The Crohn's Group

OrlandoSentinel.com
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.
Daniel 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. Jonathan 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 Johne'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. William 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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Sun Dec 2, 2007 12:22 pm