Crohn's Disease
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Crohn's disease is a chronic granulomatous disorder, which may involve any segment of the gastrointestinal tract from the mouth to the anus. Although extraintestinal manifestations are frequent, involvement of skin distant to the gastrointestinal tract is uncommon.


In addition to standard medical treatments (6-MP, mesalazine, or sulfasalazine; infliximab), get depression treated, take yogurt daily with folic acid 1600 mcg/d, vitamin D 2000 IU/day, avoid salt, and stop smoking (very important).  Boswellia is also worth a try.


Standard Treatment: From the results of randomized, controlled trials for induction of remission in patients with mildly to moderately active Crohn's disease, sulfasalazine, budesonide, and oral corticosteroids administered for 8-16 wk appear best. Patients who relapse within 6-12 months after discontinuation of induction therapy should be treated with another cycle of induction therapy and then receive maintenance therapy with an immunosuppressive agent (azathioprine, 6-mercaptopurine, or methotrexate). Long term treatment with budesonide 6-9 mg q.d. might be an alternative to immunosuppressive maintenance therapy in patients who relapse within 6-12 months after discontinuation and in prednisone-dependent patients. Evidence-based treatment algorithm for mild to moderate Crohn's disease. Sandborn WJ. Mayo Clinic. Am J Gastroenterol. 2003 Dec;98(12 Suppl):S1-5.


Standard Treatment: Sulfasalazine and the newer 5-aminosalicylates remain the first agents of choice to treat mild to moderate disease and often are effective at high doses as maintenance therapies. Corticosteroids are often required to treat more moderate to severe disease activity, although approximately one-third of patients become steroid-dependent after a steroid-induced remission. Corticosteroids have proven ineffective in maintaining remission and side effects resulting from prolonged exposure preclude their long-term use. Azathioprine and 6-mercaptopurine are effective in the setting of steroid dependence and steroid resistance, as well as for the treatment of perianal and fistulizing complications unresponsive to antibiotics. Crohn's disease commonly recurs following surgical resection, and there is expanding evidence that postoperative prophylaxis with certain antibiotics (e.g., metronidazole), aminosalicylates or immunomodulators may be beneficial in the prevention of disease recurrence following resection. Cyclosporin may benefit patients with severe Crohn's disease or refractory fistulas. Univ Chicago. Drugs Today (Barc). 1998 Jun;34(6):541-8

6-Mercaptopurine Helps Prevent Crohn's Relapse After Surgery: In a DB PC study of 131 patients after ileocolonic surgery for Crohn's disease, patients receive 6-MP (50 mg), mesalamine (3 g), or placebo. At 24 months, endoscopic recurrence rates were 43% for 6-MP, 63% for mesalamine, and 64% for placebo. Postoperative maintenance of Crohn's disease remission with 6-mercaptopurine, mesalamine, or placebo: A 2-year trial. Hanauer SB, Korelitz BI, et al. Gastroenterology. 2004 Sep;127(3):723-9

Azathioprine Continued Long-Term: In an 18-month DB PC study of 40 Crohn's patients in remission for 3.5 years on azathioprine, only 3 patients had a relapse on azathioprine vs. 9 on placebo. Thus, azathioprine maintenance therapy should be continued beyond 3.5 years. A Randomized, Double-Blind, Controlled Withdrawal Trial in Crohn's Disease Patients in Long-term Remission on Azathioprine. Lemann M, Mary JY, et al. Gastroenterology. 2005 Jun;128(7):1812-8

Boswellia Helped Chronic Colitis: In a 6-week DB study, twenty patients were given a preparation of the gum resin of Boswellia serrata (300 mg 3 times a day) and ten patients were given sulfasalazine (1 gm 3 times a day). Out of 20 patients treated with Boswellia gum resin 18 patients showed an improvement in one or more of the parameters: including stool properties, histopathology as well as scanning electron microscopy, besides hemoglobin, serum iron, calcium, phosphorus, proteins, total leukocytes and eosinophils. In the control group 6 out of 10 patients showed similar results. Out of 20 patients treated with Boswellia gum resin 14 went into remission while in case of sulfasalazine remission rate was 4 out of 10. Boswellia has minimal side effects. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Gupta I, Parihar A, et al. Medical College Jammu, India. Planta Med. 2001 Jul;67(5):391-5

Boswellia a Little Better than Mesalazine for Crohn's: In a DB PC 102-patient study, the Crohn Disease Activity Index (CDAI) was reduced by 90 after a boswellia preparation vs. by 53 with mesalazine. The difference was not statistically significant. Therapy of active Crohn disease with Boswellia serrata extract H 15. Gerhardt H, Seifert F, et al. Universitat Heidelberg. Z Gastroenterol. 2001 Jan;39(1):11-7.


