A brief overview of Inflammatory Bowel Disease
The two main forms of Inflammatory Bowel Disease (IBD) are Crohn’s disease and ulcerative colitis. Ulcerative colitis only affects the colon. Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the anus. Both are chronic, relapsing conditions, which are often progressive. Symptoms and severity vary from person to person, and treatment options are often a case of trial and error.
There’s a lot of interesting stuff going on in the world of IBD research right now. That’s probably because there are still so many unanswered questions about the cause, triggers, and recommended lifestyle advice.
I sit on the board for UK charity, Cure Crohn’s Colitis (C3). 100% of the donations we receive fund patient-centric IBD research, which means that we invest in projects based on whether the outcome will be of benefit to people with IBD.
I am really excited about personalised medicine (also referred to as precision medicine). These types of studies look for genetic markers which could determine how someone will respond to different treatments. This could potentially prevent adverse events, and the long trial and error process so many of us with IBD have experienced. It’s not uncommon to try multiple treatments before finding one which helps. When it can take 3-6 months to find out that it isn’t helping, that’s a lot of down-time! It’s also pretty common for treatments to stop working due to antibodies, which means switching treatments again. Meanwhile, the disease is progressively getting worse, which can lead to needing surgery to remove parts of the intestine.
Personalised anti-TNF therapy in Crohn’s disease study (PANTS) is a great example of personalised medicine. It highlighted that about a quarter of patients had no response to anti-TNF drugs, and in one-third of initial responders, the drug stopped working within the first year. Nearly 10% experienced harmful side effects that resulted in the treatment being stopped, and only 37% were well and still on treatment at the end of the first year.
Dr Tariq Ahmad, of the University of Exeter Medical School, who led the research, said: “The results from the PANTS study suggest there are opportunities to optimise the use of anti-TNF therapies to increase treatment effectiveness. In particular, our data suggests that early personalised dosing, guided by blood level monitoring, together with the use of thiopurine or methotrexate therapy, may help achieve optimal drug levels and minimise the risk of anti-drug antibody formation. We now have cheaper versions of infliximab and adalimumab which means that personalised dose intensification is now more affordable.”
A follow on study is happening now, which is looking at whether people who develop antibodies to their first anti-TNF drug are more or less likely to develop antibodies to their second.
PREdiCCt, which was part-funded by C3, is looking to increase the understanding of how factors such as sleep, diet, stress, and the tiny microorganisms that live in our gut influence IBD flare and recovery. This could be a huge benefit to people with IBD because it may highlight areas where people can make lifestyle changes to help them manage their disease better. Outcomes may also be able to help with future IBD management, in the form of routine predictive testing. Wouldn’t that be great; starting treatment before a flare even begins properly?
CD Treat looked at a specific diet to see whether it would be a viable alternative to exclusive enteral nutrition (EEN) for people with Crohn’s Disease. EEN is frequently declined as an option because it often needs to be administered via a nasal gastric (NG) tube. This delivers the formula straight to the stomach and can be necessary due to fairly common issues such as ‘formula fatigue’. That’s when people get so bored of drinking the same formula each day for 8 – 12 weeks, that they can’t physically make themselves do it.
The CD-Treat diet could potentially give people that would usually only have a liquid diet as an option, the chance to take back some control over their lives and activities and provide them with the opportunity to participate in social gatherings that they may usually have avoided whilst on EEN.
I could go on all day about research, but I’m afraid no-one will read on for that long! So, I’ll just try to round up some specific areas of research below:
Research into diet and nutrition is happening, it’s just not very conclusive yet.
AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders
Large study finds no link between gluten, IBD risk
Multidimensional Impact of Mediterranean Diet on IBD Patients
Dietary Guidance For Patients With IBD
Many studies have looked at the causes of IBD, and the role of different types of cells.
Antibiotics use early in life increases risk of inflammatory bowel disease later in life
A key gene modifies regulatory T cells to fine-tune the immune response
Researchers identify a useful biomarker for intestinal diseases
IBD risk increases among first-degree relatives
Then, there’s the microbiome; the genetic material of all the microbes – bacteria, fungi, protozoa and viruses – that live on and inside the human body!
Microbial imbalance in inflammatory bowel disease patients at different taxonomic levels
The microbiome and inflammatory bowel disease
Mental health in IBD a very common topic within the IBD patient community, with many believing that stress triggers flares of their disease. The if and why is also a pretty common study subject:
Microbiota-gut-brain axis and its affect inflammatory bowel disease: Pathophysiological concepts and insights for clinicians
Psychologic stress and disease activity in patients with inflammatory bowel disease: A multicenter cross-sectional study
Interrogating the Gut-Brain Axis in the Context of Inflammatory Bowel Disease: A Translational Approach
Being diagnosed with a secondary, related condition is also pretty common, so it’s great to see that research is being done in these areas too!
Impact of immune-mediated diseases in inflammatory bowel disease and implications in therapeutic approach
I also read a recent study about exercise, which says that impact training improves bone and muscle health in people with Crohn’s disease.
That is where I will conclude for today. I have to stop somewhere! I do hope that you’ve found this blog insightful.
Sahara was admitted to hospital and diagnosed with Ulcerative Colitis at the age of 19, after just two weeks of being incredibly unwell. One week later, she had emergency surgery to remove her colon and rectum, and had her first ileostomy. A turbulent journey followed; a multitude of treatments, complications, seven surgeries, a failed J-Pouch, and three ileostomies later, she is living with a permanent stoma and is a pro-active IBD and ostomy advocate.
Sahara joined the online IBD and ostomy community in 2014, and it very quickly became apparent to her that whilst awareness is important, even more important than that is providing support to others as they navigate the stormy waters of life with IBD, or an ostomy.
She runs #IBDSuperHeroes fundraising and awareness campaign, and the Facebook support group. She is a blogger for InflammatortyBowelDisease.net and an IBD Patient Consultant for merakoi – bridging the gap between patients and healthcare. She gets involved with research whenever she can, and is a volunteer for Cure Crohn’s Colitis, where she donates her time and expertise in social media marketing and content creation