What should be included in the monitoring plan after starting IBD therapy?

• A. CRP, fecal calprotectin, clinical assessment, and endoscopic evaluation as needed.
• B. Only clinical symptoms.
• C. Imaging is sufficient.
• D. Monitoring not necessary.

Answer: (A)

Monitoring after starting IBD therapy should combine clinical assessment with objective inflammatory markers and use endoscopic evaluation when indicated. Regular clinical evaluation tracks symptoms, stool frequency, blood loss, weight, and overall well-being. Objective markers like CRP and fecal calprotectin reveal intestinal inflammation even if symptoms are modest, guiding whether therapy is working or needs adjustment. Endoscopy is not done at every visit; it’s used when results from symptoms and biomarkers don’t align or when confirming mucosal healing is important for decision-making about continuing, escalating, or de-escalating therapy. Imaging has a role in specific scenarios (such as suspected deep or small-bowel involvement) but cannot replace biomarkers and endoscopy for routine monitoring. This integrated approach aligns with aiming for mucosal healing and sustained remission.