Antibiotic Use a Risk Factor for Crohn's: Using prospectively gathered data, 587 Crohn's disease cases and 1460 controls were available for analysis. Antibiotic use 2-5 years pre-diagnosis occurred in 71% of cases compared with 58% of controls (p<0.001), and the median number of courses was two in the cases and one in the controls (p<0.001). Adjusting for age, sex, smoking, and use of other drugs, antibiotic use had an odds ratio of 1.32 (1.05-1.65). Researchers were unable to show specificity to any subgroup of antibacterials. Associations similar to that with antibiotics were also found with oral contraceptive, cardiovascular, and neurological drugs. Univ Nottingham. Gut. 2004 Feb;53(2):246-50


Bacterial Overgrowth Common: Bacterial overgrowth was present in 29 patients (20%). Lactulose breath test normalization occurred in 13 out of 15 patients treated by metronidazole and in all 14 patients treated by ciprofloxacin (P = ns). In both groups antibiotic treatment induced an improvement of intestinal symptoms: bloating (Group A 85% and Group B 83%), stool softness (44% and 50%), and abdominal pain (50% and 43%). Aliment Pharmacol Ther. 2003 Dec;18(11-12):1107-12


Budesonide Better than Mesalamine: In a DB study of 57 Crohn's patients comparing budesonide 6 mg/day and mesalamine 1 g 3 times/day, the 1-year relapse rate was significantly lower in the budesonide group than in the mesalamine group (55% vs. 82%; P = 0.045). Patients assigned to budesonide also remained in remission longer (241 days vs. 147 days; P = 0.003). Compared with mesalamine, budesonide treatment also was associated with a better QOL throughout the study. Clin Gastroenterol Hepatol. 2003 Mar;1(2):122-8. 


Budesonide Helps Prevent Relapse Some: In a DB PC study of 110 patients with CD, who had previously achieved remission on budesonide 9 mg daily, those taking budesonide 6 mg once daily for 52 weeks had a median time to relapse was 360 days for budesonide vs. 169 days for placebo (P = 0.132). No significant differences were seen between groups in relapse rates at 1 year. Budesonide as maintenance treatment in Crohn's disease: a placebo-controlled trial. Hanauer S, Sandborn WJ, et al. University of Chicago. Aliment Pharmacol Ther. 2005 Feb 15;21(4):363-71.


Cancer Risk Increase Only in Small Bowel: In 374 Crohn's patients, the risk of small bowel adenocarcinoma was dramatically increased (ratio, 66.7), but the numbers wree small. The risk of colorectal cancer was not increased, either in the total group of patients or in patients with colonic Crohn's disease exclusively (morbidity ratio, 1.64; 95% confidence interval, 0.20-5.92). Extra-intestinal cancer did not occur more frequently than expected. No lymphomas were observed. Jess et al. University of Copenhagen. Aliment Pharmacol Ther. 2004 Feb 1;19(3):287-93. Small bowel cancer develops in 1.5% of chronic CD patients. Abdom Imaging. 2005 May 17


Cancer Risk Reduced by Folate and 5-ASA: In 3 studies of the protective effect of folate supplementation in development of colorectal cancer in ulcerative colitis and 4 studies regarding sulfasalazine's protective effect in longstanding extensive ulcerative colitis, a similar significance has been obtained, r = 0.148, p = 0.0007. Both sulfasalazine therapy and folate supplementation have a protective effect in colorectal cancer development in a population of patients with longstanding ulcerative colitis. Diculescu, et al. Bucharest, Romania. Rom J Gastroenterol. 2003 Dec;12(4):283-6.


Complications: Complications of the intestinal disease, such as vitamin deficiency or osteoporosis, can be treated specifically by substitution of vitamin D, calcium, or other vitamins. However, extraintestinal manifestations of Crohn's disease and ulcerative colitis, such as primary sclerosing cholangitis, arthritis or granulomatous inflammation of the skin, lung, or liver, are much more difficult to treat sufficiently.  Med Klin (Munich). 2004 Mar 15;99(3):123-30


Depression Linked to Relapses: At baseline, depression (BDI > or = 13 points) was found in 17 of 60 (28%) patients. Thirty-two patients (59%) experienced at least one relapse during the 18 months of follow-up. Regression analysis showed a significant correlation between BDI scores at baseline and the total number of relapses after 12 (p <.01) and 18 months (p <.01) of follow-up. Furthermore, depression scores at baseline correlated with the time until the first recurrence of the disease (p <.05). Anxiety and low HRQOL were also related with more frequent relapses during follow-up (p <.05 and p <.01, respectively). Psychosom Med. 2004 Jan-Feb;66(1):79-84.

