Sunday, January 5, 2014

IBD Research Update – Early Winter

 Worms, Revisited

The use of a whipworm parasite in pigs (Trichuris suis) was put forth and there were some promising new trials that were looking at it as a treatment for IBD (  The largest of these, the TRUST trials, evaluated the safety and efficacy of the treatment on 240 Crohn’s disease patients.  The trials were discontinued early when an independent data monitoring committee found they were lacking in efficacy.  While this does not close the door completely on the use of whipworm in IBD treatment, it makes it highly improbable as a treatment and new trials are not likely.(1)

Physical Activity as a Predictor of IBD

In an interesting, large scale study (the Nurses Cohort), researchers found a link between exercise and the likelihood of being diagnosed with Crohn’s Disease but not Ulcerative Colitis.  Specifically, they found that the least active fifth of women in the study had approximately twice the risk of being diagnosed with Crohn’s over the least active fifth.  The study controlled for smoking, body mass index, and similar potential aggravating factors.  Additionally, they also controlled for the possibility of pre-diagnosis Crohn’s limiting physical activity.  While there may still be an underlying factor, the correlation evidence is strong.(2)

Skin Cancer and IBD

Not specifically looking at IBD causing cancer, but looking at the associated treatments increasing the risk for skin cancer, a recent review found high correlations with thiopurine and anti-TNF-alpha drugs.  Specifically, non-melanoma skin cancers increased 5.9x with those on thiopurine and 2x with those on the anti-TNF-alpha drugs.  Additionally, the anti-TNF-alpha drug users had a 1% chance of developing drug-induced lupus and a 3% chance of psoriasis.  I suspect the anti-TNF-alpha numbers may even be a bit low, given their limited lifespan so far.  Either way, those on these drugs should consider a regular skin cancer screening with a dermatologist, and GI docs should be aware of possible skin complications.  Wearing sunscreen is probably a good idea also, given its preventative benefit for non-melanoma cancers.(3)

One more quick item of interest – it appears Finland has been having some success with their Vessapassi, from the Finnish Crohn’s and Colitis Association.  Similar to the “I can’t wait” cards that the CCFA puts out, the Vessapassi takes it one step further – getting restaurants and merchants to allow access to normally private restrooms and to allow individuals to jump in front of bathroom lines (a Disney FastPass+ for IBD).  Hats off to Finland and their Crohn’s and Colitis Association – hopefully more countries will follow suit.(4)

Bottom Line

·         Worm therapy, once thought to be promising as a treatment for IBD, does not appear to be viable from an efficacy standpoint.
·         Exercise may limit your chances of getting Crohn’s disease, but not UC, as least if you are a woman.  Even if it doesn’t, it’s a good idea to be in the top fifth for other health reasons.
·         Skin cancer (and other skin issues) have high co-morbidity with those on thiopurine and the anti-TNF-alpha drugs.  Regular screening is probably warranted.

2.       Khalili H ,Ananthakrishnan AN ,Konijeti GG ,Liao X ,Higuchi LM ,Fuchs CS ,et al. Physical activity and risk of inflammatory bowel disease: prospective study from the Nurses’ Health Study cohorts. BMJ 2013;347:f6633
3.       Moran GW, Lim AW, Bailey JL, Dubeau MF, Leung Y, Devlin SM, Novak K, Kaplan GG, Iacucci M, Seow C, Martin L, Panaccione R, Ghosh S.  Review article: dermatological complications of immunosuppressive and anti-TNF therapy in inflammatory bowel disease.  Aliment Pharmacol Ther. 2013 Nov;38(9):1002-24. doi: 10.1111/apt.12491. Epub 2013 Sep 25.

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