New NHS blood test provides hope for Crohn's disease sufferers

How a simple blood test could save thousands of patients from the agony of painful bowl operations for Crohn’s disease and ulcerative colitis

• The PredictSURE IBD test can assess the severity of several bowel conditions
• Studies suggest it can identify 90 per cent of patients who suffer the worst 
• Quick intervention and aggressive treatment can control the illness  

A simple blood test could soon help people hit by debilitating bowel diseases get the most effective treatment more quickly – reducing the risk of permanent damage that would ultimately require surgery.

The UK-developed test, called PredictSURE IBD, is designed to assess the severity of Crohn’s and ulcerative colitis, conditions that cause inflammation and ulceration inside the gut and elsewhere in the digestive tract.

Studies suggest it is 90 per cent effective at spotting which patients are most likely to suffer the worst problems. It mean they can then be put on aggressive treatment immediately, to control their illness.

The UK-developed test, called PredictSURE IBD, is designed to assess the severity of Crohn’s and ulcerative colitis, conditions that cause inflammation and ulceration inside the gut and elsewhere in the digestive tract

Currently it can be very difficult for doctors to know who will have more serious forms of the conditions – collectively known as inflammatory bowel disease – when patients are first diagnosed

James Lee, clinician scientist group leader at the Francis Crick Institute and honorary consultant gastroenterologist at the Royal Free London NHS Foundation Trust, who helped to develop the test, says that understanding the course of someone’s illness will make a huge difference to people with the conditions.

He adds: ‘This is hugely important for patients as it gives them the best chance for trying to get the disease into remission quickly, and really helpful for clinicians as you’re not wasting time trying out treatments that aren’t going to work.’

Currently it can be very difficult for doctors to know who will have more serious forms of the conditions – collectively known as inflammatory bowel disease – when patients are first diagnosed. 

This means the half a million Britons affected are typically put on a treatment ladder, working their way through different medications, starting with the least powerful, until they find the option that suits them best. 

But this approach isn’t without downsides, as some patients with aggressive conditions may suffer permanent damage inside the body when on the less effective drugs, doctors say.

This can sometimes leave them needing surgery to remove narrow or blocked sections of the gut.

At present Crohn’s and ulcerative colitis patients cannot access the new test on the NHS after it was knocked back for NHS use by health bosses in February. The National Institute for Health and Care Excellence (NICE) did not approve the £1,250-a-time test, developed by Cambridge University scientists and produced by company PredictImmune, and said more research was needed before it could be approved.

Leading doctors working in the field hope that a larger study currently under way in the UK will provide this evidence when it reports later in the year.

Crohn’s and colitis both occur when the immune system turns inward, attacking healthy gut tissue inside the body.

This causes damage, pain and inflammation, and symptoms including diarrhoea (often with blood), severe pain, extreme fatigue, and dramatic weight loss.

While there is no cure, treatment aims to keep patients in remission and control flare-ups.

The new blood test works by looking for signs that the patient’s T cells, which are a key part of the immune system, are exhausted. When these cells are exhausted, they are less likely to attack the bowel and trigger an inflammatory response, so high levels of exhaustion indicate that someone is less likely to have ongoing flare-ups. But if doctors know the patient is likely to have ongoing flare-ups, they can move more swiftly to the most powerful medicine, including immune-suppressing drugs.

A study published in the journal Gut in 2019 suggests that more than nine in ten patients with inflammatory bowel disease who required the strongest treatment were correctly identified by the approach.

Professor James Lindsay, consultant gastroenterologist at Barts Health NHS Trust, has used the test on a handful of private patients. One of these was a 19-year-old university student suffering from the typical symptoms of Crohn’s.

‘He came back with a high-risk score and I started him on advanced therapy pretty much straight away as soon as he had finished his initial steroids,’ says Prof Lindsay.

‘Crohn’s disease has a massive impact on people, particularly when they are teenagers and they want to go out and meet people and start relationships, and it will have had a major impact on his life.’

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