Fish Oil and Omega-3: Fish oil and omega-3 fatty acids do not appear to help Crohn's disease. See Omega-3 and Crohn's.

Fistulas Common: Fistulas are common in Crohn's disease. A population-based study has shown a cumulative risk of 33% after 10 years and 50% after 20 years. Perianal fistulas were the most common (54%). Medical therapy is the main option for perianal fistula once abscesses, if present, have been drained, and should include antibiotics (both ciprofloxacin and metronidazole) and immunomodulators. Infliximab should be reserved for refractory patients. Surgery is often necessary for internal fistulas. Felley et al. Lausanne University. Digestion. 2005;71(1):26-8.

Giardiasis Common in Crohn's in Study: Giardiasis is a common infection, and many of its symptoms are similar to those of Crohn's disease. In a study of the occurrence of cysts in 86 patients with Crohn's disease, in 82 patients with other gastrointestinal disease, and in 52 patients without gastrointestinal disease, the frequency of giardiasis was 62% in patients with Crohn's disease, 32% in patients with other gastrointestinal disease, and 6% in the control group (p less than 0.01). Stool frequency, disease activity, and humoral signs of inflammation in patients with Crohn's disease showed no relationship to giardiasis. All but two patients treated with metronidazole became free of cysts. Crohn's disease activity index decreased in 14 of 20 patients (p less than 0.05). Crohn's disease is frequently complicated by giardiasis. Scheurlen C, Kruis W, et al. University of Munich, FRG. Scand J Gastroenterol. 1988 Sep;23(7):833-9.

GM-CSF Helps Crohn's Disease: Granulocyte-macrophage colony stimulating factor (GM-CSF), also known by the trade name LeukineŽ (sagramostim), not only assists with the primary symptoms of these immune disorders, but also helps eliminate Crohn's disease symptoms. 80% improved in open study and 53% remission. Lancet 11/9/02. 

Growth Hormone Helps Crohn's: DB study in NEJM 2000;342;1633; 

Homocysteine Elevated: In a study of colonic biopsies of 187 intestinal disease patients, only those with Crohn's or ulcerative colitis had elevated levels homocysteine. This finding has been reported already in the literature for plasma homocysteine levels. Increased homocysteine levels in the colonic mucosa and plasma of patients with inflammatory bowel disease may play a role in the pathogenesis of Crohn's disease and ulcerative colitis. Dig Dis Sci. 2003 Oct;48(10):2083-90


Homocysteine: Take Folic Acid: In a study of 43 Crohn's children, elevated plasma tHcy is a consequence of IBD in children, probably mediated by poor folate status associated with diet or the pathophysiology of the disease. J Pediatr Gastroenterol Nutr. 2003 Nov;37(5):586-90

Hyperbaric Oxygen Used for Refractory Perianal Disease: In an uncontrolled report following three sporadic reports of successful treatment with hyperbaric oxygen (HBO), 10 patients with refractory perianal disease were treated in a hyperbaric chamber at a pressure of 2.5 atm absolute. Each session lasted 90 min, and each course consisted of 20 daily sessions. Complete healing occurred in 5 patients after one to two courses. In an additional 2, after three courses, 1 patient improved but did not heal, and 2 did not improve. No adverse effects were noted by any of the 10 patients. Follow-up of 18 months did not reveal any recurrence. Hyperbaric oxygen for perianal Crohn's disease. Lavy A, Weisz G, et al. Haifa, Israel. J Clin Gastroenterol. 1994 Oct;19(3):202-5. Another report from Russia advocate HBO for early disease and disease with hepatobiliary involvement. Fiziol Zh. 1991 Sep-Oct;37(5):120-3.

