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Experts say there may be ways to detect inflammatory bowel disease before symptoms appear. SDI Productions/Getty Images
  • Researchers report that changes indicative of inflammatory bowel disease (IBD) can be found in blood tests up to eight years prior to a diagnosis of Crohn’s disease and three years prior to a diagnosis of ulcerative colitis.
  • Experts say being able to identify the condition earlier could improve patient outcomes, including lessening severity of the disease.
  • They note that by the time many people are diagnosed with IBD, significant damage may already have occurred.

Changes that may indicate inflammatory bowel disease (IBD) may be detectable in blood tests up to eight years prior to a Crohn’s diagnosis and up to three years prior to an ulcerative colitis diagnosis.

Research published today in the journal Cell Reports Medicine suggests IBD may begin a long time before symptoms appear, providing physicians with an opportunity for early intervention.

“Our research shows that the bowel damage we’re seeing at the point of diagnosis is just the tip of the iceberg. So many changes are subtly taking place in the body before the disease takes hold,” James Lee, a co-author of the study and group leader of the Genetic Mechanisms of Disease Laboratory at the Francis Crick Institute in London, said in a press statement.

“This has huge implications for prevention as it highlights that there’s a window of opportunity for treatment,” Lee added. “We don’t yet know whether preventative measures like changing diet or stopping smoking would stop someone getting these diseases, but this opens the door to that possibility. It also underscores the importance of early diagnosis and treatment, as many of the changes in the gut are likely to have been happening long before people become ill.”

Crohn’s disease and ulcerative colitis are inflammatory bowel diseases that cause chronic inflammation to the gastrointestinal tract.

Roughly 3 million adults in the United States live with IBD.

Symptoms of IBD may mimic symptoms of other conditions such as irritable bowel syndrome, which can lead to delays in diagnosis. Studies suggest a diagnostic delay of between 2 months to 12 months can occur.

As part of their study, the researchers examined electronic health records from 20,000 people in Denmark with an IBD diagnosis. They compared them with the records of more than 4 million people without IBD.

They looked at test results spanning 10 years before a diagnosis of IBD was given.

The researchers reported that people who had been diagnosed with IBD showed changes to certain minerals and cells in the blood as well as markers of inflammation.

The researchers reported that eight years prior to a Crohn’s diagnosis, white blood cells and platelets were higher.

Seven years prior, levels of C-reactive proteins (CRP), which indicates inflammation, were higher. Levels of hemoglobin, a type of protein in blood cells that carries oxygen, were lower.

At five years prior to diagnosis iron and albumin (a protein made by the liver) were lower while monocytes, a type of white blood cell, were higher.

Three years prior to a diagnosis of ulcerative colitis levels of CRP, white blood cells, and platelets were higher.

The researchers say these changes were so subtle they wouldn’t have been flagged as a problem on a standard blood test.

They said they are hopeful their research could allow for further investigation to see if prevention is possible.

“Our findings are novel and go hand-in-hand with emerging evidence that chronic inflammatory bowel diseases likely have their onset years prior to diagnosis,” Dr. Tine Jess, a co-author of the study and the director at the Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, at Aalborg University in Denmark, said in a press statement. “These incurable diseases affect young individuals and are twice as common as type 1 diabetes. Understanding the exact mechanisms behind their development is essential to ultimately prevent the diseases from occurring. Our unique Danish data resources combined with cross-disciplinary and international collaboration help answering yet unanswered questions critical for patients worldwide.”

Dr. Sarah Streett is the director of Inflammatory Bowel Disease Education at Stanford University in California. She says the research is an important step forward in the field of IBD.

“In this field… there are some really, really important needs and this publication is getting at one of them. If we were able to identify people early, especially with a non-invasive test, that would fill a very important need,” Streett told Medical News Today.

“There are 240… at least, snips or linkage quirks that have been associated with people being at increased risk for having inflammatory bowel disease,” she explained. “So that in itself tells us this is a this is a broad, genetically diverse set of disorders. It also tells us though, that there are people that have a predisposition, probably multiple different ones that influence how our gut immune system responds to environmental stimuli. And if we could identify those folks, and try to modify what may then set off an irreversible, inappropriate series of inflammatory changes that would be ideal.”

The researchers say they hope to next investigate whether there are any treatments or prevention strategies that can have an impact before symptoms of IBD appear.

Dr. Babak Firoozi, a gastroenterologist at MemorialCare Orange Coast Medical Center in California, says being able to identify the disease earlier could help improve patient outcomes.

“Early treatment has been shown to improve long term outcomes in patients with IBD. Those patients in whom the disease is controlled before significant damage has been done have less complications, less need for surgery, and generally have longer symptom free stretches in their disease course,” he told Medical News Today.

“When the patient begins to experience the typical symptoms, significant damage to the intestines has already taken place,” Firoozi explained. “Additionally, there are patients who have mild symptoms that don’t necessarily require evaluation by a doctor and may take months to years to finally get diagnosed, after which they may have already experienced irreversible damage. If we can identify these patients before they develop symptoms, we can produce a plan for early intervention to ideally prevent the disease from occurring, or at the very least improve outcomes and minimize the severity of the disease course.”