Rising calprotectin after azathioprine: anti-TNF or surgery

What is known

• A rising calprotectin signals mucosal inflammation and impending relapse, warranting objective reassessment (endoscopic/histologic) before committing to either path ^1,2.
• Anti-TNF therapy is an established next-line agent when a thiopurine has failed ¹.
• Early surgery is reserved as a reasonable alternative in limited, medically-refractory disease ¹.

What is unknown / caveats

• The retrieved evidence does not directly resolve anti-TNF escalation versus surgical referral in azathioprine-refractory Crohn's colitis with a rising fecal calprotectin.
• No head-to-head comparison of the two paths in this specific population was retrieved.

References

1. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1-s106. PMID: 31562236.

2. [No authors listed]. A Nomogram Combining Fecal Calprotectin Levels and Plasma Cytokine Profiles for Individual Prediction of Postoperative Crohn's Disease Recurrence. Inflamm Bowel Dis. 2019;25(10):1681-1691. PMID: 30925193.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.