Infliximab: Expensive But Successful Treatment: In a 52-week DB PC study of 113 CD patients with active disease despite prednisone given for more than 6 months, the failure stratum consisted of patients receiving AZA/6-MP at a stable dose for more than 6 months, and the naive stratum consisted of patients not treated previously with AZA/6-MP. Patients were randomized to infliximab 5 mg/kg or placebo at weeks 0, 2, and 6. All patients were treated with AZA/6-MP maintained at a stable dose. At week 24, the success rate (intent-to-treat analysis) was higher in the infliximab group than in the placebo group (57% vs 29%; P = .003); at weeks 12 and 52, the corresponding rates were 75% vs 38% (P < .001) and 40% vs 22% (P = .04), respectively. Infliximab plus azathioprine for steroid-dependent Crohn's disease patients: a randomized placebo-controlled trial. Lemann M, et al. Hopital Saint-Louis, Paris, France. Gastroenterol 2006 Apr;130(4):1054-61.


Lactobacillus No Help for Children: Probiotics are widely used by patients with Crohn's disease. In a 2-year DB PC study of 75 chidlren with Crohn's disease on aminosalicylates, 6-mercaptopurine, azathioprine, or low-dose alternate day corticosteroids, the probiotic Lactobacillus rhamnosus strain GG (LGG) had a median time to relapse of 9.8 months vs. 11.0 months for placebo (P = 0.24); 31% of patients in the LGG group developed a relapse compared to 17% of placebo (P = 0.18). A Randomized, Double-blind Trial of Lactobacillus GG Versus Placebo in Addition to Standard Maintenance Therapy for Children with Crohn's Disease. Bousvaros A, et al. Children's Hospital, Boston and others. Inflamm Bowel Dis. 2005 Sep;11(9):833-839.

Lactobacillus: Crohn's Disease Not Helped by Lactobacillus Capsules in Two Studies: In an Italian 1-year DB PC study of 45 patients, no difference could be found endoscopically or by clinical symptoms between the Lactobacillus group and placebo. Probiotics and Crohn's disease. Prantera C, Scribano ML.  Dig Liver Dis. 2002 Sep;34 Suppl 2:S66-7; Apparently, the same study in Gut. 2002 Sep;51(3):405-9; Similar results in a very small 11-patient DB PC study. BMC Gastroenterol. 2004 Mar 15;4(1):5.

Lactobacillus: Crohn's Disease: Yogurt, Lactobacillus Might Help: L. salivarius and B. Infantis helped a mouse colitis model of Crohn's disease. Gut. 2003 Jul;52(7):975-80; A study is currently underway using L. GG for childhood Crohn's at 7 U.S. university med centers. Dig Liver Dis. 2002 Sep;34 Suppl 2:S63-5; A Univ. Chicago open trial of just 4 children reported a 73% improvement after four weeks on a L. GG tablet twice a day. J Pediatr Gastroenterol Nutr. 2000 Oct;31(4):453-7; Lactobacillus is not decreased in Crohn's, but Bifidobacillus, the other bacillus in ordinary yogurt, is. Dig Dis Sci. 1997 Apr;42(4):817-22

Lactobacillus: Crohn's: Type of Lactobacillus Might be Important: The rat strain Lactobacillus reuteri R2LC, but not the human strain Lactobacillus rhamnosus GG, was of benefit in reducing the severity of acetic acid-induced colitis in rats. These results suggest that it is not the total amount of Lactobacillus but the particular species or strain of Lactobacillus that is important. Univ. Helsinki. Scand J Gastroenterol. 2001 Jun;36(6):630-5

Melatonin While melatonin helped irritable bowel syndrome in one double-blind study, one case has been reported in which it appeared to make Crohn's worse. J Pineal Res 2002 May;32(4):277-8. Ed: One case isn't conclusive.

Metronidazole/Ciprofloxacin Only Helped Colon Disease When Added to Budesonide: In an 8-week DB PC study of 134 patients with active Crohn's disease of the ileum, right colon, or both with all patients on oral budesonide 9 mg daily, ciprofloxacin and metronidazole, both 500 mg twice daily had 33% in remission vs. 38% for placebo. Among patients with disease of the colon, 53% were in remission with antibiotics vs. 25% with placebo (P = 0.10). Discontinuation of therapy because of adverse events occurred in 13 of 66 (20%) patients treated with antibiotics vs. 0% with placebo (P < 0.001). Combined budesonide and antibiotic therapy for active Crohn's disease: a randomized controlled trial. Steinhart AH, Feagan BG, et al. Toronto. Gastroenterology. 2002 Jul;123(1):33-40.

