Anti-mycobacterial therapy in Crohn's disease

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Dig Liver Dis. 2007 Mar 16; [Epub ahead of print]

Anti-mycobacterial therapy in Crohn's disease heals mucosa with

longitudinal scars.

Borody TJ, Bilkey S, Wettstein AR, Leis S, Pang G, Tye S

Centre for Digestive Diseases, Level 1, 229 Great North Road, Five

Dock, NSW 2046, Australia.

BACKGROUND: A possible causative link between Crohn's disease and

Mycobacterium avium ss paratuberculosis has been suggested. AIM: To

report unique scarring in Crohn's disease patients treated with anti-

Mycobacterium avium ss paratuberculosis therapy. PATIENTS: A

retrospective review of 52 patients with severe Crohn's disease was

conducted. Thirty-nine patients who had at least one follow-up

colonoscopy during treatment were included. METHODS: Patients

received rifabutin (up to 600mg/day), clofazimine (up to 100mg/day)

and clarithromycin (up to 1g/day) - anti-Mycobacterium avium ss

paratuberculosis therapy - for 6 months to 9 years. Ramp-up dosing

was used. Colonoscopies and histological analyses monitored progress.

RESULTS: Twenty-two patients (56.4%, 22/39) healed with unusual

scarring, which appeared as branched, ribbon-like, elevated lines. In

2/6 patients (33.3%) who had >3 years of treatment after scarring

occurred, scars receded, becoming imperceptible as full healing

occurred. Histologically, a marked reduction in inflammation occurred

in 15/39 patients (38.5%). Of these, 6/15 patients (40%) displayed

restoration of normal mucosa. Longitudinal scarring occurred in 12/15

patients (80%) with improved histology. CONCLUSIONS: The presence of

scarring fading to normal mucosa on anti-MAP therapy implies a more

profound healing not seen with standard anti-inflammatory and

immunosuppressant drugs. Longitudinal scarring and consequent healing

with normal histology should become a standard treatment goal for

Crohn's disease. PMID: 17369114.