Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2021; 27(16): 1828-1840
Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1828
Surrogate markers of mucosal healing in inflammatory bowel disease: A systematic review
Monica State, Lucian Negreanu, Theodor Voiosu, Andrei Voiosu, Paul Balanescu, Radu Bogdan Mateescu
Monica State, Theodor Voiosu, Andrei Voiosu, Radu Bogdan Mateescu, Department of Gastroenterology, Colentina Clinical Hospital, Bucharest 020125, Romania
Lucian Negreanu, Department of Gastroenterology, Emergency University Hospital, Bucharest 050098, Romania
Lucian Negreanu, Theodor Voiosu, Andrei Voiosu, Paul Balanescu, Radu Bogdan Mateescu, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
Paul Balanescu, Department of Internal Medicine and Research Methodology, Colentina Clinical Hospital, Bucharest 020125, Romania
Author contributions: State M, Balanescu P contributed to study design; State M, Voiosu T, Voiosu A and Balanescu P contributed to data acquisition, analysis and interpretation; State M, Voiosu T, Voiosu A, Negreanu L and Mateescu RB contributed to writing of this article; Negreanu L, State M and Mateescu RB contributed to editing, reviewing and final approval of the article.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Lucian Negreanu, MD, Assistant Professor, Department of Gastroenterology, Emergency University Hospital, Splaiul Independentei 169, Bucharest 050098, Romania.
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: February 25, 2021
Revised: March 2, 2021
Accepted: April 7, 2021
Article in press: April 7, 2021
Published online: April 28, 2021
Research background

Mucosal healing (MH) has been one of the main therapeutic targets stipulated by recent recommendations. MH is associated with lower risks of relapse, hospitalization and surgery. In recent years, a wealth of publications regarding various noninvasive biomarkers for MH have reported conflicting results.

Research motivation

MH is objectivated by intrusive colonoscopy, and it is becoming increasingly apparent that surrogate noninvasive markers are needed for close and efficient disease monitoring and control. A reliable surrogate marker for MH would have a significant clinical impact, by reducing the number of endoscopic evaluations required during the course of disease.

Research objectives

We aimed to summarize published data regarding the performance of noninvasive biomarkers in assessing MH in inflammatory bowel disease patients.

Research methods

We conducted a systematic review of studies that reported the performance of biomarkers in diagnosing MH in patients with inflammatory bowel disease. The main outcome measure was to review the diagnostic accuracy of serum and fecal markers that showed promising utility in assessing MH.

Research results

We screened 1301 articles, retrieved 46 manuscripts and included 23 articles for full-text analysis. Fecal calprotectin (FC) was the most investigated fecal marker for assessing MH. The best performance for a serum marker was observed for the endoscopic healing index, which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive protein.

Research conclusions

Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization.

Research perspectives

For future research, a combined marker approach benchmarked against a well-investigated marker, such as FC, could be a promising alternative to endoscopic examination.