Antibiotics offer hope for Crohn's patients/Article

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Antibiotics offer hope for Crohn's patients

Some doctors think bacteria may trigger the digestive disease.

Robyn Shelton

Sentinel Medical Writer

December 2, 2007

Doctors are trying a new strategy to treat Crohn's disease, an often-

debilitating digestive condition that typically strikes in the teens

or 20s and causes lifelong problems.

About 700,000 Americans suffer from the incurable illness, which can

lead to inflammation, scarring and intestinal blockages that require

surgery. Patients often take powerful steroids and immune-suppressing

drugs to control symptoms.

But some doctors are experimenting with antibiotics as the main

therapy. Their goal is to attack a bacterial infection that they

think could be causing the disease.

Arianne Percy believes in the strategy.

The 26-year-old Deltona woman has been taking an antibiotic for six

months. After dealing with abdominal pain since the age of 12, Percy

said she is now symptom-free 90 percent of the time.

" I feel better than I have in years, " Percy said. " I just hope it

keeps working. "

Her physician, Dr. Ira Shafran of Winter Park, has been studying

potential bacterial causes of Crohn's for years. He thinks one

culprit is a cousin to tuberculosis -- Mycobacterium avium

paratuberculosis or MAP.

Shafran said an early, aggressive course of antibiotics could help

many patients get better control of their symptoms. He has been

testing antibiotic treatments in his own patients since the late

1990s, with varying success.

" While specific bacteria have never been identified as the only cause

for Crohn's, we have enough scientific evidence . . . that bacteria

are pivotal in the origin and persistence of this disease, " Shafran

said.

Inflames bowels

Crohn's disease -- named in 1932 after Dr. Burrill B. Crohn -- is a

form of inflammatory bowel disease or IBD. Historically, doctors had

thought of the illness as an autoimmune disorder.

Such conditions occur when the immune system attacks its own tissues -

- in this case, the digestive tract. But many doctors now think

Crohn's is not the body's attack on itself but a mistaken assault on

bacteria that naturally live in the intestines. Numbering in the

billions, these bacteria aid in food digestion and typically pose no

harm.

For Crohn's patients, doctors speculate that the visitors provoke a

chronic immune response that wreaks havoc on the body.

Sufferers can face abdominal cramping, diarrhea and the urgent need

to use the bathroom. The condition can flare up periodically

throughout a sufferer's lifetime.

" It's a disease of young people, [striking] at a time when they want

to go to school, get married and start their careers, " said Dr.

Present, a Crohn's expert at the Mount Sinai School of

Medicine in New York. " It can be very serious. "

Some patients need to take potent immune-suppressant medication. Many

also take antibiotics, though usually for short periods and in

combination with other medicines.

Dr. Braun from the University of California at Los Angeles

said it's too early to know whether the drugs could play a bigger

role in controlling the illness. Though many suspect Crohn's is

linked to bacteria, he said there is no consensus on which specific

types are to blame, which antibiotics are effective and how long a

patient should take them.

" There's a lot of research that's left to be done on bacteria in the

gut, and I think that as we understand those better, there will be

new treatments, " said Braun, chairman of the National Scientific

Advisory Committee for the Crohn's & Colitis Foundation of

America. " But for now, it's important to realize that while

antibiotics may help some patients, none have shown to work on the

majority of patients. "

More research needed

In his Winter Park practice, Shafran estimates that about 100 of his

patients are on long-term antibiotic therapy for Crohn's. They may

remain on the drugs for years, with Shafran monitoring their progress

and reducing the dosage as their symptoms subside.

He acknowledges the approach doesn't always work.

Another of his patients, Kira Banks, 25, of College Park has been

through a course of antibiotics without success. She now takes an

immune-suppressing drug that she credits with bringing her relief.

" This can be a very devastating disease, " Banks said.

Shafran and his like-minded colleagues say more research is needed

into the possible bacterial origins of Crohn's. For now, many have

focused on Mycobacterium because the organism is known to cause a

digestive disorder in cattle called e's disease.

But Shafran said MAP is not the sole answer to Crohn's, which is

influenced by genetics and many as-yet unknown environmental

triggers. He worries that drug companies, which typically don't make

as much money on antibiotics, will not be interested in investigating

their wider use in Crohn's sufferers.

And doctors are entrenched in their habits, turning to immune

suppressants and other, more-potent drugs to attack the illness.

" A lot of people think, 'Why should I use a small-caliber weapon when

I've got all these .44 Magnums lying around?' " Shafran said.

Dr. Chamberlin from Texas also treats many of his Crohn's

patients with antibiotics, often using generic versions that he says

offer a low-cost treatment with fewer side effects.

" I cannot say it's a cure for patients, though some do remarkably

well, " said Chamberlin, an associate professor at Texas Tech

University. " Others don't really do well at all. "

Robyn Shelton can be reached at rshelton@... or 407-

420-5487.

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