How Cleveland Clinic Is Advancing IBD Treatment Through Global Collaboration

Chronic diseases often affect overall health, not just specific body parts. To address this, Cleveland Clinic’s Digestive Disease Institute started its Integrated IBD Program nearly a decade ago for a holistic treatment of patients with Crohn’s disease and ulcerative colitis, collectively known as inflammatory bowel diseases (IBD). Since the program’s creation, Cleveland Clinic has expanded globally, and the Institute has prioritized aligning IBD care, research and education across its locations, resulting in closer integration of facilities in Florida, London, and Abu Dhabi with the main campus in Ohio.

“I think our IBD global approach has really benefited from how our clinical pathways link healthcare caregivers and researchers in Cleveland with our colleagues in Florida, Abu Dhabi and London,” says Miguel Regueiro, MD, Chief of the Digestive Disease Institute at Cleveland Clinic. “We have regular meetings between these multidisciplinary groups, and one of the benefits that’s come out of this are new research protocols.”

He continues, “We’re working towards a precision medicine approach to digestive diseases across a global spectrum. By studying patient populations from different parts of the world, we can better understand why people get these diseases — and, most importantly, how to treat them and how to prevent them. At the end of the day, our biggest priority is that our patients around the world receive the same level of expert care.”

Standardizing care and sharing insight across continents

Dr. Regueiro explains that the Integrated IBD Program is currently focused on three priorities: standardizing care, expanding global research and education, and applying those discoveries into practice. To help guide this agenda, the Integrated IBD Program is led by Staff in Ohio, but with physicians and surgeons from each of the sites – Abu Dhabi, Florida, and London. This team meets virtually at least four times per month to regularly discuss clinical cases, research, and care pathways.

“The nice part of this is that we often have at least two to three physicians engaged per site,” explains Dr. Regueiro. “By meeting regularly, we are essentially now speaking the same language, and similarly approaching the disease. These conversations help us standardize care across Cleveland Clinic so that a patient in Abu Dhabi receives the same level of care as a patient in Florida.”

One advantage of regular communication between sites is that it enables Cleveland Clinic providers to be well-prepared when new treatments become available. For example, if a treatment is approved in Europe before being approved in the United States, Cleveland Clinic physicians in Ohio and Florida can learn from their colleagues in London about their experiences and how patients respond or best practices.

“A little while back, there was a medication that was approved in the United States, but it was approved as a second-line treatment,” says Dr. Regueiro. “However, in Europe, it could be used as first-line treatment. We were able to hear from our London colleagues' experiences with the medication, which gives us a leg up should the FDA or regulatory agency update their approval designations. This is a two-way street because there have been instances where U.S. approvals have been faster, so we’ll share our experiences with our international colleagues.”

Enhancing global IBD research through collaboration

The level of frequent communication is also a major benefit as it relates to research. “I think one area where our IBD global approach has really benefited is that we can now through research in some of our clinical pathways link caregivers and researchers in Cleveland, Florida, Abu Dhabi and London,” says Dr. Regueiro.

The team recognizes that there are numerous social and environmental differences between patients in these various locations. Having data from two sites in the U.S., and two international sites means that they can compare how patients with different diets and environmental factors experience inflammation.

“What works well in Ohio, for example, may not necessarily be the ideal way to treat patients elsewhere,” says Florian Rieder, MD, a gastroenterologist at Cleveland Clinic. “If we can compare and learn from different patient populations, we can increase our chances for success.”

Dr. Regueiro explains further, “With our access to patient data from two U.S. sites, a European site and a Middle Eastern site, we really have a unique opportunity to explore lifestyle impact. Our goal is to try to understand — both on a microbiome and a molecular level — why patients get these inflammatory conditions and how their environment impacts their health.”

Part of what makes this possible is the joint research infrastructure, including a global IBD biobank, established at Cleveland Clinic. The biobank ensures that the biosamples collected in Ohio, Florida, London and Abu Dhabi can be shared with the international research teams.

I think what’s potentially most exciting about this setup is really getting a better sense of the microbiome,” says Dr. Regueiro. “Maybe there are differences in each of us based on where we are in the world as far as how we develop Crohn's disease or ulcerative colitis, and that could lead to research that would potentially change treatment.”

Translating research into cutting-edge IBD care

The team hopes to leverage their research findings and data by linking it with large-language AI models to develop predictive tools for early diagnosis and treatment. Dr. Regueiro believes that by having AI review and learn from the electronic medical records at each site, the team can truly individualize care.

“For example, let’s say there's a 37-year-old patient with ulcerative colitis diagnosed in Abu Dhabi,” explains Dr. Regueiro. “Based on what AI has identified and flagged as predictors, we can recognize the likelihood of this patient developing complications and needing surgery down the line. This kind of recognition and understanding allows us to be more proactive in our treatment and work with the patient to implement lifestyle changes before the disease escalates to the point of requiring surgery. I'm being a little bit theoretical here because it's not that black and white, but we believe that individualized, precision medicine can come from linking all of our data from these four diverse sites.”

Although using AI in this manner remains a future goal, Cleveland Clinic is already working towards incorporating AI into care in other ways. Recognizing that younger patients tend to be much more digitally inclined, the Digestive Disease Institute’s behavioral health team partnered with an innovative outside company to develop a digitally integrated medical home concept.

“Essentially, we’ve taken our holistic, whole-person approach to care that we deliver in our IBD medical home and provided it as a remote, AI platform,” says Dr. Regueiro. “Stephen Lupe, PsyD, has been the driving force behind this. These digital platforms might be app-based or remote, and we can connect and scale to a lot larger group of patients. We just started this at the end of last year, and it has already started to take off.”

The platform works with patients much the way their GI psychologist would work with them. The platform learns from the patient, and it helps resolve any issues that may arise for the patient. Everything is linked back to the behavioral health team, and they get real-time notifications about the patients. The platform provides patients with information about lifestyle management, stress management and diet, so rather than waiting for their next appointment, patients can get the individualized information they need when they need it.

“Much of what we’re doing with this program, and our Integrated Global IBD program in general, is about strengthening connections to improve care,” explains Dr. Regueiro. “Our aim is to ensure that no matter where our patients are, they still receive the same high standard of care. Through more frequent communication with our global colleagues, we’ve shared more ideas, data, research and innovations. Having data from diverse patient populations is something that we believe can drive IBD care forward. Hopefully, this kind of program model can be applied to other chronic conditions in the future.”