Monitoring & follow-up
Your Monitoring Plan
Last Updated Nov 11, 2025
Keeping inflammatory bowel disease (IBD) in remission takes a simple, steady plan. Monitoring uses symptoms, blood tests, stool tests, and, when needed, scopes or imaging. The schedule shifts after a flare or a change in therapy. This guide shows typical timelines for Crohn’s disease and ulcerative colitis, including what to check, how often to check it, and when to move sooner.
Key takeaways
In remission, check fecal calprotectin and C‑reactive protein every 6 to 12 months. (gastro.org)
During active symptoms or soon after a therapy change, repeat biomarkers every 2 to 4 months. (gastro.org)
Confirm healing after treatment changes, usually at 6 to 12 months, with endoscopy or imaging as appropriate. (guidelinecentral.com)
After Crohn’s surgery, plan a colonoscopy at 6 to 12 months, then 1 to 3 years if healed. (academic.oup.com)
Safety labs depend on the medicine class. Some need checks every 2 to 12 weeks at first, then every 3 months. (pmc.ncbi.nlm.nih.gov)
Why monitoring matters
IBD care follows a treat‑to‑target approach. The short‑term targets are calm symptoms and normal labs. The long‑term targets are mucosal healing and a stable life. Biomarkers, especially fecal calprotectin, often detect inflammation before symptoms return. Using them reduces unnecessary scoping and helps time scopes when they are most useful. (pubmed.ncbi.nlm.nih.gov)
What to track and how often
Routine schedule
What to track | After a flare or therapy change | In stable remission |
|---|---|---|
Symptoms check‑ins | Every visit, plus self‑tracking weekly | Every visit |
Blood C‑reactive protein (CRP) | Every 2–4 months until stable | Every 6–12 months |
Stool fecal calprotectin (FCP) | Every 2–4 months until stable | Every 6–12 months |
Endoscopy (scope) | UC: consider if biomarkers rise or decisions are needed. CD: confirm response 6–12 months after starting or adjusting therapy. | Not routine if biomarkers are normal and there are no concerns |
Imaging for small‑bowel Crohn’s (MRE or intestinal ultrasound) | Use to assess response or if biomarkers rise | As needed, not routine on a fixed yearly schedule |
Notes:
- AGA guidance supports biomarker‑first monitoring in both UC and Crohn’s during remission, and more frequent checks during active disease. (gastro.org)
- In Crohn’s, after symptoms settle and biomarkers normalize, plan an endoscopic or radiologic check about 6 to 12 months after treatment initiation or adjustment. (guidelinecentral.com)
- Intestinal ultrasound or MRI can track small‑bowel healing and predict response early. (pubmed.ncbi.nlm.nih.gov)
After Crohn’s surgery
Ileocolonoscopy at 6 to 12 months to look for recurrence. If healed, repeat in 1 to 3 years.
Use fecal calprotectin and CRP between scopes, often every 6 months for 2 years, then yearly. (academic.oup.com)
Safety labs by treatment
These are typical safety lab rhythms. Individual plans vary by history and risk.
Treatment class | Key safety tests | Typical monitoring rhythm |
|---|---|---|
5‑ASA (mesalamine) | Creatinine (kidney) | Baseline, 6–12 months, then yearly |
Thiopurines (azathioprine, 6‑MP) | CBC, liver enzymes; TPMT/NUDT15 before start | CBC/LFT at weeks 2, 4, 8, 12, then every 3 months; sooner after dose changes (pmc.ncbi.nlm.nih.gov) |
Methotrexate | CBC, liver enzymes, creatinine | Every 2–4 weeks for 3 months, then every 8–12 weeks (pmc.ncbi.nlm.nih.gov) |
Anti‑TNF and most biologics | CBC, liver enzymes; TB and hepatitis B screening before start | CBC/LFT every 3–6 months; risk‑based annual TB/viral review; skin checks yearly (academic.oup.com) |
JAK inhibitors (tofacitinib, upadacitinib) | CBC, liver enzymes; lipid panel | CBC/LFT at baseline, again at 4–8 or 12 weeks, then about every 3 months; lipids at 4–12 weeks, then per guidelines (xeljanz.pfizerpro.com) |
S1P modulators (ozanimod, etrasimod) | CBC, liver enzymes; blood pressure; eye exam if diabetes/uveitis or visual symptoms; ECG at baseline | LFTs periodically, often at 1, 3, 6, 9, 12 months then every 3–6 months; periodic lymphocyte counts; ophthalmic checks as indicated (academic.oup.com) |
Nutrients and general health checks
Iron and anemia: CBC, ferritin, and CRP every 6 to 12 months in remission, at least every 3 months in active disease or after iron repletion. (academic.oup.com)
Vitamin B12 and folate: check yearly if at risk, such as ileal Crohn’s or prior ileal resection. (academic.oup.com)
Bone health: consider bone density testing when risk factors exist, especially with repeated steroid use, and repeat at intervals guided by results. (journals.lww.com)
When to test sooner
Move earlier than the routine schedule if any of the following occur:
- New or worsening symptoms, bleeding, fever, or weight loss.
- A rise in fecal calprotectin or CRP on repeat testing.
- A medication start, stop, dose change, or missed doses.
- Postoperative Crohn’s within the first year.
- Pregnancy or planning pregnancy.
- Travel where infections or therapy access may be an issue.
A simple 12‑month example
Months 0–2: Start or adjust therapy, update vaccines if needed. Order baseline labs, TB and hepatitis screens where indicated.
Months 2–4: Repeat fecal calprotectin and CRP. Adjust therapy if still high.
Months 6–8: Repeat biomarkers. If Crohn’s and doing well, plan endoscopy or imaging to confirm healing.
Months 9–12: If stable, repeat biomarkers. Continue safety labs per medication. Plan the next cycle.
FAQs
If biomarkers are normal, is a routine scope needed
Often no. In remission with normal fecal calprotectin and CRP, guidelines suggest continuing biomarker monitoring and reserving endoscopy for changes or decisions. (gastro.org)
How does this differ for ulcerative colitis vs Crohn’s
Schedules for blood and stool tests are similar. Crohn’s often needs imaging or endoscopy to confirm response after therapy changes. Ulcerative colitis may defer routine scopes if biomarkers are normal. (gastro.org)
What about colon cancer surveillance
Surveillance follows its own risk‑based schedule. See “Cancer Prevention in IBD” in this section.
Linked topics: Home Fecal Calprotectin, Therapeutic Drug Monitoring, Cancer Prevention in IBD.