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Biomarkers are an accurate, cheaper, and convenient diagnostic option to monitor and manage ulcerative colitis in patients.
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AGA Guideline Recommends Blood and Stool Tests for Ulcerative Colitis

Noninvasive biomarkers are more cost-efficient than endoscopy in many cases

American Gastroenterological Association

The American Gastroenterological Association (AGA) is the trusted voice of the GI community. Founded in 1897, AGA has grown to include more than 16,000 members from around the globe who are involved in all aspects of the science, practice, and advancement of gastroenterology.

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Published:Feb 21, 2023
|2 min read
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BETHESDA, MD — In new evidence-based guidelines, the American Gastroenterological Association (AGA) recommends noninvasive biomarkers as a first-line strategy for monitoring many patients with ulcerative colitis (UC). These guidelines were recently published in Gastroenterology.

The AGA guidelines outline use cases for three biomarkers that provide accurate insights into UC disease activity: serum C-reactive protein (CRP) (blood), fecal calprotectin (stool), and fecal lactoferrin (stool).

“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,” says Siddharth Singh, MD, University of California, San Diego, CA, the guideline author. “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.”

AGA recommends a monitoring strategy that integrates noninvasive biomarkers for patients with UC in remission (no current symptoms) as well as those with current symptoms. 

Patients with UC in symptomatic remission:

  • Perform interval biomarker monitoring every six to 12 months.

  • AGA recommends stool-based biomarkers over blood testing.

  • If biomarkers are normal, AGA suggests continuing biomarker monitoring and avoiding routine endoscopic assessment.

  • If biomarkers are elevated, AGA suggests endoscopic assessment by a gastroenterologist.

  • Listen to your body! Talk to your doctor about any new symptoms.

 Patients with symptomatically active UC:

  • Biomarker testing should be the first step to determine the need for endoscopic assessment.

  • For patients with mild symptoms who have normal or elevated biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.

  • For patients with moderate to severe symptoms who have normal biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.

  • For patients with moderate to severe symptoms and elevated biomarkers, AGA suggests treatment adjustment and avoiding endoscopic assessment.

With AGA guidelines guiding the use of noninvasive biomarkers, physicians can confidently offer a more convenient and closer monitoring option for their patients. “Currently biomarkers are considered experimental by insurers,” adds Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital, MA, guideline’s co-author. “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.”

AGA will advocate for all insurers to cover the cost of biomarker testing in UC.

- This press release was originally published on the American Gastroenterological Association website