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Crohn's Disease - Infection?

Many studies show that most gastroenterologists may be wrong when they do not prescribe antibiotics to treat Crohn's disease (1-30). When a person has bloody diarrhea and doctors find ulcers in the intestines, they look for cancer, infection or parasites. When they can't find a cause, they should say that they don't have the foggiest idea why the person has intestinal ulcers. Instead, they explain that the person has Crohn's disease or ulcerative colitis, and the person's immunity is so stupid that it punches holes in the intestines, rather than doing its job of killing germs. They prescribe medications that suppress immunity or cut out parts of intestine. The immunities of these patients may not be so stupid that they attack and kill their own intestinal cells. Normal intestines are so loaded with bacteria that doctors can't possibly tell which belong there and which may be causing disease. This treatment offers no cure and is associated with many complications that shorten life (4).

Research from France showed that a variant of E. Coli, a bacteria that lives in normal intestines, sticks to the intestinal lining and produces an alpha hemolysis that punches holes in the intestines to cause at least some cases of Crohn's disease (1). Further studies show that heat shock protein can be removed from the common intestinal bacteria, E. Coli, and when given to mice, causes terrible bloody ulcers to form in the intestines (1a). The intestines looked under the microscope exactly the same as those of people who suffer from ulcerative colitis or Crohn's disease (1a). Extensive data show that people with this condition have leaky intestines that allow germs to pass into the bloodstream (2) and their immunities are trying to kill these germs (3). Antibiotics can reduce swelling and ulcers in Crohn's disease. Crohn's disease is contagious as people married to partners with ulcerative colitis are more likely to develop that disease (5).

Dr. Joel Taurog of the University of Texas in Dallas has shown that a bacteria called bacteroides causes ulcerative colitis and Crohn's disease in mice who are genetically programmed to have a HLA-B27, a special gene that causes arthritis (6,7). Special tissue staining techniques show that tissue taken from patients with Crohn's disease and ulcerative colitis contain parts of two common bacteria called E. Coli and streptococci (8). Many studies show that infections may cause Crohn's disease and that antibiotics, particularly, Cipro with or without metronidazole control ulcerative colitis and Crohns (9,10,11,12,13,14,15, 16,17,18,20). Although many doctors disagree, I treat Crohn's disease with Cipro 500 mg twice a day continuously and metronidazole 250 mg four times a day on alternate weeks and check liver tests monthly (21). I tell patients to stop metronidazole if they feel any strange nerve sensations. This treatment is highly controversial and not accepted by most doctors; discuss it with your doctor.

Recent studies show that Crohn's disease can be controlled by probiotics and prebiotics, introduced into the colon by eating a diet rich in vegetables and whole grains and taking specific good bacteria such as lactobacillus GG. (25)

Cipro and metronidazole cannot be given to children because they can cause cartilaginous and liver damage. In Alimentary Pharmacology and Therapeutics, researchers showed that clarithromycin may control Crohn's disease in children (26).

1) A Darfeuillemichaud, C Neut, N Barnich, E Lederman, P Dimartino, P Desreumaux, L Gambiez, B Joly, A Cortot, JF Colombel. Presence of adherent Escherichia coli strains in ileal mucosa of patients with Crohn's disease. Gastroenterology 115: 6(DEC 1998):1405-1413.

1a) Yagita, Y Sukegawa, S Maruyama, N Sato, Y Atomi, H Yamaguchi, S Kamiya, T Ihara, M Squamata. Mouse colitis induced by Escherichia coli producing Arsenio enterocolitica 60-kilodalton heat-shock protein - Light and electron microscope study. Digestive Diseases and Sciences 44: 2 (FEB 1999):445-451.

2) A Puspok, G Oberhuber, J Wyatt, T Maierdobersberger, J Hammer, F Pfeffel, F Wrba, R Potzi, H Vogelsang. Gastroduodenal permeability in Crohn's disease. European Journal of Clinical Investigation 28: 1(JAN 1998):67-71. gastroduodenal permeability is increased in a high proportion of patients with Crohn's disease.

3) SO Lopezcubero, KM Sullivan, GB Mcdonald. Course of Crohn's disease after allogeneic marrow transplantation. Gastroenterology 114: 3 (MAR 1998):433-440. Four of 5 patients followed up for 4.5 to 15.3 years after allogeneic hematopoietic cell transplantation remained free of Crohn's disease.

4) RS Walmsley, CD Gillen, RN Allan. Prognosis and management of Crohn's disease in the over-55 age group. Postgraduate Medical Journal 73: 858 (APR 1997):225-229. "Medical treatment (corticosteriod therapy, with or without azathioprine) was usually effective initially for treatment of symptomatic colonic Crohn's disease, but sustained remission was rare. Those patients with persistent symptoms were restored to good health with surgical treatment but at a price, in that nearly half eventually required a permanent stoma.

5) MC Comes, C Gowerrousseau, JF Colombel, J Belaiche, HJ Vankruiningen, MC Nuttens, A Cortot. Inflammatory bowel disease in married couples: 10 cases in Nord Pas de Calais region of France and Liege county of Belgium. Gut 35: 9 (SEP 1994):1316-1318.

6) Joel Taurog. J of Experimental Medicine. December, 1994.

7) Journal of Clinical Investigation. August, 1996.

8) HJ Vankruiningen. On the use of antibiotics in Crohn's disease. Journal of Clinical Gastroenterology 20: 4 (JUN 1995):310-316.

9) MJ Spirt. Antibiotics in inflammatory bowel disease: New choices for an old disease. American Journal of Gastroenterology 89: 7 (JUL 1994):974-978.

10) P Rutgeerts, M Hiele, K Geboes, M Peeters, F Penninckx. Kerremans. Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection. Gastroenterology 108: 6 (JUN1995):1617-1621.

