TNF and Cowden disease: As tumor necrosis factor (TNF) is an important mediator of the development of CD in the digestive tract, biological agents, such as infliximab and adalimumab, specifically targeting TNF, have remarkably improved the outcome of CD patients in recent years.3 However, despite these improvements in the treatment of CD, there is still subclinical inflammation in the gut, leading to higher risk of relapse or recurrence.2-4 Thus, monitoring the activity of inflammation and identifying patients who may benefit most from conventional or biological therapy are of great interest.