Could Crohn’s disease treatment become more precise?
February 19th, 2018
Crohn’s disease is an inflammatory condition that affects the gastrointestinal tract and can cause symptoms including abdominal pain, diarrhoea, bleeding, joint pain, mouth sores, fatigue and weight loss. The cause is unknown but bacteria and the immune system are implicated and there is often a family connection. Factors such as genetics, stress, viruses or smoking are also linked. The disease is more prevalent in western industrialized nations, which suggests environmental factors or even dietary differences could be an influence. Unfortunately, there is no cure at present forover 5 million people worldwide suffering with Crohn’s disease, ulcerative colitis and other related forms of inflammatory bowel disease.
Diagnostic testing for Crohn’s disease
There are various methods to diagnose the condition, although a doctor is likely to use more than one for confirmation:
Blood test to look for anaemia or infection
Fecal testing to look for blood
Colonoscopy to find inflammatory cells or take a biopsy
CT scan to take images of the bowel
MRI scan to examine the organs, small intestines, tissue and pelvic fistulas
Capsule endoscopy which enables camera images to be taken inside the small intestine
Balloon-assisted enteroscopy, for a more detailed examination of the small bowel
Existing therapies for Crohn’s disease are essentially anti-inflammatory drugs or antibiotics, and corticosteroids can tame flare–ups. Surgery to remove affected sections of the intestine or colon is also an option, especially if medication is failing. Patients can also take immunomodulators and anti-TNF (tumor necrosis factor) agents. Although new therapy development is ongoing, it has not yet been linked to precision or personalized medicine and so doesn’t require a companion diagnostic. Patients are therefore prescribed medication designed to alleviate symptoms and maintain remission rather than target the cause of the illness.
Microbiome, gut health and Crohn’s disease
Perhaps the ultimate treatment for Crohn’s lies in precision medicine, where a personalizedtherapy is given to a patient at the right time. And the hope for this could lie in the gut, the organ at the centre of inflammatory bowel conditions.
The gut is host to trillions of microbes, or the ‘microbiome’, a living ‘soup’ ofbacteria, viruses and fungi. This initially sounds like a bad thing, but this complex and varied environment is crucial to general health. It plays a role in the development of the immune system and so has potential links to Crohn’s. Projects like British Gut are inviting the public to explore the role the microbiome has on wellbeing. “The aim is to uncover the microbial content within the guts of British individuals. This data will tell us how our lifestyle choices and diet influence our microbiome and how we can alter it to reduce disease and other health related problems.”
Other areas for research which could affect Crohn’s disease are the importance of foods that can raise the number of good bacteria, or probiotics, in the microbiome. A varied diet can provide these, and certain foods are natural sources, particularly those that are fermented, such as sauerkraut or kimchi.
There has been no concluding research to link the microbiome to Crohn’s disease but 2017 research showed that the urease enzyme associated with waste material was more present in the gut of Crohn’s patients. Researchers removed a significant portion of the microbiome to eliminate this enzyme and replaced it with an influx of ‘good’ bacteria that helps to generate a healthier gut environment. It is possible that targeting this enzyme could be a more direct way to combat the disease in the future, leading to the prospect of Crohn’s becoming a general medicine disease that is transformed by precision medicine.