Hello. I am Dr. David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, United States.
Welcome back to the second part of this series featuring highlights from the Congress of the Digestive Disease Week (DDW) 2024, which took place this year in Washington, DC, United States.
In part 1 I talked about some hot topics and news from Congress. I’ll continue to do so here, focusing on five interesting studies on inflammatory bowel disease.
Poor oral health linked to inflammatory bowel disease
Two notable summaries on the topic of oral health were presented, adding to the already abundant amount of research data on the role of the oral microbiome in gastroenterology.
They also made me ask the question: should gastroenterologists be better stomatologists? I will return to this issue shortly.
For now I will begin by highlighting the work of Portuguese researchers who carried out a cohort study in collaboration between the inflammatory bowel disease clinic of a tertiary hospital and a school of dental medicine in order to gather information on dysbiosis of the oral microbiome.[1]
After collecting pertinent information from patients, the researchers identified a close relationship between poor oral health status – manifested by periodontal disease – and the presentation of inflammatory bowel disease. In patients with Crohn’s disease or ulcerative colitis, the prevalence of periodontal disease was 55.3% and 69.4%, respectively. The majority of patients with periodontal disease had the most severe forms in stages III to IV of the disease. The poor state of oral health was evident in the fact that 88.1% of patients with inflammatory bowel disease required dental treatment and 38.1% required prosthetic rehabilitation.
Additionally, the researchers collected and evaluated saliva samples to better understand the oral-gut microbiome axis in inflammatory bowel disease. Compared to healthy controls, patients with the disease had greater abundance of Firmicutes and Bacteroidetes, valuable indicators of dysbiosis.
In another single-center longitudinal study, a team led by Dr. Ali Keshavarzian, from Rush University Medical Center in Chicago, United States, evaluated the oral and fecal microenvironment of patients with active and inactive inflammatory bowel disease and healthy controls.[2] In addition to providing salivary and fecal biome samples, all participants completed the validated questionnaire Mediterranean Eating Patterns for Americans III. A subgroup of 36 participants underwent screening for periodontal disease using standard clinical evaluations and radiographs.
The team discovered a surprising relationship between inflammatory bowel disease activity and periodontal disease. There was an enrichment of the genres Rothia and Actinomyces in the saliva of people with active inflammatory bowel disease, compared to healthy controls. Stool samples from people with active disease also had a less diverse microbiome than those from people with inactive disease and healthy controls, which is consistent with what has been observed in other studies. But the main conclusion here is that patients with active inflammatory bowel disease were more likely to have severe periodontal disease.
In summary, we are discovering that it is really necessary to evaluate the oral health of patients with inflammatory bowel disease. There is much scientific data demonstrating the upregulation of cytokines (e.g., interleukins, tumor necrosis factor alpha) in periodontal disease. There is also much data indicating a possible bidirectional relationship between inflammatory bowel disease activity and periodontal disease.
So to answer the question I posed earlier, I think we need to be better dentists when treating our patients with inflammatory bowel disease.
Influence of dietary factors
A couple of interesting studies investigated the role that diet may play in inflammatory bowel disease.
In the first of these studies, the researchers used observational data obtained through large databases of the Nurses’ Health Study (NHS; 1990-2010), NHS II (1995-2015) and Health ProfessionalsFollow-up Study (HPFS; 1990-2010), which they used to compare a combination of guideline-based healthy diet and lifestyle intervention versus no intervention (usual diet and lifestyle) in patients without inflammatory bowel disease.[3]
Compared with no intervention, people who adopted a healthy diet and healthy lifestyle (e.g., not smoking) had a reduced risk of Crohn’s disease of approximately 13% over 20 years of follow-up.
This may be something we want to start talking about with our patients at risk for Crohn’s disease, given the possibility of preventing its onset by adopting a healthy diet and lifestyle.
There has also been some concern that increased dairy consumption may lead to the development of chronic inflammatory disorders and autoimmune diseases. However, little research has been conducted on this issue in inflammatory bowel disease.
To clarify this question, the researchers once again turned to the same three large American databases: NHS, NHS II and HPFS.[4] Of a group of 197,765 participants without initial inflammatory bowel disease, they identified 347 and 428 who developed Crohn’s disease and ulcerative colitis, respectively.
The researchers did not observe any relationship between dairy consumption and the development of Crohn’s disease. However, there was an inverse relationship between dairy consumption and the appearance of ulcerative colitis. This relationship increased over time and was greater if the follow-up was at least eight years before diagnosis. Initial consumption of yogurt was the dairy component with the greatest risk association with ulcerative colitis.
These results may help our patients concerned about the role that diet plays in the development of inflammatory bowel disease. We can say that diet influences this risk.
Intestinal Ultrasound Predicts Treatment Response in Pediatric Ulcerative Colitis
Point-of-care endoscopic ultrasound in patients with ulcerative colitis is becoming widespread in Europe. Although it is not commonly used in tertiary centers, some centers of excellence are already beginning to incorporate it.
In this prospective longitudinal cohort study, Dr. Marla Dubinsky and colleagues at Mount Sinai in New York evaluated the ability of intestinal ultrasound to predict response to biologic and small molecule therapy in pediatric patients with moderate to severe ulcerative colitis.[5]
The researchers found that early changes in intestinal ultrasound (i.e., intestinal wall thickness) could predict endoscopic remission and improvement, with sensitivities and specificities greater than 90%.
These results indicate that point-of-care intestinal ultrasound can be performed in one clinic day. It takes 15 to 20 minutes to complete, allowing immediate adjustments to therapeutic interventions for patients treated in inflammatory bowel disease clinics.
I’ll stop here and recommend you check out part 3 of this series, where I’ll share my latest highlights from DDW 2024.
I’m Dr. David Johnson. Thank you for your attention.
Dr. David A. Johnson, regular Medscape contributor , He is a professor of Medicine and head of Gastroenterology at the Eastern Virginia Medical School in Norfolk, Virginia, and former president of the American College of Gastroenterology . His specialty is the clinical practice of gastroenterology. He has published widely in internal medicine and gastroenterology, and his main areas of research are esophageal and colon diseases and, more recently, the effects of sleep and the microbiome on digestive health and diseases.
This content was originally published in the English edition of Medscape.