Metronidazole Appears as Good as Ciprofloxacin: In a uncontrolled, retrospective report on 233 inpatients with active Crohn's disease and treated with metronidazole and/or ciprofloxacin (1 g daily each), similar rates of success were obtained: 70.6% with antibiotic combination, 72.8% with metronidazole, 69.0% with ciprofloxacin. The most frequent symptoms and signs such as diarrhea, abdominal pain, fever, abdominal mass and abscesses improved in about 60% of patients in the three groups. Remission time after antibiotic treatment was about one year. Side effects requiring discontinuation of therapy occurred in about 20% of patients. Use of antibiotics in the treatment of active Crohn's disease: experience with metronidazole and ciprofloxacin. Prantera C, Berto E, et al. Nuovo Regina Margherita Hospital, Rome, Italy. Ital J Gastroenterol Hepatol. 1998 Dec;30(6):602-6.

Metronidazole/Ciprofloxacin as Good as Steroids: In a 12-week DB PC study of 41 CD patients, ciprofloxacin 500 mg twice daily plus metronidazole 250 mg four times daily or methylprednisolone 0.7-l mg/kg/day, with variable tapering to 40 mg, followed by tapering of 4 mg weekly resulted in 45% of antibiotic and 63% of steroid patients in clinical remission (Crohn's Disease Activity Index < or = 150) (p = NS). Five patients on antibiotics (22.7%) and five patients on steroids (26.3%) were considered treatment failures because of deterioration or persistent symptoms. Six patients receiving antibiotics (27.3%) and two on steroids (10.6%) were withdrawn from the trial because of side effects. An antibiotic regimen for the treatment of active Crohn's disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin. Prantera C, Zannoni F, et al. Ospedale Nuovo Regina Margherita, Rome, Italy. Am J Gastroenterol. 1996 Feb;91(2):328-32.

Metronidazole Helped in DB After Resection: In a DB PC study of 60 CD patients after ileal resection and ileocolonic anastomosis for Crohn's ileitis, metronidazole (20 mg/kg body wt) daily for 3 months, resulted in 52% with recurrent lesions vs. 75% for placebo (P = 0.09). The incidence of severe endoscopic recurrence was significantly reduced by metronidazole: 13% vs. 43% for placebo (P = 0.02). Patients in the metronidazole arm had more frequent side effects. Metronidazole therapy statistically reduced the clinical recurrence rates at 1 year (4% vs. 25%). Reductions at 2 years (26% vs. 43%) and 3 years (30% vs. 50%) were not significant. Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection. Rutgeerts P, Hiele M, et al. University of Leuven, Belgium. Gastroenterology. 1995 Jun;108(6):1617-21.

Metronidazole Better Than Placebo: In a 16-week DB PC study of 105 CD patients, metronidazole in two doses (20 mg/kg, 10 mg/kg), the Crohn's disease activity index decreased 97 points with metronidazole 20 mg/kg vs. 67 points with metronidazole 10 mg/kg vs. -1 point with placebo (p = 0.002). Serum orosomucoid (metronidazole 20 mg/kg/day, 49; 10 mg/kg/day, 38; placebo, -9, p = 0.001)) were detected. Metronidazole was more effective in patients with disease confined to the large intestine or affecting both small and large bowel than in those with small bowel disease only. There were no differences in remission rates between metronidazole and placebo treated patients. In the study, 21 were withdrawn for deterioration of symptoms, 17 for adverse experiences, and 11 for protocol violation. Double blind, placebo controlled trial of metronidazole in Crohn's disease. Sutherland L, Singleton J, et al. University of Calgary. Gut. 1991 Sep;32(9):1071-5.

Metronidazole Can Cause Acute Pancreatitis, Neuropathy: Rev Infect Dis. 1991 Nov-Dec;13(6):1213-5. Peripheral neuropathy with tingling and paresthesias can also result. Scand J Gastroenterol. 1991 Feb;26(2):219-24. Side effects from metronidazole (black tongue, dark urine, paraesthesia, metallic taste, epigastric pain, skin reactions, nausea) were reported by over 80% of patients. Nearly 50% of patients developed paraesthesia, which was still present 3 months after the end of treatment. Treatment of Crohn's disease with metronidazole for longer than 3 months is not recommended both because of lack of additional therapeutic gain and because of the increasing risk of side effects. Z Gastroenterol. 1989 Nov;27(11):676-82. B-12 deficiency can also cause neuropathy in Crohn's. Neurology. 1987 Aug;37(8):1414-7.

