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Environmental Factors May Play a Role in the Pathogenesis of IBD
NEW YORK (Reuters Health) Nov 14 - The clinical spectrum of inflammatory bowel disease (IBD) is evolving, results of a study published in the October issue of the Journal of Pediatrics suggest. The findings point to changing environmental factors as contributors to the pathogenesis of the disease
In a population-based study, Dr. Subra Kugathasan, of the Medical College of Wisconsin, Milwaukee, and colleagues examined the incidence of pediatric IBD and defined clinical characteristics of the disease. Demographic and clinical data on all new cases of IBD in Wisconsin over a 2-year period were prospectively analyzed.
The overall incidence of IBD in children was 7.05 per 100,000, according to the researchers. The incidences of Crohn's disease (CD) and ulcerative colitis (UC) were 4.56 and 2.14 per 100,000, respectively.
The mean ages of diagnosis for IBD, CD, and UC were 12.5 years, 13.5 years, and 11.8 years, respectively.
The IBD incidence rates were similar among all ethnic groups, as well as among children from sparsely versus densely populated regions. Only 11% of the newly diagnoses IBD cases had first- or second-degree relatives with a history of the disease.
The lack of family history and the higher incidence of Crohn's disease than ulcerative colitis suggest to the investigators that new environmental factors are involved.
Also, they point out, the incidence of IBD in children they documented is the highest ever reported.
"A parallel phenomenon is the dramatic increase in asthma during the same period in the West," Dr. Kugathasan and colleagues note. "The concomitant emergence of chronic inflammation in the lung and gut also supports the concept that changing environmental factors play a pivotal role in the increased frequency of these disorders in children."
J Pediatr 2203;143:525-531.
http://www.medscape.com/viewarticle/464442?mpid=21407
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Diseases of the Colon & Rectum 2003; 46(12):1685-1689
Increased Anal Resting Pressure and Rectal Sensitivity in Crohn's Disease
Peter Andersson, M.D., Ph.D. *; Gunnar Olaison, M.D., Ph.D. *; Olof Hallböök, M.D., Ph.D. *; Bernt Boeryd, M.D., Ph.D. †; Rune Sjödahl, M.D., Ph.D., F.R.C.S. *
PURPOSE:
Anal pathology occurs in 20 to 80 percent of patients with Crohn's disease in which abscesses, fistulas, and fissures account for considerable morbidity. The etiology is not clearly defined, but altered anorectal pressures may play a role. This study was designed to investigate anorectal physiologic conditions in patients with Crohn's disease compared with healthy controls.
METHODS:
Twenty patients with Crohn's disease located in the ileum (n = 9) or the colon (n = 11) without macroscopic proctitis or perianal disease were included. All were subjected to rectal examination, anorectal manometry, manovolumetry, and rectoscopy. Comparison was made with a reference group of 173 healthy controls of whom 128 underwent anorectal manometry, 29 manovolumetry, and 16 both examinations.
RESULTS:
Maximum resting pressure and resting pressure area were higher in patients than in controls (P = 0.017 and P = 0.011, respectively), whereas maximum squeeze pressure and squeeze pressure area were similar. Rectal sensitivity was increased in patients expressed as lower values both for volume and pressure for urge (P = 0.013 and P = 0.014, respectively) as well as maximum tolerable pressure (P = 0.025).
CONCLUSIONS:
This study demonstrates how patients with Crohn's disease without macroscopic proctitis have increased anal pressures in conjunction with increased rectal sensitivity. This may contribute to later development of anal pathology, because increased intra-anal pressures may compromise anal circulation, causing fissures, and also discharging of fecal matter into the perirectal tracts, which may have a role in infection and fistula development.
http://ipsapp003.lwwonline.com/content/getfile/164/91/18/abstract.htm
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By Megan Rauscher
NEW YORK (Reuters Health) Dec 26 - Scientists have evidence in mice that osteoporosis-like bone disorders and inflammatory intestinal disorders are both caused by abnormal regulation of a common protein.
