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  • Year in Review
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IBD IN 2018

New approaches along the IBD course: diet, tight control and stem cells

Important studies published in 2018 highlight novel therapeutic strategies along the disease course of IBD, including potential specific dietary modifications at early stages and treatment with adipose-derived stem cells in perianal Crohn’s disease. A treat-to-target approach that involves proactive serial monitoring of inflammatory biomarkers can assist in timely treatment escalation and promises improved patient outcomes.

Key advances

  • Specific mixtures of macronutrients and emulsifiers within the diet affect intestinal permeability, gut microbiota density and predispose to intestinal inflammation in IBD2

  • Allogeneic expanded adipose-derived stem cells result in long-term clinical and radiological healing in patients with treatment-refractory perianal Crohn’s disease3

  • An approach of tight control, using faecal calprotectin and C-reactive protein measurements to guide treatment escalation, resulted in improved endoscopic and clinical outcomes in patients with Crohn’s disease4

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Fig. 1: New targets and strategies along the course of IBD.

References

  1. Ng, S. C. et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 390, 2769–2778 (2018).

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  2. Llewellyn, S. R. et al. Interactions between diet and the intestinal microbiota alter intestinal permeability and colitis severity in mice. Gastroenterology 154, 1037–1046 (2018).

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  3. Panes, J. et al. Long-term efficacy and safety of stem cell therapy (Cx601) for complex perianal fistulas in patients with Crohn’s disease. Gastroenterology 154, 1334–1342 (2018).

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  4. Colombel, J. F. et al. Effect of tight control management on Crohn’s disease (CALM): a multicentre, randomised, controlled phase 3 trial. Lancet 390, 2779–2789 (2018).

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  5. Chassaing, B. et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature 519, 92–96 (2015).

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  7. D'Haens, G. et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial. Lancet 371, 660–667 (2008).

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  8. Khanna, R. et al. Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomised controlled trial. Lancet 386, 1825–1834 (2015).

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  9. Peyrin-Biroulet, L. et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am. J. Gastroenterol. 110, 1324–1338 (2015).

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Acknowledgements

The authors thank Whitney Tang for assistance with preparing the figure.

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Correspondence to Siew C. Ng.

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Competing interests

S.C.N. has received consulting and speaker fees from AbbVie, Ferring, Janssen, Menarini and Takeda, served as a Scientific Advisory Board member for AbbVie, Ferring and Takeda and received research grants from AbbVie, Ferring and Janssen. A.N.A. has served as a Scientific Advisory Board member for Abbvie and Gilead and received research grants from Pfizer and Merck.

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Ng, S.C., Ananthakrishnan, A.N. New approaches along the IBD course: diet, tight control and stem cells. Nat Rev Gastroenterol Hepatol 16, 82–84 (2019). https://doi.org/10.1038/s41575-018-0088-4

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