation while their CRP readings are normal," he says. "But in general, these tests give a good indication in detecting disease activity."

"For the two principal forms of IBD, Crohn's disease and ulcerative colitis, almost 50 per cent and 25 to 30 per cent of patients respectively have an active disease in the absence of symptoms."

- Remo Panaccione
is professor of medicine and director of the inflammatory bowel disease unit at the University of Calgary

Studies have shown that CRP or fecal calprotectin biomarkers can be elevated six months prior to a patient experiencing a flare-up, says Dr. Panaccione. "If any of the markers are elevated, this triggers an amber light, an early warning that can give us the opportunity to intervene at a time when the patient is not yet experiencing symptoms." Emerging data to be presented at a major gastroenterology conference in the spring will demonstrate that this method of tight control leads to better patient outcomes.

Routine evaluations of these biomarkers can allow gastroenterologists to look beyond symptom management towards disease control. Another method being championed at the University of Calgary is the trans-abdominal ultrasound, which provides yet another non-invasive option, says Dr. Panaccione. "This is a very specialized technique for revealing whether the bowel is inflamed or not. It is currently available at the University of Calgary, which also serves as a training centre for gastroenterologists from around the globe who want to learn the technique."

The findings from recent clinical trials support the long-held view of experts that a timely response to inflammation – even in the absence of symptoms – can change patient outcomes for the better and reduce complications such as hospitalizations and surgery, says Dr. Panaccione. "These non-invasive modalities are helping us manage patient care and therapies more effectively."

This content was produced by Randall Anthony Communications, in partnership with The Globe and Mail's advertising department. The Globe's editorial department was not involved in its creation.