Dr. Simon R. Carding from the University of Leeds in England and colleagues report their study in the December issue of the journal Immunity. "Autoimmune associated bone disease and intestinal inflammation are closely linked with deregulation and hyperactivation of autoreactive CD4 T cells," they write. "How these T cells are activated and mediate disease is not clear."
Mice engineered to lack a key regulator of CD4 T cells have overactive T cells and spontaneously develop ulcerative colitis and osteopenia, the scientists explain. Dr. Carding and colleagues' experiments indicate that this is caused by increased production of the ligand for receptor activator of NFkB (RANKL).
"We find that the hyperactive CD4 T cells produce too much of this protein, which then contributes to bone breakdown and bowel inflammation," Dr. Carding said.
Treating mice with exogenous recombinant osteoprotegerin -- a protein that interferes with RANKLs binding to its receptor -- reversed bone loss and improved colitis.
"This study shows that some bone diseases and intestinal problems may share a common cause," Dr. Carding told Reuters Health. "If similar mechanisms occur in humans, then osteoprotegerin might prove a useful treatment for intestinal disorders such as ulcerative colitis and Crohn's disease," he said, which are both often accompanied by bone loss.
Immunity 2003;19:849-861.
http://www.medscape.com/viewarticle/466447?mpid=23090
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Once-Daily Probiotic Treatment Maintains Remission in Ulcerative Colitis Patients with Pouchitis
Mindy Hung
Jan. 7, 2004 — Once-daily high-dose probiotic therapy (VSL#3) sustains antibiotic-introduced remission in ulcerative colitis patients with pouchitis, according to a randomized, double-blind study published in the January issue of Gut.
"In parallel with clinical, endoscopic, and histological remission, a high level of QOL [quality of life] was maintained with this therapy," Toshiki Mimura, MD, and colleagues from St. Mark's Hospital in London, U.K., report.
Investigators drew 36 patients with recurrent (occurrence at least twice in the previous year) or refractory (requiring continuous use of antibiotics) pouchitis from St. Mark's Hospital and a center in Bologna, Italy.
All patients had a Pouchitis Disease Activity Index (PDAI) score of 7 or higher, with zero being no inflammation and 18 being the worst. Researchers induced remission in all patients with a four-week course of the antibiotics metronidazole (400 mg or 500 mg twice daily) and ciprofloxacin (500 mg twice daily).
Twenty patients were randomized to receive placebo, while 16 patients received 6g VSL#3 (3-g sachets containing 300 billion bacteria/g, made up of four strains of lactobacilli, three strains of bifidobacteria, and one strain of Streptococcus salivarius subsp thermophilus) once daily for one year or until relapse.
The researchers conducted physical examination prior to randomization and every two months for 12 months, or until relapse, which was defined as an increase in clinical PDAI score of 2 or higher together with an increase in the endoscopic PDAI score of 3 or higher compared with baseline. Researchers performed endoscopic and histological evaluations before randomization, at two months, and at 12 months.
The primary end point was a cumulative maintained remission rate at 12 months. Health-related QOL, a secondary outcome, was assessed at study entry, every two months, and at the time of relapse using the inflammatory bowel disease questionnaire (IBDQ).
Researchers evaluated the other secondary outcome, patient satisfaction with the treatment at study entry, every two months and at the time of relapse. Subjects chose their answer from the following options: (1) very dissatisfied, unhappy most of the time; (2) generally dissatisfied, unhappy; (3) neither dissatisfied nor satisfied; (4) generally satisfied, pleased; (5) very satisfied, happy most of the time.
Researchers confirmed the presence of viable probiotic bacteria in the stool of patients in the active group via stool analysis of a subgroup of 12 patients receiving active treatment or placebo at the beginning of treatment and after 60 days.
The median compliance rate was 96% in the VSL#3 group and 97% in the placebo group.
Seventeen patients (85%) in the VSL#3 group maintained remission at one year, while in the placebo group, one patient (6%) maintained remission (P < .0001). Two patients in the VSL#3 group relapsed at month two and month eight while one patient dropped out due to acute gastroenteritis-like symptoms.
