Crohn's disease Ileocolonoscopy C-reactive protein Mucosal healing
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Carretero, C. (Cristina); Bojórquez, A. (Alejandro); Eliakim, R. (Rami); et al. "Updates in the diagnosis and management of small-bowel Crohn's disease". Best Practice & Research Clinical Gastroenterology. 64-65, 2023, 101855
Crohn's disease (CD) can affect any part of the GI tract, but small bowel (SB) involvement is present in 80% of patients with CD; 30% have exclusive SB disease  presenting a diagnostic challenge due to the inaccessibility of standard endoscopic techniques.
Accurate assessment of treatment response  and regular monitoring are crucial to prevent surgery and to identify patients at risk of relapse and/or complications before the onset of clinical symptoms . Ileocolonoscopy (IC) is considered the gold standard for evaluating mucosal healing (MH) in CD, but it is invasive and costly  and only allows visualization of the terminal ileum (TI). The CALM study has demonstrated that C-reactive protein (CRP) and faecal calprotectin (FCP) can be effective surrogate markers of MH and help guide treatment . Nonetheless, their efficacy is limited  as approximately 30% of patients do not present with elevated CRP levels during relapse  and the correlation between FCP and active SB disease is weak .
Thus, CD requires a multidisciplinary approach. We aim to provide an overview of recent advances in the diagnosis and management of small bowel CD.