Muscle Strength Decreased in One Study: No significant difference was found between 44 CD patients and 25 controls regarding weight, height, body mass index, fat mass, and fat-free mass. Strength performance was lower in CD subjects compared with controls, particularly for lower limb indexes: lower limb strength test (-24.6%, P < 0.001), LE (-25.8%, P < 0.001), and sit-up test (-25.1%, P < 0.001). Previous disease severity, disease duration, the cumulative dose of glucocorticosteroids, current inflammation, and global habitual physical activity did not affect muscle performance. A recent use of steroids improved LE. Wiroth, et al. France. Inflamm Bowel Dis. 2005 Mar;11(3):296-303.

Mycobacterium Avium Paratuberculosis in Milk May be a Cause: John Hermon-Taylor, St. George's Hospital Medical School, detected Mycobacterium avium paratuberculosis (MAP) bacteria in 92% of ileocolonic biopsy specimens from patients with Crohn's disease but in only 26% of patients in a control group. This implicates this pathogen in disease causation. 7/03 J Clinical Microbiology. Live MAP bacteria is present in 2% of retail pasteurized milk cartons. Patients with irritable bowel syndrome (IBS) were also infected with the MAP bug. In animals, MAP inflames the nerves of the gut. Recent work from Sweden shows that people with IBS also have inflamed gut nerves. There is a real chance that the MAP bug may be inflaming people's gut nerves and causing IBS.

Ornidazole Helps CD After Resection: In a DB PC study of 80 patients after resection and treated for 1 year, ornidazole 1 g/d had 3 recurrences in 38 patients vs. 15 in 40 for placebo. (P = .0046) ; odds ratio, 0.14). Ornidazole for prophylaxis of postoperative Crohn's disease recurrence: a randomized, double-blind, placebo-controlled trial. Rutgeerts P, Van Assche G, et al. University Hospital Gasthuisberg, Leuven, Belgium. Gastroenterology. 2005 Apr;128(4):856-61. Ed: Ornidazole is apparently not yet available. It has been used for vaginal yeast infections. 

Pancreatitis Increased in Crohn's; Less with 5-ASA: In 1,590 cases of acute pancreatitis and 15,913 matched controls, the adjusted odds ratios for acute pancreatitis in patients with Crohn's disease and ulcerative colitis were 3.7 and 1.5. In all patients treated with 5-aminosalicylic acid and sulfasalazine the adjusted odds ratios for acute pancreatitis were 0.7 and 1.5. In patients with inflammatory bowel diseases, the use of 5-aminosalicylic acid or sulfasalazine was not associated with increased risk of acute pancreatitis. Munk et al. Denmark. Am J Gastroenterol. 2004 May;99(5):884-8.

Perianal CD Helped by Topical Metronidazole: In a 4-week prospective, nonblinded, nonrandomized study of topical 10 percent metronidazole of 14 patients with perianal CD symptoms, Perianal Crohn's Disease Activity Index decreased from 8.8 to 4.1(P < 0.0001). Significant decreases were noted in pain and discharge (P < 0.0001) and induration (P < 0.001). Efficacy of Topical Metronidazole (10 Percent) in the Treatment of Anorectal Crohn's Disease. Stringer EE, Nicholson TJ, et al. Atlanta, Georgia. Dis Colon Rectum. 2005 Mar 22. Ed: Honey may also work.

Pig Whipworms Beneficial for Crohn's and Colitis: Live worms are an effective treatment for Crohn's disease and colitis. The eradication of worms from human stomachs over the past 50 years may be behind the rise in these conditions. As the number of infections by parasites, such as roundworms and human whipworms, has fallen, the number of people being diagnosed with inflammatory bowel disease has increased. Researchers tested their product on 200 people with the condition. They opted for pig whipworms eggs because the whipworms do not survive very long in humans. They say symptoms disappeared in most of those who took part in the trial. Joel Weinstock, University of Iowa, New Scientist 4/8/04. BioCure, a German company, is working on seeing if a useful capsule or method can be developed. TSO is taken twice a month. The original Univ Iowa study used a dose every three weeks and did so for 28 weeks with remission in three of four patients and improvement in the fourth without side-effect. Am J Gastroenterol. 2003 Sep;98(9):2034-41.


