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Dig Liver Dis. 2007 May;39(5):438-44. Epub 2007 Mar 21.

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

Author information

1
Centre for Digestive Diseases, Level 1, 229 Great North Road, Five Dock, NSW 2046, Australia. tborody@cdd.com.au

Abstract

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 600 mg/day), clofazimine (up to 100 mg/day) and clarithromycin (up to 1 g/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
DOI:
10.1016/j.dld.2007.01.008
[Indexed for MEDLINE]

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