The IBDQ score remained high in the VSL#3 group (P = .30) but deteriorated in the placebo group (P = .0005) over the year.
In terms of patient satisfaction, the investigators did not find a significant difference at entry between the two groups (median, 4 vs. 4 points; P = .26) but they differed significantly at the time of relapse or 12 months (4 points in the VSL#3 group vs. 2 points in the placebo group; P < .0001).
"This study has demonstrated that in patients with recurrent or refractory pouchitis who have achieved remission with intense antibiotic treatment, the probiotic therapy VSL#3 is highly effective in maintaining remission," write Dr. Mimura and colleagues.
This study was partially supported by VSL Pharmaceuticals, Inc.
Gut. 2004;53:108-114
Reviewed by Gary D. Vogin, MD
http://www.medscape.com/viewarticle/466792
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5-ASA Therapy for Inflammatory Bowel Disease No Bar to Colon Cancer
NEW YORK (Reuters Health) Jan 28 - Contrary to previous reports, new study findings suggest that treatment with 5-aminosalicylate (5-ASA) does not prevent colorectal cancer in patients with inflammatory bowel disease.
In studies in the UK and Denmark, Dr. Charles N. Bernstein and colleagues from the University of Manitoba in Winnipeg, Canada note that 5-ASA use has been linked to a reduced risk of cancer in patients with ulcerative colitis and Cohn's disease. However, it is possible that patient selection bias may have influenced the results.
To investigate, the researchers report in December issue of The American Journal of Gastroenterology, that they compared 25 inflammatory bowel disease patients who were diagnosed with colon cancer in Manitoba between 1997 and 2000 and 348 matched patients who did not develop cancer.
The investigators suggest that the main advantage of this study was that "it is population-based and is not sampling only those subjects who present to referral centers,"
Among patients exposed to 5-ASA, the average duration of use and the daily dose were similar in each group. In fact, the researchers note that the cancer patients were more likely to have been exposed to 5-ASA than were comparison patients. However, the difference was not statistically significant.
The researchers conclude that 5-ASA does not reduce the risk of colon cancer in such patients. However, they add that further studies with a larger sample size and longer duration of use are needed to completely rule out an anti-cancer effect.
Am J Gastroenterol 2003;98:2784-2788.
http://www.medscape.com/viewarticle/467896?mpid=24237
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Elan Reports Successful Results of Antegren Trial for Crohn's Disease
By Kevin Smith
DUBLIN (Reuters) Jan 29 - Irish pharmaceutical firm Elan Corp Plc raised market hopes for its much-vaunted experimental drug Antegren on Thursday after it announced successful results from a key clinical trial in Crohn's disease.
The data are "very significant for patients with Crohn's disease-- the safety aspects of the drug and its efficacy are very encouraging," Lars Ekman, Elan's head of research and development, told Reuters in a telephone interview.
"This is a big step forward, a major breakthrough," he said.
Elan is pinning its future on Antegren, principally as a treatment for MS. Data from phase III studies of Antegren's effect on MS are expected by late 2004 or early 2005.
The results of the phase III trial on Crohn's disease showed no recurrence of the disease during a 6-month course of the drug, Elan said.
There was a significant treatment difference of more than 30% in patients taking the drug compared with those taking a placebo, and no difference in the rate of side effects, it said.
The result is a boost for Elan after a trial last summer of the drug's effects on the initial phase of a Crohn's attack failed to show any difference between the drug and the placebo. The latest trial showed the drug to be effective in the longer-term treatment of the disease.
(Additional reporting by Ben Hirschler in London)
http://www.medscape.com/viewarticle/468001?mpid=24237
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Data link Crohn's disease, antibiotics - But it is unclear whether antibiotic use is a disease trigger or a result of patients seeking symptom relief.
By Victoria Stagg Elliott, AMNews staff. March 1, 2004.
--------------------------------------------------------------------------------
Use of antibiotics is a potential risk factor for the development of Crohn's disease, according to a paper published in the February issue of the journal Gut.