Refrigeration is a Risk Factor: Findings point to refrigeration as a potential risk factor for Crohn's disease. Cold-chain development paralleled the outbreak of Crohn's disease during the 20th century. The cold chain hypothesis suggests that psychrotrophic bacteria such as Yersinia spp and Listeria spp contribute to the disease. Lancet. 2003 Dec 13;362(9400):2012-5


Relapse Triggered by C. Difficile Infection in 20%: In a study of 54 patients during 62 relapses with 99 stool samples, 12 stool tests were positive. C. difficile made up 10 of the 12. Of these, 9 (90%) were associated with antibiotic use in the prior month. Hospitalization, prednisone use, or sulfasalazine use did not differ significantly with C. difficile status. Eight C. difficile-positive patients improved clinically with targeted antibiotic therapy. Two bacterial cultures (4%) were positive for Campylobacter jejuni and Plesiomonas shigelloides. The diagnostic yield of stool pathogen studies during relapses of inflammatory bowel disease. Meyer AM, Ramzan NN, et al. Mayo Clinic, Scottsdale, AZ. J Clin Gastroenterol. 2004 Oct;38(9):772-5.

Sargramostim Minimal Benefit: Sargramostim, granulocyte-macrophage colony-stimulating factor, a hematopoietic growth factor, stimulates cells of the intestinal innate immune system. In a 56-day DB PC study of 124 patients with moderate-to-severe active Crohn's disease, antibiotics and aminosalicylates were allowed. Those also receiving 6 mcg of sargramostim per kilogram per day had no significant difference in decrease in their Crohn's Disease Activity Index (54 percent vs. 44 percent, P=0.28). However, significantly more patients in the sargramostim group than in the placebo group reached the secondary end points of a clinical response defined by a decrease from baseline of at least 100 points in the CDAI score on day 57 (48 percent vs. 26 percent, P=0.01) and of remission, defined by a CDAI score of 150 points or less on day 57 (40 percent vs. 19 percent, P=0.01). Sargramostim for active Crohn's disease. Korzenik JR, Dieckgraefe BK, et al. Harvard MGH. N Engl J Med. 2005 May 26;352(21):2193-201.

Selenium Decreased in Crohn's Disease: Selenoprotein-P is a selenium-rich serum protein that carries more than 50% of serum selenium. In a study of 20 healthy controls, 34 patients with ulcerative colitis, and 37 patients with Crohn's disease (CD), there was no significant difference in serum selenoprotein-P levels between healthy controls (3.4 mug/mL) and patients with ulcerative colitis (3.0  mug/mL). However, selenoprotein-P levels were significantly lower in CD (1.8 mug/mL). Serum selenoprotein-P levels in patients with inflammatory bowel disease. Andoh A, Hirashima M, et al. Shiga University, Otsu, Japan. Nutrition. 2005 May;21(5):574-9.

Smoking Makes Crohn's Worse: Crohn's disease in cigarette smokers runs a more aggressive course. Prof Nurse. 2004 Mar;19(7):386-; in Crohn's colitis, current smoking hastened disease onset in women (from 35 to 29 yr; P < 0.001), but not men (from 32 to 31 yr), and increased the need for immunosuppressants in women (10-yr cumulative risk, 48% in nonsmokers vs. 58% in smokers; P < 0.01), but not men. Clin Gastroenterol Hepatol. 2004 Jan;2(1):41-8


Smoking Cessation Dramatically Reduces Crohn's Surgery: In a survey of 267 patients, smokers were more likely to have undergone 1, 2, and 3 reoperations for recurrence at any site (relative incidence rates [RIR] 1.32; RIR 1.55; and RIR 1.77) and were more likely to have undergone one reoperation for recurrent ileocecal CD (RIR 1.48). Patients who quit smoking were less likely to have undergone 1, 2, and 3 reoperations for recurrence at any site (RIR 0.25; RIR 0.30; and RIR 0.25) and were less likely to have undergone one reoperation for recurrent ileocecal CD (RIR 0.27). Stanford. Crohn's disease patients who quit smoking have a reduced risk of reoperation for recurrence. Ryan WR, Allan RN, Yamamoto T, Keighley MR. Am J Surg. 2004 Feb;187(2):219-25


Smoking Reduced Risk of CD in Korea: Korea J Gastroenterol 2006 Mar;47(3):198-204.


