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Deeper understandings and improved treatments for IBD

The European Crohns and Colitis Organization (ECCO) is the largest forum of medical IBD specialists in the world. The 2018 ECCO Congress drew 6,676 delegates from 86 different countries. Over one thousand abstracts were accepted and presented this year, covering overwhelming amounts of data and analysis. The wide range of topics included novel treatment strategies, IBD diagnosis, disease predictions, management of IBD, evolving concepts in IBD, and Pediatric IBD.

I encourage you to check the detailed agenda of the event. The long lists of studies and presentations demonstrate the magnitude of the IBD challenge, and the enormous investments of money and talent that are being invested in finding better treatment options. This raises hopes for better understanding and ultimately resolution and cure of IBD. 

Here are only a few presentations summaries from the 2018 ECCO Congress. I specifically selected abstracts that focus on diets and microbiome.

1. Individualized variations in the gut microbiota during remission precede Crohn’s disease flares The lead study investigator, Yael Haberman Ziv, MD, PhD, an adjunct associate professor in the Department of Pediatrics at Cincinnati Children’s Hospital Medical Center. Dr. Haberman noted that the microbial findings were “more pronounced among those not in remission than in patients in clinical and biomarker-based remission". Fecal samples from patients in remission who subsequently relapsed contained significantly smaller populations of Lachnospiraceae, bacteria that produce the anti-inflammatory short-chain fatty acid butyrate. Higher levels of fecal calprotectin were associated with more marked dysbiosis and less microbial richness.

The study suggests a model that can be used to guide preemptive therapy strategies during remission and prior to flares. Manipulating the microbiome or avoiding undesired microbial alteration during remission may help avoid or change the course of disease related flares.

2. Dietary interventions may modify intestinal inflammation via altering microbial composition—a cross-over trial The study evaluated the short-term effect of two dietary regimens, Mediterranean diet (MED) and the Specific Carbohydrate Diet (SCD) on clinical parameters, inflammatory markers and gut microbial composition of IBD patients after pouch surgery. Both diets rapidly improved clinical and metabolic parameters in patients with IBD. However, the study authors state that the effect of SCD on inflammatory markers was ambiguous and may be related to increased abundance of Enterobacteriaceae, previously shown to be associated with a high-fat diet.

3. Vegetarian and gluten-free diet in patients with IBD—associated with a different microbiota compared with omnivore IBD patients The gut microbiota composition in meat-eating IBD patients is significantly different compared with those following a VD or GFD. The potentially anti-inflammatory taxa Faecalibacterium and Butyricimonas were reduced and the inflammatory taxa Erysipelotrichaceae and Enterococcus were increased in the high-meat-intake Crohn’s patients. In UC meat-eating patients there was a significantly higher relative abundance of Ruminococcus compared with GFD and VD patients. The high-meat-intake UC patients had a higher relative abundance of Lachnospira, Ruminococcus, and Parabacteroides.

4. Dysbiosis and ecotypes of the salivary microbiome associated with inflammatory bowel diseases and the assistance in diagnosis of diseases using oral bacterial profiles Salivary dysbiosis found in IBD communities provides an easier option for identifying the risk population, considering that saliva can be sampled conveniently and non-invasively.

5. Crohn’s disease is characterized by a fungal dysbiosis Candida, Pichia, and Cyberlindnera were overrepresented in Crohn’s patients, suggesting they play a role in the inflammation or find inflamed gut a suitable environment.

6. The protective effect of Saccharomyces boulardii on intestinal mucosal barrier of inflammatory bowel disease Saccharomyces boulardii shows an anti-inflammatory effect on colitis and has a protective effect on the intestinal mucosal mechanical barrier, which means it may be as effective as mesalazine.

7. Characterizing and managing issues with food-related quality of life in inflammatory bowel disease: a qualitative study of patients and healthcare professionals Inflammatory bowel disease (IBD) has a profound impact on diet and nutrition. This creates limitations in psychosocial functioning and impacts quality of life. Both patients and health care professionals who were interviewed emphasized the need for more individualized care in relation to food and IBD, and required quality and timely sources of information. The development and testing of interventions designed to address food related quality of life is required.

8. Home based fecal calprotectin testing: a Canadian user performance evaluation study of IBDoc®  The fecal calprotectin measurements produced by patients using the IBDoc® were strongly correlated with the standard measurements. The majority of patients found the IBDoc® home kit easy to use and a product that they would likely to use in the future. Further studies are needed to determine whether patients adopt the device for use beyond the clinical trial setting and to assess its impact on patient care for IBD.

9. Association of disease activity and quality of life with dietary habits in patients with inflammatory bowel disease The aim of this study was to investigate the association between disease activity or quality of life and dietary fiber or fat intake in IBD patients. Higher dietary fiber intake overtime was significantly associated with lower disease activity and better quality of life in patients with IBD. Fat consumption seems to play a less important role.

The following brochures, produced by The European Crohns and Colitis Organization (ECCO), are also interesting:

 

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