Dietary interventions, stem cells and the microbiome are three areas which will deliver major breakthroughs in the management of IBD in the future.

Speaking to the limbic, Professor Paul Pavli predicted where the advances in patient care might come from while admitting it wouldn’t necessarily come easily.

Professor Pavli, from The Canberra Hospital and a director on the board of Crohn’s & Colitis Australia (CCA), said diet for example was a notoriously difficult area of research due to methodological challenges such as blinding of participants.

The role of diet in both preventing and managing IBD featured in the CCA’s top 10 research priorities, after a rigorous consultation process including patients and clinicians, while the role of food additives in IBD diagnosis and flares appeared just outside the top 10.

Professor Pavli said many of the research priorities were already being addressed. For example, the last three research grants awarded by CCA were in the area of diet.

He said gastroenterologist Professor Peter Gibson and dietician Dr Emma Halmos, from The Alfred Hospital and Monash University, and best known for their extensive work on low FODMAP diets in managing IBS, were also exploring diet in IBD.

A recent review article they co authored [link here] highlights the emerging role of dietary therapy in IBD including identifying and correcting nutritional gaps, the use of exclusive enteral nutrition (EEN) to treat IBD, therapeutic diets to control existing complications of IBD, and the role of diet in preventing IBD development in high-risk populations.

Overlapping with diet is the role of the microbiome and whether it can be modified to help prevent IBD.

“My colleague Dr Claire O’Brien is focusing on E. coli as one of the triggers of Crohn’s disease, but lots of other people are looking at the microbiome.”

Both are co-investigators on the longitudinal Australia IBD Microbiome (AIM) study [link to protocol here] which aims to enrol 1000 participants, both IBD patients and healthy controls.

Professor Pavli said the role of stem cells in the treatment of IBD did not quite make the top 10 research priorities – ranking #17 of 890 original research questions – but was one of his personal favourites to deliver a major breakthrough.

“There’s a lot of exciting work being done in Melbourne…[Associate Professor] Greg Moore at Monash is looking at stem cells and the treatment of perineal fistulising Crohn’s disease, and I think that’s really one of the big questions.”

“Maybe it wasn’t ranked so highly because it only affects about 20-30% of people with Crohn’s disease. So not as many people get it but the people that do get it, really do have problems with it.”

Professor Pavli also identified the psychological impact of IBD – another of the top 10 research priorities – and the causes and management of fatigue – a near miss at #11 – as areas which could make a big difference to the quality of life of patients.

He flagged the promising work [e.g. link here] of health psychologist Professor Antonina Mikocka-Walus and gastroenterologist Associate Professor Simon Knowles on strategies to manage IBD-related anxiety and psychological distress.

On fatigue, he said it was one of the issues that people don’t understand.

“How can you be so tired and lacking in energy when you look normal? If you’ve broken your wrist or you’ve got Parkinson’s disease, someone can tell the difference. But when you’re sitting there [with IBD]…and you’ve got all of these cytokines and all of the products of inflammation making you feel tired and sleepy… you can’t see them from the outside.”

Gastroenterologist Dr Rimma Goldberg, from Monash Health, told the limbic that the profession had to become more holistic regarding IBD in the future and that the new approach required system-wide support.

“I think that drug development in IBD has really exploded in the last decade. There’s more medication options, there’s different mechanisms of action, modes of administration, frequency of administration, so I think that we can certainly tailor the medication to the patient.”

“This is an area that’s being invested in… and it’s providing some excellent results and better outcomes for patients. But what we understand from the research priorities is that patients, whilst they appreciate medications, they don’t like taking medications.”

“They appreciate them when they need them, but they want to be able to prevent their disease, they want to be able to manage it with diet, and they want to be able to manage it with other therapies. I think we under-appreciate that’s what they want.”

Dr Goldberg said having more access to allied health professionals would be a big improvement in patient management.

“We don’t have the time to explore all those aspects that are important to patients, nor the expertise to be honest – we’re not psychologists, we’re not dieticians. But having that allied health support, I think is invaluable.”