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  • Biological changes show up in blood tests in people with inflammatory bowel disease years before their diagnosis.
  • Researchers used these findings to develop a way to predict whether someone may have the early stages of this condition.
  • While more research is needed, early diagnosis could help prevent some of the damage to the gastrointestinal tract that occurs with the disease.

Biological changes can be detected in blood tests up to eight years before a person is diagnosed with Crohn’s disease and up to three years before a diagnosis of ulcerative colitis, a new study shows.

This suggests that changes associated with inflammatory bowel disease (IBD), as these two conditions are collectively known, may occur long before people develop symptoms.

The findings from the new study could enable researchers to design a way to identify which people may be in the pre-clinical phase of IBD, as researchers call the period before patients develop symptoms.

As a result, “our research might help [predict] who could potentially suffer from IBD, and thus start treatment earlier, which would greatly improve their quality of life,” study author Marie Vestergaard, a PhD student at the Center for Molecular Prediction of Inflammatory Bowel Disease, at Aalborg University in Denmark, said in a news release.

Right now, though, the researchers’ model is not completely accurate at predicting who is at risk of IBD, so more research is needed before this tool can be used in the clinic.

IBD is generally not difficult to diagnose once a person has symptoms, said Dr. Babak Firoozi, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif.

However, “by the time a patient begins to experience the typical symptoms, significant damage to the intestines has already taken place,” he told Healthline.

“Additionally, there are patients who have mild symptoms that don’t necessarily require evaluation by a doctor, so they may take months to years to finally get diagnosed, after which they may have already experienced irreversible damage,” he said.

In the new study, published Nov. 7 in Cell Reports Medicine, researchers hoped to better understand what happens in the years leading up to an IBD diagnosis. They focused on standard blood tests of vitamin and mineral levels, cells commonly found in the blood, and markers of inflammation.

They reviewed electronic health records for around 20,000 patients in Denmark who were diagnosed with IBD between 2008 and 2018, with test results available up to 10 years before the IBD diagnosis.

As a comparison, they looked at records from the same period for 4.6 million people without IBD, also known as the control group.

In IBD patients, changes were present in the majority of these tests up to eight years before a diagnosis of Crohn’s disease, and in more than half of the tests up to three years before an ulcerative colitis diagnosis.

Most of the changes were small enough that they would have fallen within a normal range for that test, so the test result would not have raised a concern with a doctor, the researchers said.

The researchers were only able to detect these small differences between IBD patients and control patients because they had access to a nationwide electronic health database in a country with a free healthcare system.

The results of the study may one day enable doctors to identify people who have early stages of IBD, before they develop symptoms.

“This has huge implications for prevention [of IBD], as it highlights that there’s a window of opportunity for treatment,” study author James Lee, PhD, Group Leader of the Genetic Mechanisms of Disease Laboratory at the Francis Crick Institute in the UK, said in the release.

However, the researchers point out that more work is needed. Their model was not able to correctly identify all people who would eventually go on to be diagnosed with IBD. Adding other blood tests to the model might improve the performance of their prediction, they wrote.

In addition, it is not known if the biological changes seen in people later diagnosed with IBD also show up in people with other inflammatory conditions, such as rheumatoid arthritis, the researchers said. More research is needed.

Firoozi questions whether this would be useful as a wide-scale screening tool. “It would be very difficult to monitor an entire population to identify a small group of people who are at risk,” he said.

“A better approach would be to try and identify those who are at higher risk, such as family members of people with IBD, people with a family history of IBD, certain ethnic groups, or possibly through DNA analysis,” he said.

If an accurate predictive tool can be developed, it would improve the lives of many people, because early treatment of IBD has been shown to improve long-term outcomes.

If the disease can be controlled before significant damage has been done, patients “will have fewer complications, less need for surgery and generally have longer symptom-free stretches in their disease course,” said Firoozi.

Early intervention before the start of symptoms might also preserve the gastrointestinal tract and prevent serious damage.

In addition to medications already in use for IBD, Firoozi said people might benefit from early lifestyle and dietary interventions, such as stopping smoking, and the Mediterranean diet, which includes avoiding red meat, sugars and processed foods.

“This could potentially lead to a less severe disease course or even prevent them from even getting the disease,” he said.

By reviewing blood tests up to 10 years before patients were diagnosed with inflammatory bowel disease, researchers were able to identify early changes that occur in the disease.

When these blood test results were combined in a statistical model, researchers were able to predict which patients would go on to develop IBD, although not yet with complete accuracy.

If a better predictive tool can be developed, it could help doctors identify people with a high risk of developing IBD, and start treatment early. This includes medications as well as dietary and lifestyle changes.