16 Figure 1 | Simplified overview of biomarker targets and utilities alongside the disease progression pathway in IBD. Targets of biomarkers may be found in the main determinants of IBD susceptibility (e.g. genetics, the gut microbiota, host immunity, and environmental triggers such as lifestyle and dietary habits), the routinely used outcome parameters of intestinal inflammation (e.g. endoscopy as ‘gold standard’, followed by fecal calprotectin, C-reactive protein, imaging modalities such as intestinal ultrasonography, and symptom-based scores), or in disease complications such as intestinal fibrosis. From early risk factors towards irreversible disease complications, the utility of biomarkers may range from the early detection and initial diagnosis of IBD to the prediction of fibrotic complications and post-surgical disease course. The usefulness or value of a given biomarker generally decreases further downstream the disease progression pathway, since the disease becomes increasingly resistant against the established therapeutic arsenal. Abbreviations: CRP, C-reactive protein; FCal, fecal calprotectin; IBD, inflammatory bowel disease. In this thesis, biomarkers will be explored that may potentially be useful for elucidating disease pathophysiology and/or IBD susceptibility to improve the initial disease diagnosis. In addition, biomarkers will be evaluated for assessment of intestinal inflammatory disease activity, assessment of disease complications, for prediction of response to established medical treatment, monitoring of therapeutic efficacy, as potential targets for novel therapeutic interventions, and for prediction of disease course and/or disease prognosis. Improving the initial diagnosis of IBD using immune-based biomarker signatures As clinical symptomatology is rather non-specific for diagnosing IBD, biomarkers form an integral part in establishing the initial diagnosis of IBD. Every patient suspected for IBD undergoes a Chapter 1
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