The drugs for current inflammatory bowel disease (IBD) patients only help around 50% of patients. And some who do find relief find it short lived as remissions often occur. The majority of people are left hoping and waiting for a change in treatment options.
Recently, two established members in the inflammatory bowel disease community created a review paper in the Cell Press, an online resource for scientific studies and research. Ramnik Xavier, a gastroenterologist and director of the Microbiome Program at MIT and Harvard, and Daniel Graham, an established member of and researcher in the IBD community, talked about some of the difficulties in creating better therapies for people with IBD.
Three of the questions they discussed are below.
Why is it so hard to understand IBD?
Graham says that IBD includes people with both ulcerative colitis and Crohn’s disease but current treatments only work on around half of the 3 million patients affected in the US. The reason why treatment effectiveness is so low is because each person’s case is different; they may present different symptoms that are dictated by a unique mix of a person’s genetics, what they eat, their environmental triggers and exposure, their immune system, and the intricate and highly variable microorganisms (or microbiomes) in the gut.
Researchers are just beginning to understand all of the factors that can affect a person with the disease. All of these differences can contribute to why it’s hard to find a treatment that works for everyone. There may be dozens of variations of the diseases that make up IBD.
While only 60% of patients respond to the current IBD drugs, 13-46% of them become resistant to the drugs in 12 months or less. Why?
Xavier says the different types of Crohn’s disease and ulcerative colitis needs to be understood so that treatments can start earlier and more careful monitoring of drug response and remission can take place.
What part of research needs to improve to help researchers better understand IBD?
Graham says IBD researchers are just beginning to understand the gut ecosystem and how microbiomes respond to a person’s immune system. People with IBD have an immune system that overreacts to normal gut microbes, which can cause inflammation and a lack of balance in the gut ecosystem. The most needed research is to understand what causes the immune system to react and disrupt the microbiome. With this, the biggest goal is to end the terrible cycle of inflammation in the gut.
Read more of this discussion here.