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Credit: CC0 Public domain
Credit: CC0 Public domain
Researchers from the Francis Crick Institute and Aalborg University in Copenhagen have shown that changes in blood tests can be detected up to eight years before the diagnosis of Crohn’s disease and up to three years before the diagnosis of ulcerative colitis.
This means that the onset of inflammatory bowel disease begins long before symptoms appear, and may in the future provide doctors with the opportunity to take preventative measures before symptoms begin, or prescribe medications when they are most effective.
Crohn’s disease and ulcerative colitis are collectively known as inflammatory bowel disease (IBD). They are incurable conditions that involve excessive inflammation in the intestines, leading to symptoms such as abdominal pain and diarrhea. Early diagnosis and treatment are crucial to improving outcomes, but almost a quarter of the 25,000 people diagnosed each year in Britain wait more than a year.
In their study published in Cell reports medicinethe team used electronic health records of people in Denmark, comparing 20,000 people with an IBD diagnosis with controls of 4.6 million people without IBD.
It was previously thought that most people have symptoms for about a year before diagnosis, but significant intestinal damage is often seen, suggesting that changes have been happening for much longer.
The researchers confirmed this by looking at 10 years of test results before diagnosis. They observed changes in a range of minerals, cells in the blood and markers of inflammation, such as fecal calprotectin, a molecule released in the intestines during inflammation and currently used to determine which people with intestinal complaints need further investigation. These changes were observed up to eight years before diagnosis in Crohn’s disease and three years in ulcerative colitis.
Importantly, most of the changes observed were subtle and would have appeared within the normal range for standard blood tests, and thus would not have been flagged as a cause for concern. A huge data set was needed to detect these changes on many different markers.
The researchers’ next steps are to investigate whether treatment or prevention has an effect before people develop symptoms, and whether the findings from this study can be further developed to predict who will develop IBD in the future.
First author, Marie Vestergaard, Ph.D. student at the Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, at Aalborg University, said: “So many young people are affected by IBD. Their lives, hopes and ambitions for the future are turned upside down by a diagnosis and trying I am pleased that our research could help predict who might be suffering from IBD and thus start treatment earlier, which would significantly improve their quality of life.”
James Lee, group leader of the Crick’s Genetic Mechanisms of Disease Laboratory, said: “Our research shows that the intestinal damage we see at the time of diagnosis is just the tip of the iceberg. Many changes are taking place in subtle ways. in the body before the disease manifests itself.
“This has huge implications for prevention because it highlights that there is a chance for treatment. We don’t know yet whether preventative measures such as changing diet or quitting smoking would prevent someone from developing these diseases, but this opens the door to that possibility. It also underlines the importance of early diagnosis and treatment, as many of the changes in the gut are likely to have occurred long before people become ill.”
Tine Jess, director of the Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, at Aalborg University, said: “Our findings are novel and go hand-in-hand with emerging evidence that chronic inflammatory bowel diseases likely develop years before their onset. diagnosis.”
“These incurable diseases affect young people and are twice as common as type 1 diabetes. Understanding the exact mechanisms behind their development is essential to ultimately prevent the diseases from occurring. Our unique Danish data sources, combined with interdisciplinary and international collaboration, help answer still unanswered questions that are critical for patients worldwide.”
Sarah Sleet, CEO of Crohn’s & Colitis UK, said: “There are more than 500,000 people in the UK with Crohn’s disease and Colitis. We know that earlier diagnosis leads to better outcomes for everyone, but waiting lists for diagnostic tests can be a long time. Not only that many people delay visiting the doctor to have their symptoms examined, either because they do not realize how serious they can be or out of fear or embarrassment. Everything that affects the process of obtaining an accurate could speed up diagnosis is a hugely positive step in the right direction.”
Vestergaard, M. et al., Characterization of the preclinical phase of inflammatory bowel disease, Cell reports medicine (2023). DOI: 10.1016/j.xcrm.2023.101263. www.cell.com/cell-reports-medi … 2666-3791(23)00440-8
Cell reports medicine
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