IBD care updates of 2023 (so far): Promising strategies to improve patient quality of life
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Two of the most important goals in the treatment of patients with inflammatory bowel disease are to improve patient quality of life and increases the odds of remission.
Patients with IBD want to be able to travel without limitations, predict flares without invasive testing, and manage symptoms without being restricted to immune-suppressing options. Fortunately, new resources and advancements including IBD Passport, a website with information for travelers with IBD, wearable technology to monitor symptoms, and an increased emphasis on dietitian’s role in multidisciplinary care are making patient desires even more attainable.
Healio has been monitoring recent developments in IBD care throughout the first few months of 2023. In case you have missed any of them, we have compiled a list of the most exciting developments in helping patients with IBD live their lives.
Curcumin-QingDai induces remission in active UC, ‘paves the way’ for integration in care
The combination of herbal extracts curcumin and QingDai induced clinical response and remission in patients with active ulcerative colitis, according to data presented at the Crohn’s and Colitis Congress.
“Even our most modern biologics and small molecules drugs are still unable to bring all our patients to complete remission, and prolonged preauthorization and costs sometimes limit patients’ access to needed medications,” Nir Salomon, CHb, founder and director of the Integrative Medicine Clinic at the gastroenterology department of Sheba Medical Center in Israel, told Healio. “It is also obvious that many [inflammatory bowel disease] patients with active disease are looking for alternative, nonimmune-suppressing solutions, whether dietary or other.” Read more.
Q&A: IBD Passport aims to tackle ‘unique barriers’ for travelers with Crohn’s, UC
Travel may no longer be daunting for patients with inflammatory bowel disease, thanks to a “one-stop travel advice” website that offers key resources, support and access to a comprehensive network of IBD specialists worldwide.
The nonprofit website IBD Passport was founded by Kay Greveson, an IBD nurse specialist in London, and is directed by Shomron Ben-Horin, MD, professor and chief of gastroenterology at the Sackler School of Medicine at Tel-Aviv University and director of IBD service at Sheba Medical Center. They developed the multilevel platform for patients with Crohn’s disease and ulcerative colitis to help them overcome disease-related limitations and enjoy travel. The site provides practical information and advice about vaccinations, traveling with medications, dietary guidance and managing travel-related illness. Read more.
Updated AGA guidelines urge use of biomarkers for the management of UC
New AGA clinical practice guidelines highlight the role of noninvasive biomarkers, including fecal calprotectin, fecal lactoferrin and C-reactive protein, for the management of patients with ulcerative colitis.
“Despite the fact that early proactive assessment of bowel inflammation is associated with superior long-term outcomes, there is significant variability in utilization,” Siddharth Singh, MD, assistant professor of medicine at the University of California, San Diego, and colleagues wrote in Gastroenterology. “Moreover, in routine clinical practice, repeated endoscopic assessment is invasive, expensive and may be impractical.” Read more.
Frequent antibiotic use raises risk for IBD, particularly in older adults
Antibiotic exposure was associated with an increased and cumulative risk for inflammatory bowel disease and was highest among individuals aged 40 years and older, according to results from a Danish study published in Gut.
“From prior data, it seems that the environment may play an increasing role in the pathogenesis of IBD as we age. We think this because older adults with new onset IBD are less likely to have a positive family history [of IBD] as compared to younger adults with new onset IBD,” Adam S. Faye, MD, MS, assistant professor of medicine and population health at NYU Grossman School of Medicine, told Healio. “Additionally, prior data has shown an association between antibiotic use and the development of IBD in younger patients, but there is little data exploring the role of antibiotics in the development of IBD among older adults.” Read more.
‘Why not combine them?’: Early dual biologic therapy may overcome limits in severe IBD
Early data suggest combination therapy with biologics or advanced small-molecules may be safe and effective in patients with inflammatory bowel disease, according to a presenter at the Crohn’s and Colitis Congress.
“We have all these different mechanisms of action right now — in newer development are some of the oral and p-19 [inhibitors],” Edward V. Loftus Jr., MD, the Maxine and Jack Zarrow Family Professor of Gastroenterology at the Mayo Clinic in Rochester, Minnesota, told attendees. “We have all these different targets: Why not combine them?” Read more.
Mortality twice as high for patients with IBD, non-STEMI vs. IBD alone
Patients with inflammatory bowel disease and non-ST elevation myocardial infarction had higher mortality, hospital stays and hospital charges than patients with IBD alone, noted a presenter at the Crohn’s and Colitis Congress.
“Based on our study results, IBD patients with non-STEMI require closer monitoring, and there needs to be a focus on better treatment and preventing complications that may develop,” Neethi R. Dasu, DO, from the Rowan University School of Osteopathic Medicine, told Healio. “Furthermore, our study revealed these patients with IBD are at an increased risk for cardiovascular events.” Read more.
Dietitians ‘a valuable resource’ in multidisciplinary IBD care team
A varied and well-balanced diet plays “a significant role” in the management of patients with inflammatory bowel disease and can be guided with support from a dietitian, a presenter reported at the Crohn’s and Colitis Congress.
“IBD has long been thought to arise from inappropriate and maladaptive stimulation of the immune system, although emerging data has actually shown that diet plays an important role in the pathogenesis and inflammation," Keisa M. Lynch, DNPAPRN, FNP, associate professor in the College of Nursing at the University of Utah, said. “This highlights the abundant need for guidance. The International Organization for Inflammatory Bowel Disease formed a working group and put together recommendations and guidance for future considerations.” Read more.
Hyperbaric oxygen therapy ‘safe and potentially effective’ for fistulizing Crohn’s
Hyperbaric oxygen therapy yielded a clinical response rate of 87% among patients with fistulizing Crohn’s disease with few adverse events, according to systematic review data presented at the Crohn’s and Colitis Congress.
“Fistulas are a common complication of Crohn’s disease occurring in up to 50% of patients,” Amr Dokmak, MD, a hospitalist at Catholic Medical Center in Manchester, New Hampshire, told Healio. “Despite significant expansion of the IBD therapeutics, particularly biologics and innovations in treatment strategy, there remains a significant gap in achieving long-standing fistula healing. Hyperbaric oxygen therapy has gained interest as a potential adjunct therapy for refractory IBD.” Read more.
Smartwatches, wearable technology ‘may hold promise’ to identify, predict IBD flare
Wearable technology, including wrist-worn smartwatches that monitor heart rate variability, may help identify and predict flares of inflammatory bowel disease, according to data presented at the Crohn’s and Colitis Congress.
“It is challenging to identify and predict IBD flares, and we lack easy and convenient means to monitor patients,” Robert P. Hirten, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai, told Healio. “Currently we rely on the use of blood or stool tests, imaging tests such as CT scans or MRIs, colonoscopies [and] symptom reporting by patients. It is our hope to one day be able to use wearable devices, which are commonly used, convenient and passive, to be able to monitor for changes in the body that could alert us to a current or impending disease flare.” Read more.
Longer adalimumab dose intervals improve infection risk, worsen remission rates in Crohn’s
Increasing adalimumab dose intervals reduced infection-related adverse events and costs in patients with Crohn’s disease, but also resulted in lower remission rates, researchers reported in The Lancet Gastroenterology & Hepatology.
“Patient’s living with Crohn’s disease often need lifelong medication,” Reinier C.A. van Linschoten, MD, of the department of gastroenterology and hepatology at Erasmus Medical Center in the Netherlands, told Healio. “Adalimumab is one of these treatments that is effective in inducing and maintaining remission. However, adalimumab is quite expensive and can lead to adverse effects, such as injection site reactions and increased incidence of infections.” Read more.