can be difficult for humans to pick the correct score and sometimes there is wide variability across the entire colon . Now , researchers are applying AI for endoscopic evaluation and have been able to extract additional information from the colon , giving a cumulative pattern of injury , refining the sensitivity of the colonoscopy and endoscopic findings , so they can improve predictions of response to therapy or benefits of a medication .
The problem with patients with longstanding disease is that they begin to join the penetrating / stricturing class of patients rather than inflammatory , and inflammatory therapies won ’ t work . When you have a predominantly inflammatory phenotype , those patients are much more likely to respond to medical therapy . As they move toward penetrating / stricturing and less inflammation , those patients will be better served with endoscopic or operative therapy to “ reset the clock .”
At the Sheba Medical Center in Tel Aviv , they have developed an AI tool that can predict IBD patients ahead of the primary care diagnosis . This was evaluated in over 1,200 patients seen in a primary care clinic , who were later diagnosed with IBD based on a learning cohort . In the first four years , a working diagnosis was often able to be made before a patient was officially diagnosed .
Dr . Dryden said that one important thing to remember is that you can ’ t just start treatment and then forget about it , patients must be continuously evaluated . After initiating therapy , you assess different milestones or markers along the way in the shortterm , intermediate and long-term to determine if the medication is working . If at any point in time , you fail these endpoints , you go back to the drawing board and reassess active IBD therapy .
Intestinal ultrasound is a new technology being used to monitor patients more robustly and more frequently . The procedure takes about 10 minutes to do and starts in the left lower quadrant , looks at the rectum , follows the colon around to look at the entire colon , then evaluates for the terminal ileum and eventually scans the abdomen for anything of interest . This technique can measure
things like bowel wall thickness , bowel wall hyperemia , bowel wall stratification , inflammatory fat , lymphadenopathy and complications . A Simple Ultrasound Score system has been developed for CD and correlates well with the SES-CD ( Simple Endoscopic Scoring system for CD ). The intestinal ultrasound had a higher correlation with the SES-CD than either Calpro , HBI or CRP .
Much research is being done now to determine which bacteria are playing a role in IBD . Throwing probiotics into the gut and hoping they will make a difference hasn ’ t benefited many patients , especially in the setting of CD , so they are now beginning to evaluate dietary interventions . The IBD anti-inflammatory diet ( IBD-AID ) looks at whole foods , restricted intake of complex carbohydrates , refined sugar , gluten and dietary starch . They also focus on prebiotics for probiotic growth . In this early study , 19 patients with mixed IBD tried this for four weeks with induction , and then maintenance for 8-10 weeks . They evaluated stool metagenomics and were able to see which patients benefitted and what those changes were . The Crohn ’ s disease exclusion diet ( CDED ) excludes gluten , dairy products , animal fats , emulsifiers and canned or processed foods . In a study of 37 children and young adults with active Crohn ’ s disease , CDED + PEN ( partial enteral nutrition ) looked at a combination where 50 % of calories come from the enteric formulation . In just six weeks there was clinical remission in a majority of both groups by the Pediatric Crohn ’ s Disease Activity and CRP .
There are many advances in the knowledge of IBD such as beginning to understand pathophysiology , applying those changes to medical therapy and monitoring disease activity to improve outcomes for patients . They are beginning to delineate between high- and low-risk IBD populations with more specificity and may be able to apply therapies more effectively to improve outcomes and reduce risk and cost of therapy .
Kathryn Vance is the Communication Specialist at the Greater Louisville Medical Society .
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