Research Highlights for the IBD Community from Digestive Disease Week® 2022
Published: June 8, 2022
After two years of virtual programming due to COVID-19, Digestive Disease Week® (DDW) 2022 came back with a bang in San Diego, CA last month. There was a lot of research presented about various gastrointestinal and liver conditions and it was exhilarating to see and hear about all the latest developments in the inflammatory bowel disease (IBD) space. From emerging therapies to better understanding of psychosocial aspects of IBD in addition to the role of antibiotics in IBD as well as growing up with pets and the development of IBD, there is tremendous research being done to help improve our lives as patients. We were able to attend in person (Tina) and virtually (Madhura) and are excited to share some of what we learned with the IBD community.
Dogs and IBD – How are they connected?
The CD-GEM project was widely discussed during DDW 2022. The study analysed exposure to eight environmental factors in different age groups and the risk of developing Crohn’s disease later in life. Interestingly, the study found that exposure to dogs at an early age (2-4 years) may provide protection against the onset of Crohn’s disease in the future. Dr. Mingyue Xue and Dr. Williams Turpin and their team from Lunenfeld-Tanenbaum Research Institute found that living with a dog was associated with normal gut permeability and likely provided added fortification against IBD -- great news for dog lovers! The study also highlighted that living in a larger family (three or more members) in the first year of life was associated with a lower risk of getting Crohn’s disease. This reminds us that environmental factors and age of exposure to these elements play a vital role in the development and prevention of IBD.
Antibiotic Use & IBD in Older Adults - Is There a Link?
Research led by Dr. Adam Faye, Assistant Professor at NYU Grossman School of Medicine, found that older adults (age 60+) who have taken antibiotics frequently have been shown to be at higher risk for developing IBD. Dr. Faye found that one course of antibiotics used in this population could increase risk of IBD by 27%. With five or more courses of antibiotics, that risk jumped 236%.
Why is this of importance to us as patients? Previous research from 2020 showed an association between antibiotic exposure in the development of IBD in young people. Now new research shows it in older adults as well. There is clearly a link and Dr. Faye says it will be of vital importance for healthcare providers to be cautious in their use of antibiotics to treat a variety of infections.
Moreover, this points to IBD not just being a genetic condition, but also an environmental one. Dr. Faye shared that the antibiotic link proves that there is an environmental association that can lead to the onset of IBD.
Medical post traumatic stress & IBD - What’s the Connection?
Did you know that at least 25% of IBD patients experience medical post-traumatic stress (PTS) symptoms? During her presentation at DDW 2022, Dr. Tiffany Taft, Research Associate Professor of Medicine at the Northwestern University Feinberg School of Medicine, explained that hospitalizations are a major risk factor of PTS along with certain procedures, particularly nasogastric tube placement. Dr. Taft showcased sources of medical trauma in IBD during her talk and said trauma can manifest from various IBD experiences and exposures (see Figures A & B).
So what’s the bottom line? Addressing our anxiety as patients is just as important as treating our IBD symptoms to reduce the risk of developing PTS, per Dr. Taft. And how does one treat PTS once it has developed? It’s important to have a trauma-informed counselor involved in treatment using some of the modalities listed below, including medication (see Figures C & D).
If you are experiencing medical trauma, it’s important to speak to your gastroenterologist and get a referral to a mental health counselor or see someone specialized in trauma to get the care you need (see Figure E).
**All figures above are from Dr. Taft’s DDW 2022 presentation with her express permission.
Therapeutic and Technological Advances in IBD – What’s New?
At the session on Therapeutic Advances in IBD, Dr. Bruce E. Sands, Dr. Burrill B. Crohn Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Dr. Ryan Stidham, Associate Professor at the University of Michigan, gave us an overview of the latest in the world of IBD medication and monitoring.
The great news for us patients is that there are many new medications in the drug pipeline that have had positive results in clinical trials. This means that we could see new treatment options being approved by the FDA and becoming available in the coming months and years.
Ozanimod (Zeposia®), etrasimod, upadacitinib (Rinvoq®), and filgotinib are oral pills, making them attractive to patients who struggle with needle phobia. Given they do not need to be stored in a refrigerator or given at an infusion center or doctor’s office, oral medication will also make the latest IBD therapies more accessible and affordable to IBD patients in the developing world.
Patients with complex IBD that don't respond to current therapies adequately often undergo multiple surgeries, cycles of steroids, and lose significant quality of life. Combining different IBD therapies is one way to improve outcomes. Two studies – EXPLORER Study, which combines vedolizumab (Entyvio®), adalimumab (Humira®), and Methotrexate for Crohn’s, and VEGA Study combining guselkumab (Tremfya®) and golimumab (Simponi®) for UC, were also presented at DDW 2022. These studies showed that combination therapies were safe and effective for IBD patients.
Clinicians must now determine how to position these new therapies, and shared decision-making with patients will be vital in deciding what is the right medication for the right patient at the right time.
Lastly, Dr. Stidham discussed the use of artificial intelligence (AI) and machine learning to improve the detection of dysplasia (abnormal cells) in IBD to prevent colorectal cancer (CRC). This technology can also be used to accurately determine the extent of bowel damage and fibrosis caused by Crohn’s. How do such tools end up helping us as patients? AI and machine learning will help us and our doctors proactively manage disease complications, prevent CRC and significant complications from Crohn’s disease, which at the end of the day, will improve outcomes for our future living with IBD.
Where Do We Go From Here?
As patient advocates, we believe that evidence-based information is vital to patient education, empowerment, and ultimately better health outcomes. We were thrilled to be able to attend DDW 2022 to learn about the latest research and clinical practice advancements in IBD and make this information accessible to our IBD patient community. We are hopeful that there will be better quality of life for all of us with all this research being done.
Madhura Balasubramaniam is a patient advocate living with Crohn’s disease in India who attended DDW 2022 virtually. Tina Aswani-Omprakash (of the blog Own Your Crohn’s) is a patient advocate living with Crohn’s disease in the United States who attended DDW 2022 in person. They work together alongside many clinicians and patients to run the South Asian IBD Alliance and create credible patient education for the wider IBD community.