Blood tests offer hope for early diagnosis of Crohn's disease, ulcerative colitis

LONDON, Nov. 7 (UPI) -- Blood tests can reliably detect warning signs of inflammatory bowel disease much earlier than previously thought, paving the way for preventative or prophylactic action to be taken before the illness progresses, according to a new, large-scale study by British and Danish researchers.

A study of 20,000 Danish IBD patients by scientists at the Francis Crick Institute in London and Aalborg University in Copenhagen, published Tuesday in the journal Cell Report Medicine, found changes in blood tests up to eight years before Crohn's disease is diagnosed and up to three years before ulcerative colitis.

The scientists focused in on a mismatch between the length of time sufferers typically experience symptoms before being diagnosed -- about a year -- and the severity of the damage already caused to the bowel at that stage.

They posited that if, as they believed, changes in the gut were actually underway long beforehand, there may be a way to detect them ahead of the onset of symptoms, which are triggered by inflammation in the gut, causing abdominal pain and diarrhea.

Using the study patients' electronic health records going back 10 years to compare blood results with a control group of 4.6 million people with no IBS, the team found changes in a series of minerals, blood cells and markers of inflammation.

The inflammation markers included fecal calprotectin, a molecule released into the gut when there is inflammation, conventionally used to earmark patients with bowel symptoms for further investigation.

However, the counts were within the normal range for standard blood tests and had never previously been looked at. The Francis Crick-Aalborg team was only able to sift them out because of the massive dataset it used for analysis.

"Our research shows that the bowel damage we're seeing at the point of diagnosis is just the tip of the iceberg. So many changes are subtly taking place in the body before the disease takes hold," said James Lee, group leader of the Genetic Mechanisms of Disease Laboratory at Francis Crick.

"This has huge implications for prevention, as it highlights that there's a window of opportunity for treatment. We don't yet know whether preventative measures like changing diet or stopping smoking would stop someone getting these diseases, but this opens the door to that possibility," Lee said.

"It also underscores the importance of early diagnosis and treatment, as many of the changes in the gut are likely to have been happening long before people become ill."

Chronic inflammatory bowel diseases, which are incurable, mostly affect young people and are twice as common as type 1 diabetes, said Tine Jess, director of Aalborg University's Center for Molecular Prediction of Inflammatory Bowel Disease.

"Understanding the exact mechanisms behind their development is essential to ultimately prevent the diseases from occurring. Our unique Danish data resources combined with cross-disciplinary and international collaboration help answer yet unanswered questions critical for patients worldwide," Jess said.

First author Marie Vestergaard, an Aalborg University doctoral research student, said IBD turned the lives, hopes and dreams of many young people upside down, but the research findings could herald a brighter future for them.

"As a young person myself, it gets me. I am happy that our research might help predicting who could potentially suffer from IBD and thus start treatment earlier, which would greatly improve their quality of life," she said.

The scientists said the buffer early detection could provide may be a critical factor in Britain, where more than 6,000 of the 25,000 people diagnosed every year go on to wait for over a year to begin treatment from the country's universal National Health Service.

IBS patient groups welcomed the study.

"There are over 500,000 people in the U.K. with Crohn's and Colitis. We know that earlier diagnosis leads to better outcomes for everyone, but waiting lists for diagnostic tests can be long," Crohn's and Colitis U.K. CEO Sarah Sleet said.

"Not only that, many people put off going to their [general practitioner] to get their symptoms checked out -- either because they don't realize how serious they could be, or through fear or embarrassment.

"Anything that could potentially speed up the process of getting an accurate diagnosis is a hugely positive step in the right direction."