Researchers at England's University of Nottingham and Cambridge University analyzed the British General Practice Research Database for information about antibiotic use of those with and without the disease. The database includes information about diagnosing and prescribing practices of 5% of the nation's physicians and is considered to be one of the world's largest computerized databases of longitudinal anonymous patient medical records from this setting.
The researchers found that those with Crohn's received twice as many prescriptions over a five-year period and were 30% more likely to have been prescribed antibiotics.
Although Crohn's disease is primarily regarded as a genetic condition, researchers have been hunting for environmental reasons why the disease has increased significantly over the past few decades. Antibiotics are just one of many environmental triggers being scrutinized, along with factors such as appendectomies, the birth control pill, and smoking.
"Finding the environmental trigger is the million dollar question," said Subra Kugaphasan, MD, a pediatric gastroenterologist at the Medical College of Wisconsin in Milwaukee.
Researchers conceded that antibiotic use may be due in part to patients hunting for relief from symptoms before receiving a definitive diagnosis.
"Our data provide some support for antibiotic exposure playing a role, but we now need other studies particularly in children and looking at antibiotic use early in life," said Dr. Richard Logan one of the authors and a professor of clinical epidemiology at the University of Nottingham.
Experts said that although the study was provocative, the numbers did not seem strong enough to draw its conclusion even if they did reach statistical significance. Experts did say that studies like this should give physicians additional pause when it comes to prescribing antibiotics.
"Here is another condition that should make all physicians circumspect with regard to the application of antibiotics unless it's truly indicated," said Marvin L. Corman, MD, vice chair of surgery at North Shore-Long Island Jewish Medical Center in New York.
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ADDITIONAL INFORMATION:
Which comes first?
Objective: To determine if antibiotic use is linked to the development of Crohn's disease.
Participants: Patients with and without Crohn's who had five years' worth of data in Britain's General Practice Research Database.
Method: Data were extracted based on smoking status, drug prescriptions, age and sex. Logistic regression was used to investigate the relationship between Crohn's and antibiotic use.
Results: Seventy-one percent of those with Crohn's had used antibiotics in the previous five years, compared to 58% of controls. Those with the disease had twice as many antibiotic prescriptions than those without.
Conclusion: There is a statistically significant association between antibiotic use and Crohn's disease, although it is unclear whether this is the cause of the disease or a result of seeking treatment for symptoms.
Source: Gut, February
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Weblink
"Antibiotic use and the development of Crohn's disease," Gut, February (gut.bmjjournals.com/cgi/content/abstract/53/2/246)
Facts about Crohn's from the National Digestive Diseases Information Clearing House (digestive.niddk.nih.gov/ddiseases/pubs/crohns)
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Copyright 2004 American Medical Association. All rights reserved.
http://www.ama-assn.org/amednews/2004/03/01/hlsc0301.htm
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Faulty gene for bowel disease found
By ANDRÉ PICARD
From Monday's Globe and Mail
Canadian researchers have isolated a gene that predisposes people to Crohn's disease, a painful disorder that strikes young people and that has sharply increased in frequency in recent years.
The discovery will have an immediate impact, allowing researchers to distinguish more readily between Crohn's and colitis, both inflammatory bowel diseases.
"The diagnostic benefits will be immediate," said Katherine Siminovitch, a professor of medicine at the University of Toronto. "That's important because you really want to catch these diseases in the early stages . . . then you can start a therapy that might put patients in remission and even eradicate the disease."
Dr. Siminovitch said, however, that development of new drugs based on this genetic finding is a long-term prospect; new treatments are probably a decade away.
The research, published in today's edition of the medical journal Nature Genetics, is nonetheless welcomed by people suffering from Crohn's disease.
"This is an exciting event for us," said Michael Howarth, executive director of the Crohn's and Colitis Foundation of Canada.
"It's important because it's one more piece in the puzzle. Finding the cure is not likely going to be one big event, but come about by finding out a little more every year."
More than 150,000 Canadians suffer from inflammatory bowel disease.
