title: Monitoring inflammatory bowel disease activity: clinical activity is judged to be more relevant than endoscopic severity or biomarkers.
abstract: BACKGROUND
  There is increasing evidence for the clinical relevance of mucosal healing (MH) as therapeutic treatment goal in inflammatory bowel disease (IBD). We aimed to investigate by which method gastroenterologists monitor IBD activity in daily practice.
  
  
  METHODS
  A questionnaire was sent to all board-certified gastroenterologists in Switzerland to specifically address their strategy to monitor IBD between May 2009 and April 2010.
  
  
  RESULTS
  The response rate was 57% (153/270). Fifty-two percent of gastroenterologists worked in private practice and 48% worked in hospitals. Seventy-eight percent judged clinical activity to be the most relevant criterion for monitoring IBD activity, 15% chose endoscopic severity, and 7% chose biomarkers. Seventy percent of gastroenterologists based their therapeutic decisions on clinical activity, 24% on endoscopic severity, and 6% on biomarkers. The following biomarkers were used for IBD activity monitoring: CRP, 94%; differential blood count, 78%; fecal calprotectin (FC), 74%; iron status, 63%; blood sedimentation rate, 3%; protein electrophoresis, 0.7%; fecal neutrophils, 0.7%; and vitamin B12, 0.7%. Gastroenterologists in hospitals and those with ≤ 10 years of professional experience used FC more frequently compared with colleagues in private practice (P=0.035) and those with > 10 years of experience (P<0.001).
  
  
  CONCLUSIONS
  Clinical activity is judged to be more relevant for monitoring IBD activity and guiding therapeutic decisions than endoscopic severity and biomarkers. As such, the accumulating scientific evidence on the clinical impact of mucosal healing does not yet seem to influence the management of IBD in daily gastroenterologic practice.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Lausanne/CHUV, Lausanne, Switzerland. Alain.schoepfer@chuv.ch
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
authors.forename: Stephan
authors.initials: S
authors.lastname: Vavricka
authors.forename: Nadine
authors.initials: N
authors.lastname: Zahnd-Straumann
authors.forename: Alex
authors.initials: A
authors.lastname: Straumann
authors.forename: Christoph
authors.initials: C
authors.lastname: Beglinger
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005762:Gastroenterology / Q000379:methods*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011379:Prognosis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013557:Switzerland
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex