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Crohns disease CD is a long-lasting condition causing inflammation in the gut. This research aims to find out if replacing a normal diet with specialized milkshakes for 6 weeks can help improve treatment response and maintain remission in children and young adults with active CD receiving biologic therapies. The study focuses on patients aged 6 to 18 years who are starting biologic treatment with TNF alpha inhibitors, aiming to compare diet approaches alongside these medications to better manage CD symptoms and disease activity. Participants will be randomly assigned or choose to follow either their usual unrestricted diet or replace varying amounts of their diet with a liquid formula called enteral nutrition for 6 weeks while receiving biologic treatments such as infliximab or adalimumab. Additional groups receiving exclusive enteral nutrition alone or combined with biologics will also be observed to compare different treatment outcomes. The study uses a proprietary liquid formula to replace energy intake and tracks effects during biologic induction therapy. Throughout the study, participants will be monitored for improvements in symptoms and disease markers over 10 to 12 weeks, with follow-up up to a year to assess sustained remission. Researchers will evaluate nutritional status, body composition, quality of life, immune markers, and gut and oral microbiome changes. Safety and treatment adherence will also be tracked, with various blood tests, questionnaires, and physical assessments included. Overall, the study spans over a year to assess both immediate and long-term treatment effects in pediatric CD patients.

Researchers are studying patients with newly diagnosed stage I, II, and III colorectal cancer CRC to understand how circulating tumor DNA ctDNA in the blood can predict disease relapse. The study evaluates whether using ctDNA to guide adjuvant chemotherapy decisions after surgery is as effective as standard chemotherapy, aiming to reduce unnecessary treatments and side effects. This multi-center, prospective research includes both observational and randomized components to better manage early-stage CRC. The study has two parts Part B focuses on collecting tumor tissue, serial blood samples, and clinical data to detect minimal residual disease MRD using ctDNA after curative surgery. Part C is a randomized trial comparing ctDNA-guided adjuvant chemotherapy versus standard care in patients with high-risk stage II or III CRC. Patients are randomized post-surgery to either standard chemotherapy or a ctDNA-guided approach where those testing negative for ctDNA may receive less chemotherapy. Participants will undergo regular blood sampling and clinical assessments to monitor ctDNA levels and disease status. Researchers will measure outcomes such as 3-year disease-free survival and the relationship between ctDNA detection and treatment response over several years. The study includes follow-up periods of 4 to 8 years to evaluate long-term outcomes and safety. Participants need to consent, adhere to follow-up schedules, and be suitable for chemotherapy if randomized to Part C.