It most often strikes between the ages of 15-25, though a growing number of people are being diagnosed in their late 50s.
Crohn's and colitis affect the digestive system and cause the intestinal tissue to become inflamed, form sores and bleed easily, leading to problems eating, bloody diarrhea and excruciating pain.
Most sufferers experience periods of remission and flare-ups of the disease, often requiring long-term medication, hospitalization or surgery.
Jessica Grossman, 14, of Toronto, was diagnosed as having Crohn's five years ago. Since then, she has suffered greatly, enduring a number of drug treatments, all of which had severe side effects but none of which worked, and then surgery to remove her colon.
"It makes me happy to know they did this research because I don't want other people to go through what I did," Jessica said in an interview. She is currently in remission and remarkably healthy and active.
But Jonathan Grossman, Jessica's father, said he is excited by the new finding.
"We're quite cognizant of the fact that Crohn's doesn't just go away, so we really hope this will result in new treatments," he said.
"Anything that alleviates the suffering of people with Crohn's would be a godsend."
Inflammatory bowel disease does not have a single cause but is believed to result from a combination of genetic and environmental factors, such as diet and exposure to disease. (When the body fights off disease, there is inflammation, and these diseases have their roots in inflammation gone awry.) The newly isolated gene is located on Chromosome 5.
It produces a protein that sits on the cell surface and regulates how substances enter and leave the cell. In a majority of Crohn's disease patients, this protein functions improperly and allows in toxins.
Three years ago, French researchers discovered another abnormality, on Chromosome 16, that predisposes people to Crohn's.
Dr. Siminovitch, who is also the founding scientist of Ellipsis Biotherapeutics Corp., said a person with both genetic abnormalities has a tenfold risk of developing Crohn's disease.
She and her fellow researchers are now working on the development of a chemical that would alter the protein to restore its normal function. That chemical would become the basis of new drugs. The problem with drugs now being used to treat Crohn's is that they are non-specific, and as a result have a lot of side effects.
Dr. Siminovitch said the findings could also shed light on the basic causes of chronic inflammation.
From www.globeandmail.com
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CONTACT: Tuesday, May 18, 3:00 pm CDT Kellie Hanzak, 202-955-6222 khanzak@spectrumscience.com Jessica Willocks, 301-941-2625 jwillocks@gastro.org
In New Orleans: Morial Convention Center 504-670-6420
RESEARCH HONES IN ON THERAPIES AND DIAGNOSIS OF BOWEL DISEASES
Pipeline Treatments, Novel Procedures Offer New Options for GI Diseases
New Orleans, LA – Inflammatory bowel diseases collectively cause significant lifestyle sacrifices and suffering and millions of dollars in related health care costs every year, partially due to a lack of effective diagnostic procedures and therapies. In new studies presented today at Digestive Disease Week in New Orleans, researchers show evidence of accurate and effective new methods for diagnosis, as well as improved treatment options, for sufferers of ulcerative colitis and Crohn's diseases.
Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
"We are pleased to see more attention directed toward improving the lives of people suffering from inflammatory bowel diseases," said Jim Lewis, M.D., of the University of Pennsylvania. "For too long, the rate of discovery was slow. Now we are seeing more answers for the millions of sufferers."
Capsule Endoscopy in IBD: Findings and Effects on Clinical Outcomes (Abstract 105669*)
The M2A video capsule or "camera pill" allows gastroenterologists their best view yet of the small bowel, assisting in the diagnosis of inflammatory bowel disease. Until now, studies have not analyzed the influence of capsule endoscopy on clinical decision-making and therapeutic outcomes in IBD.
According to research presented by scientists from Mount Sinai Medical Center, use of the video capsule improves clinical outcomes significantly.
2 – 2 – 2 Bowel Diseases
For the study, the team of researchers reviewed the results of capsule endoscopy in patients with IBD-related indications. A total of 65 patients met the inclusion criteria and fit in four categories: A) abnormal small bowel series, rule out Crohn's Disease (CD); B) abdominal pain, normal radiologic studies, rule out CD; C) known ulcerative or Crohn's colitis; normal small bowel series and persistent symptoms, rule out small bowel disease; and D) known CD, with persistent obscure bleeding.
