The role of fecal biomarkers in individuals with inflammatory bowel disease

Teagan S Edwards ¹, Andrew S Day ¹

Expert Rev Mol Diagn.. 2024 Jun;24(6):497-508. doi: 10.1080/14737159.2024.2375224. Epub 2024 Jul 12.

Introduction: Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and Ulcerative Colitis (UC), is a relapsing and remitting condition. Noninvasive biomarkers have an increasingly important role in the diagnosis of IBD and in the prediction of future disease course in individuals with IBD. Strategies for the management of IBD increasingly rely upon close monitoring of gastrointestinal inflammation.

Areas covered: This review provides an update on the current understanding of established and novel stool-based biomarkers in the diagnosis and management of IBD. It also highlights key gaps, identifies limitations, and advantages of current markers, and examines aspects that require further study and analysis.

Expert opinion: Current noninvasive inflammatory markers play an important role in the diagnosis and management of IBD; however, limitations exist. Future work is required to further characterize and validate current and novel markers of inflammation. In addition, it is essential to better understand the roles and characteristics of noninvasive markers to enable the appropriate selection to accurately determine the condition of the intestinal mucosa.

• Noninvasive inflammatory markers play an important role in diagnosis and management of IBD.
• Fecal inflammatory markers can reflect gut inflammation in IBD; however, they are not specific and various limitations must be considered.
• Although FCal is the most well-established and routinely used marker in IBD, it may have reduced sensitivity and specificity in some settings.
• Several emerging biomarkers including MPO have been assessed and show promise.
• Identification of effective and accurate noninvasive markers of inflammation may limit the need for repeat invasive endoscopic examinations in the future.