New Approaches to Treating IBD
Although accelerating the development of new drugs and technologies is crucial, the Foundation is simultaneously supporting efforts to use currently available therapies more effectively.
We’re also striving to identify non-drug treatments, including dietary and stress-reduction interventions, that could impact patients almost immediately.
Testing a “Treat-to-Target” Approach
In recent years, there has been a major shift in thinking about what the goal of IBD treatment should be. Previously, physicians aimed to control a patient’s symptoms, but research has shown that mucosal healing of the gut—meaning no inflammation is visible when a patient has an endoscopy—is essential for long-term remission and reducing the likelihood of complications. That’s why the new approach of “treat to target” aims to control symptoms (clinical remission) as well as mucosal healing.
While this tactic might seem logical, it has never been studied in a real-world setting. Now we’re doing just that, thanks to the collective efforts of participating care centers in IBD Qorus and a recent grant from the Patient-Centered Outcomes Research Institute (PCORI).
Researchers at the University of California, San Diego, and Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston, TX, are leading the Foundation’s effort to study this approach. They have launched a clinical trial that enrolls IBD patients who continue to have inflammation in their gut despite no longer having symptoms and divides them into two groups: One continues with their regular treatment, and the other is switched to a different medication with the goal of getting to mucosal healing. The study will compare the outcomes of both groups to understand which is the better strategy for patients to get to the best outcomes possible.
We believe that the treat-to-target approach will enable more patients to move beyond symptom relief and have better long-term outcomes.
Only patients who are already enrolled in IBD Qorus through their provider are eligible to participate in this study. Click here to learn more about IBD Qorus and participating sites.
Not able to take part in IBD Qorus? The treat-to-target approach and shared decision-making may still help get you to remission and keep you there. Learn more at crohnscolitisfoundation.org/effective-partnering.
Designing Personalized Diet Recommendations to Improve Gut Health
IBD is a chronic, inflammatory disease, and there’s no diet known to cure it. However, dietary changes may help manage symptoms. The results from the Diet to INducE Remission in Crohn’s Disease (DINE-CD) study, which was supported by the Crohn’s & Colitis Foundation, were published in May, 2021. This study, which compared the Specific Carbohydrate Diet (a limited carbohydrate plan) to the Mediterranean diet, found that about half of the participants, people with mild to moderate Crohn’s disease who stayed on their current medications, reported some improvement in their symptoms.
These findings suggest that diet changes may be useful, yet the benefits will be greater if we can figure out how to tailor a patient’s diet to suit their unique clinical and biological characteristics. That’s where our Precision Nutrition in IBD Initiative comes in. We are currently funding research at four institutions around the world to evaluate the effectiveness of anti-inflammatory diets, find ways to measure the body’s response to diet changes using biomarkers, and identify dietary triggers that can cause flares. Scientists are also using artificial intelligence tools to predict a person’s individual response to foods and develop personalized, data-driven diets that improve gut health.
At the University of Calgary, researchers are using a grant from our Precision Nutrition Initiative to study the impact of a specific anti-inflammatory diet. They’re also gathering data on participants’ genetics, microbiome composition, and metabolism; in the future, this information might be used to predict who is most apt to respond to this diet before they even try it.
This initiative is also providing funding for scientists at the University of Glasgow, who are identifying dietary triggers that increase the risk of relapse in mild Crohn’s disease among teenagers who are in remission following treatment with a liquid diet. They are also testing whether a solid-food diet that mimics a remission-inducing liquid diet can help keep teenage Crohn’s patients in remission.
We’re also supporting researchers at the University of California, Los Angeles, who are running a clinical trial on the potential benefits of a specific whole food diet. And we are funding researchers at the University of California, San Diego, who are figuring out how to identify foods someone has eaten based on the metabolic end products that result in the body afterward.
Reducing Stress to Prevent Flares
Preliminary research supported by the Foundation has identified a link between mental stress and flares in patients with ulcerative colitis. We are now supporting research that aims to determine whether changes in stress reactivity—how someone mentally and physically responds to stress—and corresponding physiological and molecular patterns are associated with flares and response to IBD treatment.
Scientists at the David Geffen School of Medicine at UCLA and UCLA’s G. Oppenheimer Center for Neurobiology of Stress and Resilience have already learned that that some ulcerative colitis patients who display high levels of stress and anxiety are significantly more likely to experience future flares. However, they also learned that certain patients reported flaring, but their stool did not have higher levels of fecal calprotectin, an indicator of gut inflammation.
This suggests that the flares were caused by other changes, such as the brain producing more stress hormones that may, in turn, alter the gut microbiome. This research is ongoing, with plans to analyze stress reactivity, microbiome, and gene expression longitudinally and evaluate the relationship between these patterns and flaring and treatment response.
