PhD defence M.M.E. (Myrthe) Jongsma

Summary:

Inflammatory bowel disease is an incurable, debilitating immune mediated inflammatory disease of the gastrointestinal tract. The inflammation of the gastrointestinal tract is characterized by a relapsing and remitting disease. In newly diagnosed patients with inflammatory bowel disease, rapid disease control is desirable, but this is not always achieved with current treatment strategies. The results of this thesis show that, the first blow is half the battle in treating moderate-to-severe paediatric Crohn’s disease patients. First-line infliximab treatment was superior to conventional treatment with exclusive enteral nutrition of prednisolone, in moderate-to-severe paediatric Crohn’s disease patients in achieving disease remission after one year. We showed that in patients treated with first-line infliximab there was achieved a stronger reduction in inflammation, and modulates more inflammatory proteins in peripheral blood than after exclusive enteral nutrition or prednisolone induction treatment. By profiling patients on inflammatory proteins we were able to identify patients with a poor chance of maintaining disease remission. Immune profiling of moderate-to-severe Crohn’s disease patients provides a rational approach to initiating and discontinuing first-line anti-TNF treatment.