11) C Prantera, F Zannoni, ML Scribano, E Berto, A Andreoli, A Kohn, C Luzi. An antibiotic regimen for the treatment of active Crohn's disease: A randomized, controlled clinical trial of metronidazole plus ciprofloxacin. American Journal of Gastroenterology 91: 2 (FEB 1996):328-332.

12) D Lamarque. Role of bacteria in the pathogenesis of inflammatory bowel disease. Semaine Des Hopitaux 74: 17-18 (MAY 21 1998):757-758.

13) C Rachima, E Maoz, S Apter, M Thaler, E Grossman, T Rosenthal. Cytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals. Postgraduate Medical Journal 74:874(AUG 1998):486-489.

14) unpublished results R Balfour Sartor of the University of North Carolina in Chapel Hill.

15) HJ Vankruiningen. On the use of antibiotics in Crohn's disease. Journal of Clinical Gastroenterology 20: 4 (JUN 1995):310-316.

16) SL Greenbloom, AH Steinhart, GR Greenberg. Combination ciprofloxacin and metronidazole for active Crohn's disease. Canadian Journal of Gastroenterology. 12: 1(JAN-FEB 1998):53-56.

17) UM Turunen, MA Farkkila, K Hakala, K Seppala, A Sivonen, M Ogren, M Vuoristo, VV Valtonen, TA Miettinen. Long-term treatment of ulcerative colitis with ciprofloxacin: A prospective, double-blind, placebo-controlled study. Gastroenterology 115: 5 (NOV 1998):1072-1078.

18) Kangro et al. A prospective study of viral and mycoplasma infections in chornic inflammatory bowel disease. Gastroenterol 1990;98:549-553. 19) F Casellas, N Borruel, M Papo, F Guarner, M Antolin, S Videla, JR Malagelada. Antiinflammatory effects of enterically coated amoxicillin-clavulanic acid in active ulcerative colitis. Inflammatory Bowel Diseases 4: 1 (FEB 1998):1-5.

20) M Stahl, D Ludwig, K Fellermann, EF Stange. Intestinal expression of human heat shock protein90 in patients with Crohn's disease and ulcerative colitis. Digestive Diseases and Sciences 43: 5 (MAY 1998):1079-1087.

21) C Prantera, E Berto, ML Scribano, G Falasco. Use of antibiotics in the treatment of active Crohn's disease: experience with metronidazole and ciprofloxacin. Italian Journal of Gastroenterology and Hepatology. 30: 6 (DEC 1998): 602-606.

22) PY Chung, MA Peppercorn. Antibiotics in inflammatory bowel disease. Drugs of Today, 1999, Vol 35, Iss 2, pp 89-103.

23)G Mingrone, A DeGaetano, M Pugeat, E Capristo, AV Greco, G Gasbarrini.The steroid resistance of Crohn's disease.Journal of Investigative Medicine, 1999, Vol 47, Iss 6, pp 319-325.

24)JR Cangemi.The role of antibiotics in Crohn's disease.Digestive Diseases, 1999, Vol 17, Iss 1, pp 1-5. 24)K Persson, S Osser, S Birkelund, G Christiansen, H Brade.Antibodies to Chlamydia trachomatis heat shock proteins in women with tubal factor infertility are associated with prior infection by C-trachomatis but not by C-pneumoniae. Human Reproduction, 1999, Vol 14, Iss 8, pp 1969-1973

25)T Tsujikawa, J Satoh, K Uda, T Ihara, T Okamoto, Y Araki, M Sasaki, Y Fujiyama, T Bamba. Clinical importance of n-3 fatty acid-rich diet and nutritional education for the maintenance of remission in Crohn's disease. Journal of Gastroenterology, 2000, Vol 35, Iss 2, pp 99-104.

26)K Leiper, AI Morris, JM Rhodes. Open label trial of oral clarithromycin in active Crohn's disease. Alimentary Pharmacology & Therapeutics, 2000, Vol 14, Iss 6, pp 801-806. Address: Rhodes JM, Univ Liverpool, Dept Clin Med, Duncan Bldg, Daulby St, Liverpool L69 3GA, Merseyside, ENGLAND. Eleven of the 25 patients studied continued on oral clarithromycin after 12 weeks for a median of 28 weeks (range 20-60). Eight (73%) remained in remission on treatment. When treatment with clarithromycin was stopped three remained in remission and five relapsed after a median of 5 months (range 4-9). Two patients withdrew due to non-serious side-effects. Treatment was well tolerated in the remaining patients.

27)KL Madsen, JS Doyle, MM Tavernini, LD Jewell, RP Rennie, RN Fedorak. Antibiotic therapy attenuates colitis in interleukin 10 gene-deficient mice. Gastroenterology, 2000, Vol 118, Iss 6, pp 1094+. Address: Fedorak RN, Univ Alberta, Div Gastroenterol, Dept Med, 519 Newton Bldg, Edmonton, AB T6G 2C2, CANADA.

28) K Leiper, AI Morris, JM Rhodes. Open label trial of oral clarithromycin in active Crohn's disease. Alimentary Pharmacology & Therapeutics, 2000, Vol 14, Iss 6, pp 801-806.

29) KL Madsen, JS Doyle, MM Tavernini, LD Jewell, RP Rennie, RN Fedorak. Antibiotic therapy attenuates colitis in interleukin 10 gene-deficient mice. Gastroenterology, 2000, Vol 118, Iss 6, pp 1094+.

30) Preliminary study of ciprofloxacin in active Crohn's disease. Inflammatory Bowel Diseases, 2002, Vol 8, Iss 1, pp 10-15. GL Arnold, MR Beaves, VO Pryjdun, WJ Mook.

Checked 8/9/05

January 1st, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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