DEfining MechanIsms Shared across mulTI-organ FIbrosis to prevent the development of long-term multi-morbidity (DEMISTIFI)

The incidence and prevalence of obesity is increasing world-wide, with 39% of patients being overweight in 2016. Similarly, Inflammatory Bowel Disease (IBD) is getting commoner with a recent UK study describing that nearly 1% of the British population now have IBD. It is unclear if IBD is getting commoner due to the world-wide increase in obesity as the world becomes more westernised.

Abdominal fat may have a role in perpetuating the inflammation in the gut due to IBD. Moreover, abdominal fat may be linked to increased scarring in the bowel as well. Small studies have shown that Crohn's Disease (CD) patients with high abdominal fat may have more strictures and scarring inthe bowel leading to surgery. This potential link between scarring and fat is not unique to CD. For instance patients with lung fibrosis tend to be overweight and suffer from diabetes and high blood pressure. Metabolic syndrome is a common syndrome (25% of world-wide population) that describes patients with a high BMI, diabetes, high blood pressure and high cholesterol. Important changes in signalling molecules called mTOR and AMPK have been described in metabolic syndrome and lung fibrosis. Drugs that have an effect on mTOR (sirolimus) and AMPK (metformin) are already available. We think that a link exists between metabolic syndrome and scarring in the gut in CD. In this study we aim to use the information stored in the NIHR IBD Bioresource related to CD scarring, hospitalisation and surgery to information related to obesity, hypertension, diabetes, high cholesterol and any medication used to treat these conditions. If we can show a strong link between metabolic syndrome and scarring, this would pave the way for more studies using available medication to reverse scarring.