Study may lead to more effective treatments for chronic intestinal inflammation

Finding the right treatment for people living with chronic intestinal inflammation, also known as inflammatory bowel disease (IBD), might soon be getting easier. World IBD Day happens on 19 May each year, with the goal to raise awareness about the disease and urge action.

IBD is a fairly common condition. Between 35000 and 40000 people in Norway live with the diagnosis. Each year approximately 3500 people are diagnosed.

However, it has been difficult to find the right treatment since the symptoms, the course of the disease and the effect of medication vary so much from person to person.

The goal of our research is to develop tools that tell us what the course of the disease will look like for each patient, so that they can receive a more targeted treatment."

Ann Elisabet Østvik, Associate Professor, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology

Østvik is also a chief physician at St. Olavs Hospital in Trondheim.

IBD can last for decades

Chronic intestinal inflammation often affects young people. Typically, patients are young adults and many are already diagnosed in childhood.

"The complaints range from almost imperceptible to a reduced overall condition, abdominal pain, diarrhoea and the need to always be close to a toilet. Since the complaints can last as long as 30 years, IBD can significantly reduce the quality of life for people who are affected," says Østvik.

No single treatment for everyone

Chronic intestinal inflammation refers to two main conditions: ulcerative colitis and Crohn's disease. Ulcerative colitis affects only the colon, with superficial inflammation. Crohn's disease can affect all parts of the gastrointestinal tract, from the mouth to the anus, but occurs most commonly in the transition between the small intestine and the large intestine.

"The treatment for the two forms is more or less the same. But it's difficult to predict how the disease will develop," says Arne Kristian Sandvik, a professor in NTNU's Department of Clinical and Molecular Medicine and a chief physician at St. Olav's hospital.

Often, doctors try the mildest medications first and work up to stronger ones as needed. But what works for some patients does not necessarily work for others.

Developing tools

Today the health service lacks tools that could predict a probable course of the disease for each patient and the best treatment in each case.

"The goal of the IBD research group is for the research results to make it possible to divide patients with IBD into subgroups, where the course of the disease and the treatment outcomes are more similar. This division will hopefully enable us to provide more effective treatment and follow-up for each individual," says Professor Sandvik.

Breaking patients into these different groups, could for example be done according to where in the intestinal system the inflammation is, what kind of inflammation is involved and molecular differences in the inflammatory process. To get a proper overview, patients need to be tracked for a long time.

Interdisciplinary collaboration

The IBD research group in Trondheim was established in 2007 at the initiative of Professor Sandvik.

This year, the research group has been granted the status of a CAG - Clinical Academic Group, which was established collaboratively by the Central Norway Regional Health Authority and NTNU. CAG is a new model in Norway, intended to bring research closer to patients and to secure research results that will benefit patients quickly.

"As the results of the research emerge, we have ongoing projects in progress, and the results flow continually," says Østvik. "As part of the newly created CAG, we're starting a project that involves collecting patient material and following patients over time, for a total of five years.

This longitudinal study will be important in developing precision medicine. We generate results along the way in the course of the collection, and this material provides the basis for important research results for several years to come."

The group is highly interdisciplinary and has grown to 12 employees with backgrounds in gastroenterology, nursing, pathology, molecular biology and cell biology. The IBD research group also includes clinicians who conduct daily treatments of a large number of IBD patients at the various partner hospitals.