Overall, for 20 of the 21 patients (95 percent) in whom major diagnostic findings were discovered using capsule endoscopy, therapeutic decisions based on the results led to clinical improvement in patient outcome. In groups A and B, an absence of small bowel findings in 30 of 32 patients helped rule out CD. Throughout an average follow-up of 19 months, no evidence of CD developed, leading to a negative predictive value for the capsule study of 100 percent in this setting. In groups C and D, researchers discovered positive diagnostic findings on capsule endoscopy in 18 of 33 patients.
"Based on our research, we believe that capsule endoscopy may play an important role in clinical diagnosis and therapeutic decisions in patients with IBD indications," said Peter Legnani, M.D., lead author of the study. "We hope that the ease of use of the capsule may encourage more patients to undergo screening to confirm diagnosis of IBD and receive appropriate treatment."
Basiliximab (anti-CD25) for the Treatment of Steroid Resistant Ulcerative Colitis (Abstract 104640*)
Steroid therapy is one of the most effective treatments for ulcerative colitis (UC), which causes inflammation and ulcers in the lining of the large intestine, but up to 30 percent of patients will have a poor response to steroids. These steroid-resistant individuals present a difficult clinical challenge to gastroenterologists, because few treatment options exist after steroids other than removal of the entire colon (colectomy).
Basiliximab (Simulect®), a novel monoclonal antibody, has potential as a new treatment option, according to research from Henry Wellcome Laboratories at the University of Bristol in England.
3 – 3 – 3 Bowel Diseases
Basiliximab has been proven effective as a steroid sensitizer in steroid resistant UC both in the lab and in humans. This uncontrolled pilot study examined an extended series of 30 steroid resistant UC patients treated with basiliximab. Twenty patients with moderately active disease and 10 patients with severe disease were treated with a single intravenous (IV) dose of basiliximab (40 mg) in addition to their standard steroid therapy to monitor for remission within eight weeks, defined by an Ulcerative Colitis Symptom Score (UCSS) of less than two.
A total of 24 out of the 30 patients (80%) improved their UCSS score, with 19 of 30 (63%) achieving full remission. In the moderate disease group, 14 of 20 patients (70%) achieved full remission, and an additional five of 20 (25%) showed an improvement. In the severe disease group, five of the 10 patients (50%) achieved remission, while five required colectomy. There were no infusion reactions.
"These studies show that the use of basiliximab can provide significant improvements or remission for patients with ulcerative colitis," said Tom Creed, M.D., lead author of the study. "We hope that a larger, controlled trial will confirm these results and help make this potentially valuable therapy available to patients who can benefit from it."
Randomized, Double-Blind, Placebo Controlled, Parallel Arm, Safety and Efficacy Trial of Once-Daily, Oral OPC-6535 in the Treatment of Active Ulcerative Colitis (Abstract 105516*)
For patients suffering from severe ulcerative colitis (UC), new treatments that are safe and have minimal side effects are desperately needed. In this randomized study, researchers at the University of Chicago examined the effectiveness and tolerability of the compound OPC-6535 to treat UC. OPC-6535 was administered orally in a once-daily 25 mg or 50 mg dose to subjects with a new or established diagnosis of UC, flare within 12 weeks, and Disease Activity Index (DAI) of four to 11 on a scale of 12. A total of 186 patients were given either OPC-6535 or placebo for eight weeks. Patients were permitted to take 5-ASA (aminosalicylic acid) if they were stable for 14 days before entry and subsequent study duration (approximately 75% of subjects); 5-ASA is a standard treatment for UC.
4 – 4 – 4 Bowel Diseases
ore than half (55%) of the 25 mg group and 48 percent of the 50 mg group showed clinical improvement. The average change in DAI was significantly greater in the 25 mg group and was nearly statistically significant in the 50 mg OPC-6535 group versus placebo. Improvement in physician global assessment was more noticeable in the 50 mg dosage group, as a significantly higher proportion of these patients achieved remission (DAI 0-1) compared to the other treatment groups.
