Scientists Discover Hidden Sign of Crohn’s Disease and Ulcerative Colitis Before a Flare-Up

A hidden molecular defect may persist in the intestines of people with inflammatory bowel disease (IBD) even when they have few or no noticeable symptoms. A study conducted by researchers at the Walter and Eliza Hall Institute of Medical Research (WEHI) in collaboration with the Royal Melbourne Hospital found that intestinal cells in these patients are more prone to dying, which may contribute to future disease flare-ups. The study was published in the journal Science.

The researchers focused on Crohn’s disease and ulcerative colitis, chronic conditions in which periods of remission are followed by episodes of active disease. Although modern treatments can help control symptoms, the disease eventually returns in many patients.

For the study, scientists analyzed around 900 biopsies collected from 80 people, as well as organoids—miniature models of intestinal tissue—grown from patient samples. The participants were followed for more than two years.

The researchers found that even patients whose disease was well controlled continued to show signs of increased activity in processes associated with intestinal cell death. Moreover, the stronger this molecular signal was, the greater the likelihood of a subsequent relapse.

The findings also challenge the idea that cell death is simply a consequence of inflammation. According to the researchers, the defect may emerge at a very early stage of the disease and could itself contribute to its progression.

The scientists describe the mechanism they identified as a “smoldering” defect: the intestine may appear relatively healthy from the outside, while the pathological process continues to persist at the cellular level.

The authors hope that the molecular markers identified in the study could eventually help doctors assess patients more accurately, predict the risk of flare-ups earlier, and tailor treatment to the characteristics of each individual’s disease. However, further research is needed before a new diagnostic test or treatment can be developed.