This transcript has been edited for clarity.
Hello. I’m Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia.
Welcome back to part two of this series offering highlights from Digestive Disease Week (DDW) 2024, held this year in Washington, DC.
In part 1, I shared some hot topics and news from the meeting. I’ll continue to do so here, focusing on five exciting studies in inflammatory bowel disease (IBD).
Poor Oral Health’s Link to IBD
Two notable abstracts were presented on the topic of oral health, which add to an already abundant amount of data investigating the role of the oral microbiome in gastroenterology.
They also provoked a question for me: Should we as gastroenterologists be better dentists? I’ll return to that question shortly.
For now, I’ll begin by highlighting the work of Portuguese researchers,[1] who conducted a collaborative cohort study between an IBD consultation in a tertiary hospital and a dental medicine faculty in order to gather information on oral microbiome dysbiosis.
After collecting relevant patient information, the researchers identified a strong association between poor oral health status — in the form of periodontal disease — and the presence of IBD. Among patients with Crohn’s disease and ulcerative colitis, the prevalence of periodontal disease was 55.3% and 69.4%, respectively. Most patients with periodontal disease had the more severe stage III/IV forms of the disease. Poor oral health status was evident in the fact that 88.1% of patients with IBD required dental treatment and 38.1% needed prosthetic rehabilitation.
In addition, the researchers collected and assessed saliva samples to better understand the oral-gut microbiome axis in IBD. In comparison with healthy controls, patients with IBD had an elevated abundance of Firmicutes and Bacteroidetes, which are valuable indicators of dysbiosis.
In a separate single-center longitudinal study[2] conducted along similar lines, a team led by Dr Ali Keshavarzian at Rush University Medical Center in Chicago, Illinois, assessed both the oral and stool microenvironment of patients with active IBD, inactive IBD, and healthy controls. In addition to providing salivary and stool biome samples, all participants completed the validated Mediterranean Eating Patterns for Americans III questionnaire. A subset of 36 participants underwent periodontal disease examinations via standard clinical evaluations and radiographs.
The team reported a striking association between the activity of IBD and periodontal disease. There was enrichment of the genera Rothia and Actinomyces in the saliva of people with active IBD, as compared with healthy controls. The stool samples of those with active IBD also had a less diverse microbiome than those with inactive IBD and healthy controls, which is consistent with what we’ve seen in other studies. But the main conclusion here is that patients with active IBD were more likely to have severe periodontal disease.
In summary, we’re discovering that oral health really needs to be assessed in patients with IBD. There’s lots of science showing upregulation of cytokines (eg, interleukins, tumor necrosis factor alpha) in periodontal disease. There’s also a lot here to suggest a possibly bidirectional relationship between IBD activity and periodontal disease.
So, to answer the question I posed earlier, I believe we do need to become better dentists when treating our patients with IBD.
The Influence of Dietary Factors
A pair of interesting studies investigated the role that diet potentially plays in IBD.
In the first of these studies,[3] researchers used observational data obtained via the large databases of the Nurses’ Health Study (NHS; 1990-2010), NHS II (1995-2015), and the Health Professionals Follow-up Study (HPFS; 1990-2010), which they used to compare a combination of guideline-based healthy diet and lifestyle intervention vs no intervention (usual diet and lifestyle) in patients without IBD.
In comparison with no intervention, people who adopted a healthy diet and lifestyle intervention (eg, not smoking) had an approximately 13% risk reduction for Crohn’s disease over the 20-year duration of follow-up.
This may be something that we want to start talking about with our patients who are at risk of developing Crohn’s disease, given the possibility of preventing its development following the adoption of a healthy diet and lifestyle.
There has also been some concern that increased dairy consumption can lead to the development of chronic inflammatory disorders and autoimmune diseases. However, limited research has been conducted around this issue in IBD.
To shed light on this issue, researchers turned again to the same three large US databases: NHS, NHS II, and HPFS.[4] From a group of 197,765 participants without baseline IBD, they identified 347 and 428 who eventually developed Crohn’s disease and ulcerative colitis, respectively.
The investigators observed no association between dairy consumption and developing Crohn’s disease. However, there was an inverse relationship between dairy consumption and developing ulcerative colitis. This increased over time, becoming strongest with at least 8 years follow-up before the diagnosis. Baseline yogurt consumption was the dairy component with the strongest risk association with ulcerative colitis.
These results may help our patients who are concerned about the role of diet in developing IBD. We can tell them that diet does make a difference in influencing this risk.
Intestinal Ultrasound Predicts Treatment Response in Pediatric Ulcerative Colitis
Point-of-service endoscopic ultrasound in ulcerative colitis is becoming very widespread in Europe. Although it’s not commonly used at tertiary centers, some centers of excellence are starting to incorporate it.
In this prospective longitudinal cohort study,[5] Dr Marla Dubinsky and colleagues at Mount Sinai in New York City assessed the ability of intestinal ultrasound to predict response to biologic and small-molecule therapy in pediatric patients with moderate to severe ulcerative colitis.
Researchers found that early changes on intestinal ultrasound (ie, bowel wall thickness) were able to predict endoscopic remission and improvement, with sensitivities and specificities in excess of 90%.
These results indicate that point of service intestinal ultrasound can be done on a clinic day. It takes about 15-20 minutes to perform, with immediate adjustments of therapeutic interventions potentially made available to patients being treated at IBD clinics.
I’ll stop here and recommend you consult part 3 of this series, in which I’ll share my final abstracts of interest from DDW 2024.
I’m Dr David Johnson. Thanks for listening.
David A. Johnson, MD, a regular contributor to Medscape, is professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia, and a past president of the American College of Gastroenterology. His primary focus is the clinical practice of gastroenterology. He has published extensively in the internal medicine/gastroenterology literature, with principal research interests in esophageal and colon disease, and more recently in sleep and microbiome effects on gastrointestinal health and disease.