While inflammatory bowel disease (IBD) can be a very frustrating condition for many children – and some may wonder if the symptoms will ever end – there is much to be hopeful about.
About 80% of our patients are truly doing well after a few months of IBD treatment. But we still have about 20% who have frequent relapses and an even smaller amount who never really get under control.
There are about 100,000 kids in the United States with IBD, which is an inflammation or swelling in the gastrointestinal tract. In kids, the disease is most common in early adolescents around ages 12 or 14, but unfortunately that’s shifting to a younger age. The age range where IBD is increasing at the fastest rate is in children under 10.
For that smaller subset of patients who have frequent relapses or their disease is never controlled, our standard classes of medications haven’t worked for them like they have for other patients. And it is this scenario for which it feels like the pace of IBD research is moving way too slow.
I am hopeful that some of the research currently happening here and around the country will be game-changers for these patients, so that they can find some relief and normalcy. The one area of research that I am most excited about is related to the microbiome, which is the collection of 100 trillion microorganisms that live in our bodies and help us digest our food, prevent disease and absorb vitamins and minerals.
So one problem that gastroenterologists have in treating the disease is that while the medications which suppress the immune system and regulate inflammation are much better than they used to be, they’re not a perfect solution. Many patients still have relapses, even after the medications were once working for them.
And studies have shown that the explanation for this might lie in the microbiome, which isn’t affected by the drugs we’re using to treat IBD. The body has both good and bad bacteria in it, and the research that we’ve done over the past few years has given us a roadmap for how we might be able to influence the good bacteria to treat the disease better and keep it under control longer.
One way we think we might be able to do this is by having patients take prebiotics, which is a nondigestible starch that the human body doesn’t really digest and use, but the good bacteria in the intestine can use it as food. The name for this bacteria is 2-Fucosllactose (2FL) – a naturally occurring substance in breastmilk – and early research has shown that it can help the good bacteria grow and produce metabolites, which aid the intestine in healing and reducing inflammation.
We think that medications fall short because they don’t address the role diet and environment play in patients with IBD. Medications can help reduce inflammation, but if everything else stays the same, our poor diet and environment can give a huge advantage to the bad bacteria.
Whereas, our early research has shown that giving 2FL can help more beneficial bacteria to grow and the harmful bacteria to shrink, and turn on the healthy pathways that develop normal metabolism.
So we’re working toward a research study that would test different amounts in 2FL in patients with IBD who are already on medications, to see if it changes their good bacteria and makes those beneficial metabolites while reducing inflammation. We’re hoping to get started later this year, but we still need to settle on our final protocol and funding.
Influencing the microbiome is just one area of IBD research that I’m excited about and that I’m hopeful has the potential to really make a difference in the lives of patients with IBD. To learn more about other IBD research studies happening at Cincinnati Children’s, visit this page for more information.