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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2016; 22(3): 1017-1033
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1017
How to predict clinical relapse in inflammatory bowel disease patients
Elisa Liverani, Eleonora Scaioli, Richard John Digby, Matteo Bellanova, Andrea Belluzzi
Elisa Liverani, Eleonora Scaioli, Matteo Bellanova, Andrea Belluzzi, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
Richard John Digby, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, United Kingdom
Author contributions: Liverani E, Scaioli E and Belluzzi A contributed to study concept, design, and draft the manuscript; Bellanova M contributed to the review of the literature and draft the manuscript; Digby RJ contributed to critical revision and language evaluation of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Andrea Belluzzi, MD, Department of Medical and Surgical Sciences, University of Bologna, via Massarenti 9, 40138 Bologna, Italy.
Telephone: +39-51-2143873 Fax: +39-51-2143873
Received: April 17, 2015
Peer-review started: April 19, 2015
First decision: June 23, 2015
Revised: July 7, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: January 21, 2016

Inflammatory bowel diseases have a natural course characterized by alternating periods of remission and relapse. Disease flares occur in a random way and are currently unpredictable for the most part. Predictors of benign or unfavourable clinical course are required to facilitate treatment decisions and to avoid overtreatment. The present article provides a literature review of the current evidence on the main clinical, genetic, endoscopic, histologic, serologic and fecal markers to predict aggressiveness of inflammatory bowel disease and discuss their prognostic role, both in Crohn’s disease and ulcerative colitis. No single marker seems to be reliable alone as a flare predictor, even in light of promising evidence regarding the role of fecal markers, in particular fecal calprotectin, which has reported good results recently. In order to improve our daily clinical practice, validated prognostic scores should be elaborated, integrating clinical and biological markers of prognosis. Finally, we propose an algorithm considering clinical history and biological markers to intercept patients with high risk of clinical relapse.

Keywords: Crohn’s disease, Ulcerative colitis, Clinical relapse, Clinical predictors, Fecal calprotectin

Core tip: Natural course of inflammatory bowel diseases (IBD) is mostly unpredictable so far. Predictors of benign or unfavourable clinical course are required to facilitate treatment strategies. Our aim is to review current evidence on the main clinical and biological markers to predict the aggressiveness of IBD and to discuss their prognostic role. No single marker is reliable as a flare predictor but a combination of clinical and biological indicators better serves our requirements; we propose an algorithm applicable in our daily practice, arising from a combination of clinical history and biological markers.