Anti-mycobacterial therapy in Crohn's disease heals mucosa with longitudinal scars.
BACKGROUND
A possible causative link between Crohn's disease and Mycobacterium avium ss paratuberculosis has been suggested.


OBJECTIVE
To report unique scarring in Crohn's disease patients treated with anti-Mycobacterium avium ss paratuberculosis therapy.


METHODS
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.
Borody
T J
TJ
Centre for Digestive Diseases, Level 1, 229 Great North Road, Five Dock, NSW 2046, Australia. tborody@cdd.com.au
Bilkey
S
S
Wettstein
A R
AR
Leis
S
S
Pang
G
G
Tye
S
S
D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage; D002991:Clofazimine / Q000008:administration & dosage; D003424:Crohn Disease / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009162:Mycobacterium avium / Q000187:drug effects*; D012189:Retrospective Studies; D017828:Rifabutin / Q000008:administration & dosage; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D017828:Rifabutin; D002991:Clofazimine; D017291:Clarithromycin