Crohn’s disease (CD) and Ulcerative colitis (UC) are the two main types of Inflammatory Bowel Diseases (IBD). For unknown reasons IBD is more common in Canada than other parts of the world.
IBD is increasing in children and can be a very aggressive disease in children. There are no cures for IBD and the ultimate cause also remains unknown. The suffering caused by inflammation of the bowels, which is what defines IBD, and the problems from this gut inflammation may include many bowel related problems and many other serious problems in other parts of the body. Currently, diagnosing IBD, as well as distinguishing CD from UC in a timely fashion, is particularly difficult because the main symptoms seen in early IBD are either non-specific (e.g. abdominal pain), subtle/difficult to detect depending on the location of the active disease (e.g. anemia), or extraintestinal (e.g. growth delay in children with CD). Consequently, identifying children that should be evaluated can be problematic and lead to significant delays in diagnosis with consequent increase in complications from untreated disease. Furthermore, there is no single and simple test and currently used tests are difficult on the patient.
This project will dramatically improve the detection and treatment of IBD, provide a simple patient friendly approach, and do so in a more cost-effective manner. Specifically, through the analysis of the ‘gut microbiome’, i.e. the microorganisms present in the intestines, new tests to determine whether a child has UC or CD and that predict disease severity will be developed.
In order to develop these tests, the gut microbiota will be analyzed to identify disease-specific biomarkers using the genomic technologies DNA sequencing and proteomics. Results from this study will be translated i.e. put into practice, through the development of diagnostic tests in collaboration with industrial biotechnology partners. The availability of these diagnostic tests will further help guide therapeutic decisions. In addition, the project will develop simple methods to manipulate the bacterial activities in the intestine in a safe way that will not cause problems for the children, unlike what many current medications and surgery for IBD currently do.
For individuals with IBD, the developed tests will significantly decrease the number of unnecessary endoscopies and radiological imaging studies (current testing methods), which will substantially reduce costs to the health care system and improves patient outcomes by lowering medical complications resulting from endoscopic procedures.
Risk-stratifying patients with these tests will allow for a more personalized treatment approach that is currently available. These improvements in guiding therapeutic decisions could change the course of the disease and minimize intestinal structural damage, complications and long term disability enabling to reach “deep and long-lasting remission” in most patients. Deep remission comprises restoration of normal bowel function and thereby reducing complications of disease, the need for surgery and hospitalization.
The direct economic costs of IBD are estimated to be $1.8 billion per year in Canada for both pediatric and adult IBD. However these costs are likely to increase dramatically in the coming years due to the increasing incidence of pediatric IBD. While it is very difficult to quantify the indirect costs associated with psychosocial wellbeing borne by the patient with IBD and their family, it can be appreciated that estimates for direct economic costs incurred by the disease significantly underestimate the true costs of IBD.