Tacrolimus Is Safe and Effective in Patients with Severe Steroid-Refractory or Steroid-Dependent 
In a retrospective, observational single center study the charts of 53 adult patients with steroid-dependent (n = 18) or steroid-refractory (n = 35) IBD, Crohn's disease (CD) (n = 11), ulcerative colitis (UC) (n = 40), or pouchitis (PC) (n = 2), tacrolimus (0.1 mg/kg body weight per day) was administered orally in all and initially intravenously in 2 patients (0.01 mg/kg body weight per day), aiming for serum trough levels of 4-8 ng/mL. Forty-one of 53 (77.1%) patients were receiving concomitant azathioprine. Thirty-one UC (78%), 10 CD (90.1%), and both PC (100%) patients experienced an immediate clinical response or went into remission at 30 days. A statistically significant drop on the M-CAI was documented for UC and CD patients. Nine UC patients (22.5%) underwent colectomy between 1.6 and 41.3 months following initiation. Mean colectomy-free survival was 104.8 months. Cumulative colectomy-free survival was estimated 56.5% at 43.8 months. Steroids were reduced or discontinued in 40 of 45 UC and CD patients (90%) taking steroids. Side effects included a temporary rise of creatinine (n = 4, 7.6%), tremor or paresthesias (n = 5, 9.4%), hyperkalemia (n = 1, 1.9%), hypertension (n = 1, 1.9%), and opportunistic infections (n = 2, 3.8%). Inflammatory Bowel Disease-A Long-Term Follow-Up. Baumgart DC, et al. Humboldt-University of Berlin, Germany. Am J Gastroenterol 2006 Mar 30.


Vitamin C Good; Sweets, Fats, Vitamin E Bad: In a retrospective study, cases were IBD Japanese patients ageds 15-34 [ulcerative colitis (UC) 111 patients; Crohn's disease (CD) 128 patients] were compared to controls. In the food groups, a higher consumption of sweets was positively associated with UC risk [OR for the highest versus lowest quartile, 2.86], whereas the consumption of sugars and sweeteners (OR, 2.12), sweets (OR, 2.83), fats and oils (OR, 2.64), and fish and shellfish (OR, 2.41) were positively associated with CD risk. Vitamin C intake (OR, 0.45) was negatively related to UC risk, while the intake of total fat (OR, 2.86), monounsaturated fatty acids (OR, 2.49) and polyunsaturated fatty acids (OR, 2.31), vitamin E (OR, 3.23), and n-3 (OR, 3.24) and n-6 fatty acids (OR, 2.57) was positively associated with CD risk. Dietary risk factors for inflammatory bowel disease: a multicenter case-control study in Japan. Sakamoto N, et al. Hyogo College of Medicine, Japan. . Inflam Bowel Dis 2005 Feb;11(2):154-63.


Vitamin D and Calcium Helps Bones: In a DB study of 74 Crohn's patients with low bone mineral density at the lumbar spine and/or hip 500 mg of calcium with 400 IU of vitamin D alone or in combination with four three-monthly infusions of 30 mg of intravenous pamidronate over the course of 12 months were compared. Both groups gained bone mineral density at the lumbar spine and hip after 12 months. There were significant (P < 0.05) changes in the pamidronate group, with gains of + 2.6% at the spine and + 1.6% at the hip, compared with gains of + 1.6% and + 0.9% at the spine and hip, respectively, in the group taking vitamin D and calcium supplements alone. Aliment Pharmacol Ther. 2003 Dec;18(11-12):1121-7. Ed: This was an inadequate dose of vitamin D and calcium. If vitamin D had been 2000 IU and calcium 1000 mg and vitamin K added, the expensive medication would probably not have done better.


Vitamin D Much Lower in Crohn's Year-round: BIn a study of 44 Crohn's disease patients and matched controls, serum 25-hydroxyvitamin D concentrations were significantly (P < 0.003) lower in Crohn's disease during both seasons. In Crohn's disease patients, serum 25-hydroxyvitamin D concentrations were lower (P < 0.0001) whereas serum parathyroid hormone, osteocalcin and bone-specific alkaline phosphatase and urinary N-telopeptides of type 1 collagen levels were higher (P < 0.001) during late-winter than late-summer. Seasonality of vitamin D status and bone turnover in patients with Crohn's disease. McCarthy D, Duggan P, et al. University College, Cork, Ireland. Aliment Pharmacol Ther. 2005 May 1;21(9):1073-83.


Zinc Male Infertility May be Caused by Zinc Deficiency: In Great Britain, married couples were reported to have between 1.9 and 2.1 children, while men with Crohn's disease had a mean of 1.2 and of 0.4 children before and after diagnosis, respectively. The role of zinc for male fertility is essential. Although lack of zinc in Crohn's disease is well established in up to 70% of patients, a possible relation between zinc deficiency and male subfertility in Crohn's disease remains unclear. Andrologia. 2003 Dec;35(6):337-41