Responses were uniformly greater in the subgroup of patients with more severe disease. No differences were observed between 5-ASA users and non-users. "Based on these results, we are confident that OPC-6535 could be an effective treatment option for patients with ulcerative colitis, particularly in those with moderately severe disease," said Stephen Hanauer, M.D., lead author of the study.
"Further clinical studies are needed to confirm the best dose, but we were pleased to see a positive response to higher doses, as the efficacy may be even greater." ### Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 15-20, 2004 in New Orleans, Louisiana. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. *Abstract numbers listed above correlate to abstract ID numbers listed on the DDW Web site, www.ddw.org. They do not coincide with program numbers as found in the printed DDW Program Guide.
http://www.ddw.org/media/newsReleases/IBDTherapies.pdf
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Patrick B. Massey, M.D., Ph.D.,
"The Alternative Approach", Daily Herald, August 2, 2004
Is it possible that an intestinal parasite holds a key to the treatment and possible cure for Crohn's disease, ulcerative colitis and other inflammatory bowel diseases (IBD)? Research at the University of Iowa suggests that infection by specific intestinal parasites may reduce the pain and inflammation associated with these serious diseases.
Crohn's disease and ulcerative colitis are part of a group of chronic inflammatory diseases of the gastrointestinal tract. The cause is unknown.
Crohn's disease is characterized by fever, abdominal pain, diarrhea and fatigue. Symptoms of ulcerative colitis include bloody diarrhea, abdominal pain, fatigue, dehydration, anemia and weight loss. In the most severe cases, surgery may be necessary to remove the affected
parts of the bowel.
IBD is becoming more common and our success at ridding our bodies of parasites may be to blame. With sanitation, better food and medications, intestinal parasites are relatively rare in industrialized societies, and that is a good thing. However, by making our lives increasingly hygienic, we may have made ourselves more susceptible to auto-immune diseases like Crohn's and ulcerative
colitis.
A successful parasite is very good at avoiding detection by the host. Parasites that live in the intestines, such as whip worms, or in the blood, such as malaria, survive by manipulating the host's self defense mechanisms. They are able to depress the immune system in a way that limits detection and response. They are able to moderate the
immune response in a way that may also prevent IBD.
IBD is often treated with powerful medications that suppress the immune response. These medications have saved the lives of many people with life-threatening Crohn's disease and ulcerative colitis. However, as good as these medications are, the side effects can be severe and
limit their use.
Other options are needed. Research involving intestinal parasites by Dr. Robert Summers of the University of Iowa, supported by the National Institutes of Health, may provide clues for a more natural (and effective) treatment of IBD.
In his study, 29 patients with active Crohn's disease ingested the pig whip worm, Trichuris suis. This parasite cannot multiply in the human intestine and is not transmissible from human to human. These patients
consumed the parasite every three weeks for 24 weeks. At 12 weeks, the symptoms of Crohn's disease decreased by 75 percent - and for 62 percent of the patients, the disease went into remission. At 24 weeks, the remission rate was an incredible 72.4 percent. There were no complications or adverse reactions.
In another study at the University of Iowa, patients with ulcerative colitis had a 48 percent improvement after 12 weeks, again without complications.
These response and remission rates with the pig whip worm are similar to those seen with medication, but apparently without the complications often associated with the drugs.
Now, I do not recommend infecting yourself with intestinal parasites. However, the increases we are seeing in many of the chronic diseases - heart disease, cancer, IBD, asthma, arthritis and others - are directly related to our modern lifestyle. We need to find safer solutions.
I believe that in nature everything has an antidote and that studying nature will reveal the solutions to many chronic medical problems. Parasite therapy for IBD is a novel approach.
About the Author: Patrick B. Massey M.D. Ph.D. is Medical Director for Alternative & Complementary Medicine, Alexian Brothers Hospital Network.
Website: www.ALT-MED.org.
<http://www.ALT-MED.org>
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