Body changes detected up to eight years before inflammatory bowel disease diagnosis

Researchers have shown that changes can be detected in blood tests up to eight years before a diagnosis of Crohn's disease and up to three years before a diagnosis of ulcerative colitis.

This means the beginnings of inflammatory bowel diseases start a long time before symptoms occur, and in the future may provide an opportunity for doctors to take preventative action before symptoms begin, or prescribe medication when it will be most effective.

Crohn's disease and ulcerative colitis are collectively known as inflammatory bowel diseases (IBD). They are incurable conditions which involve excessive inflammation in the gut, leading to symptoms like abdominal pain and diarrhea.

The team used electronic health records from people in Denmark, comparing 20,000 people with an IBD diagnosis with controls from 4.6 million people without IBD.

It was previously thought most people have symptoms for about a year before diagnosis, but significant bowel damage is often seen, suggesting that changes have been taking place for a lot longer.

The researchers confirmed this by looking at 10 years of test results before diagnosis. They observed changes in a series of minerals, cells in the blood and markers of inflammation, such as fecal calprotectin, a molecule released into the gut during inflammation and currently used to determine which people with bowel symptoms need further investigations. These changes were observed up to eight years before diagnosis in Crohn's disease and three years in ulcerative colitis.

Importantly, most of the changes observed were subtle and would have appeared within a normal range for standard blood tests, so wouldn't have been flagged as a cause for concern. It required a huge dataset to be able to detect these changes across many different markers.

The researchers' next steps are to investigate if treatment or prevention has an impact before people get symptoms.

The write up above does a poor job saying what was identified.

From the paper:

“For many tests, this association became gradually weaker at earlier time points. However, 8 years before a diagnosis of CD, levels of leukocytes, neutrophils, and platelets remained significantly higher in CD cases compared to controls. 7 years before CD diagnosis, levels of CRP were also higher, while levels of hemoglobin were lower. 5 years before CD diagnosis, levels of monocytes were higher in cases than controls, while levels of iron, albumin, and bilirubin were lower. In UC, we also observed significant differences in several blood tests in the pre-diagnostic phase of disease, although these differences were detectable over a much shorter period compared to CD. For example, 3 years before UC diagnosis, cases had higher levels of CRP, leukocytes, neutrophils, eosinophils, and platelets compared to controls, but these differences were not apparent at earlier time points (Figure 1). In total, 14/17 and 9/17 tests showed pre-clinical changes (within time interval −2 to −9) that were associated with CD and UC, respectively (Figure 1).”

https://dx.doi.org/10.1016/j.xcrm.2023.101263

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