Determination of serologic and genetic markers aid in the determination of the clinical course and severity of patients with IBD

Data are mounting that seroreactivity to microbial antigens is not only associated with disease complications in CD, but is, in fact, predictive of their development in a prospective sense. The determination of NOD2 status may be equally useful in determining the risk of developing small bowel complications in CD patients. Moreover, the recent use of a broad DNA array to predict disease behavior, not only in CD but in UC as well, may represent a "real world" application of this technology. Increasing evidence suggests that the clinician may be able to use these tools to determine, at the time of diagnosis, the likelihood of a more complicated versus a more benign disease course. This research offers unique insight into the underlying immunogenotype of an individual based on their seroreactivity and their genotype. With this knowledge, clinicians will be able to create and implement appropriate and timely therapeutic management regimens based on the aggressiveness of the IBD subtype so as to alter and, thus, improve the long-term prognosis. In the era today of "top-down" therapy and earlier use of immunemodulating agents, the clinician would be best served by being able to select, in advance, those patients most likely to need such therapy.39,40 The use of serologic and genetic markers may prove to be the ideal way to accomplish this task. Copyright © 2007 Crohn's & Colitis Foundation of America, Inc.