Advances in inflammatory bowel disease—what's new, what's next

Every five years, the Crohn's & Colitis Foundation of America (CCFA) gathers top researchers in inflammatory bowel disease (IBD) to set the research agenda for the next five years. The findings and recommendations of these expert workgroups are presented in a series of detailed "Challenges in IBD Research" reports, now available in Inflammatory Bowel Diseases, official journal of the CCFA.

Each workgroup is assigned to specific topic areas including genetics, epidemiology and environmental factors, the "microbiome" (intestinal bacteria), epithelial cell biology, innate and adaptive immunity, clinical classification and prognostic models, and optimizing medical therapy. A special "Challenges in IBD Research" progress report appears in the March issue of Inflammatory Bowel Diseases.

Experts Outline New Agenda for IBD Research

Based on a thorough review in each area, the workgroups have defined key research priorities for the next few years, including:

• Defining clinically relevant subgroups of IBD patients—using different types of information to predict aggressiveness of disease, complications, and response to treatment.
• Understanding the environmental factors affecting the risk and course of IBD—including environmental "triggers" and a specific focus on the role of diet.
• Clarifying the complex interrelationships among genes, bacteria, and epithelial and immune responses—focusing on cellular pathways and critical cell types that may lead to new "therapeutic targets."
• Determining the optimal treatment approaches and strategies through comparative effectiveness studies.

The workgroup reports also identify the resources needed to carry out this ambitious research agenda, including a "centralized and distributable infrastructure" for integrated studies of IBD in humans and long-term follow-up studies of children and adults with IBD.

"Through development of the ambitious research goals outlined in this document, the Crohn's & Colitis Foundation of America has again led the effort to further the understanding of IBD," said Dr. Lee Denson of Cincinnati Children's Hospital Medical Center. "CCFA is keen to advance this research agenda in 2013 and beyond."

Building on Recent Scientific and Clinical Advances

The CCFA research agenda builds on recent advances in scientific and clinical research. They include major strides in IBD genetics—more than 160 genes affecting susceptibility to Crohn's disease and ulcerative colitis have now been identified. Using sophisticated techniques, researchers have gained new insights into the complex interactions between intestinal bacteria and immune responses, including the role of specific types of immune cells.

Clinical studies have improved the ability to predict the response to IBD treatment in children and to track the short- and long-term adverse effects of IBD treatments. Progress has also been made in understanding the risks and benefits of medical and surgical treatments for key patient subgroups, including pregnant women and newborns. These studies point the way toward future efforts to optimize treatment for individual patients with IBD.