Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2025; 17(4): 106083
Published online Apr 16, 2025. doi: 10.4253/wjge.v17.i4.106083
Assessing endoscopic remission in small bowel Crohn's disease: Are markers enough?
Iyad A Issa, Taly Issa
Iyad A Issa, Department of Gastroenterology and Hepatology, Harley Street Medical Center, Abu Dhabi 41475, United Arab Emirates
Taly Issa, Medical School, University of Nicosia, Nicosia 24005, Lefkosía, Cyprus
Author contributions: Issa IA and Issa T contributed to this paper; Issa IA designed the overall concept and outline of the manuscript; Issa T contributed to the discussion and design of the manuscript; Issa IA and Issa T contributed to the writing, and editing the manuscript, illustrations, and review of literature. All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Iyad A Issa, Department of Gastroenterology and Hepatology, Harley Street Medical Center, Marina Village, Villa No. A21, Abu Dhabi 41475, United Arab Emirates. iyadissa71@gmail.com
Received: February 17, 2025
Revised: March 23, 2025
Accepted: April 3, 2025
Published online: April 16, 2025
Processing time: 58 Days and 13.7 Hours
Abstract

Mucosal healing in Crohn’s disease (CD) has been established as a crucial target of treatment, leading to long term remission and decrease in complication rates. Endoscopy still serves as the gold standard for assessment, particularly in the small bowel where balloon or capsule enteroscopy is frequently needed. However, these modalities are often unavailable, expensive, and invasive, posing risks to patients. Consequently, the identification of accessible and reliable biomarkers, especially in small intestinal CD, remains a challenge. The study by Ohno et al, published in this issue, further illuminates this field. It confirms the potential role of fecal biomarker leucine-rich α2 glycoprotein (LRG) and validates findings from previous smaller trials. Comparing to other markers LRG showed a much higher predictive value for mucosal healing of the small bowel, making it a useful option for small intestinal CD follow up. In this editorial, we explore the optimal marker of inflammation or mucosal healing in CD, particularly in the small bowel. We provide an overview of available conventional biomarkers and introduce several novel biomarkers, including an update on emerging technologies and innovations.

Keywords: Biomarker; C-reactive protein; Crohn’s disease; Diagnosis; Fecal calprotectin; Inflammatory bowel disease; Leucine-rich α2 glycoprotein

Core Tip: Small bowel Crohn’s disease can be challenging to monitor during treatment. Balloon endoscopy is an invasive procedure, and capsule enteroscopy is costly. The identification of the optimal biomarker remains an ongoing research area. Leucine-rich α2 glycoprotein presents a promising solution, which is discussed in the trial conducted by Ohno et al.