Preclinical disease and preventive strategies in IBD: perspectives, challenges and opportunities

Lymphoproliferative Disorders in Inflammatory Bowel Disease Patients: Is It the Drugs or the Disease

“…Treatment with those agents was associated with a 4-to 5-fold increase in the risk of lymphoproliferative disorders; this risk appears to rise with longer duration of therapy and to decrease after drug withdrawal [6,7]. These data, taken together with the identification of predictors of relapse, have encouraged authors to redefine thiopurine treatment specificities, either in combination or as monotherapy [9,10]. Despite having also been implicated as potential contributing factors for the development of lymphoma in IBD subjects, no clear correlation was found between anti-TNF-α agents and the occurrence of these disorders [11,12].…”

Microbiote intestinal et développement des maladies inflammatoires chroniques de l’intestin

“…Par l'acquisition de facteurs de virulence, elle peut des marqueurs de l'immunité innée ou acquise, une composition bactérienne fécale modifiée, ou une combinaison de plusieurs de ces facteurs [23]. La susceptibilité génétique à la maladie est l'un des facteurs de risque mais des facteurs environnementaux ou alimentaires qui peuvent aggraver la dysbiose augmentent ce risque de déclencher la maladie.…”

Editorial: serologic microbial associated markers to predict Crohn's disease behaviour – authors’ reply

“…3 Given the limited data available, most guidelines recommend generically starting a fibre supplement and gradually increasing the dose to reduce potential side effects such as bloating and gas. 4,5 Fibre is classified as 'soluble' or 'insoluble' based on its ability to dissolve in water. Soluble fibre increases the water content in the colon while insoluble fibre has been shown to increase faecal mass and colonic transit.…”

“…A different approach to disease mitigation, is to try and identify the so-called 'pre-clinical phase' of CD, where altered aberrant immune and inflammatory responses are present, and intervene before established disease pathways have been set. 4,5 In that setting, our encouraging results using a combination of microbial antibodies should certainly be considered as preliminary, but insightful. 6 It is likely that comprehensive panels of immunological, genetic, and microbial biomarkers will, via integrative methods, allow a better elucidation of causal mechanisms and disease states preceding overt inflammatory bowel disease.…”

“…While the prediction of complex and multifactorial diseases such as CD might seem overly ambitious, in fact it is already being investigated in other immune mediated diseases. 4 Finally, the two delineated approaches may be complementary in our journey towards prevention of CD. The first approach to limit progression and the consequences of disease once established could be considered as 'tertiary prevention,' while seeking to identify disease process in at-risk patients and intervene before it becomes symptomatic would be the first approach to 'secondary prevention'.…”