AGA clinical practice guideline on the role of biomarkers for the management of ulcerative colitis
Gastroenterology
; 164(3): 344-372, 20230301. tab
Artigo
em Inglês
| BIGG - guias GRADE
| ID: biblio-1436078
Biblioteca responsável:
BR1.1
ABSTRACT
Biomarkers are used frequently for noninvasive monitoring and treatment decision making in the management of patients with ulcerative colitis (UC). This American Gastroenterological Association (AGA) guideline is intended to support practitioners in decisions about the use of biomarkers for the management of UC. A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to prioritize clinical questions, identify patient-centered outcomes, and conduct an evidence synthesis on the clinical performance of serum C-reactive protein (CRP), fecal calprotectin, and fecal lactoferrin as biomarkers of disease activity in patients with established UC in symptomatic remission or with active symptoms. The guideline panel used the Evidence-to-Decision framework to develop recommendations for the use of biomarkers for monitoring and management of UC and provided implementation considerations for clinical practice. The guideline panel made 7 conditional recommendations. In patients with UC in symptomatic remission, the panel suggests the use of a biomarker- and symptom-based monitoring strategy over a symptom-based monitoring strategy. For patients in symptomatic remission, the panel suggests using fecal calprotectin <150 µg/g, normal fecal lactoferrin, and/or normal CRP to rule out active inflammation and avoid routine endoscopic assessment of disease. In patients with UC with moderate to severe symptoms, the panel suggests using fecal calprotectin >150 µg/g, elevated fecal lactoferrin, or elevated CRP to inform treatment decisions and avoid routine endoscopic assessment of disease. However, in patients in symptomatic remission but elevated biomarkers, and in patients with moderate to severe symptoms with normal biomarkers, the panel suggests endoscopic assessment of disease to inform treatment decisions. In patients with UC with mild symptoms, the panel suggests endoscopic assessment of disease activity to inform treatment decisions. The panel identified the use of a biomarker-based monitoring strategy over an endoscopy-based monitoring strategy as a knowledge gap. The panel also proposed key implementation considerations for optimal use of biomarkers, and identified areas for future research. In patients with UC, noninvasive biomarkers, including fecal calprotectin, fecal lactoferrin, and serum CRP can inform disease monitoring and management.
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Assuntos
Texto completo:
Disponível
Coleções:
Bases de dados temática
Base de dados:
BIGG - guias GRADE
Assunto principal:
Biomarcadores
/
Colite Ulcerativa
/
Lactoferrina
Tipo de estudo:
Guia de prática clínica
/
Estudo prognóstico
Idioma:
Inglês
Revista:
Gastroenterology
Ano de publicação:
2023
Tipo de documento:
Artigo
Instituição/País de afiliação:
Cleveland Clinic/US
/
Duke University/US
/
Kaiser Permanente Medical Group/US
/
Massachusetts General Hospital/US
/
University of California San Diego/US
/
University of Michigan/US
/
University of Minnesota/US
/
University of Pennsylvania Perelman School of Medicine/US
/
University of Wisconsin School of Medicine and Public Health/US