Crohn’s disease is an inflammatory bowel disease that generally affects the small intestine, although it can affect any portion of the gastrointestinal tract. Unfortunately it is chronic and has no cure, although Crohn’s sufferers may go through periods of remission where symptoms are absent. Crohn’s affects both genders equally and can strike at any age, although it is most often diagnosed between ages thirteen and thirty. Habits and ethnicity do matter; smokers have a higher incidence of Crohn’s. African Americans have the least likelihood of developing Crohn’s, while people from Eastern Europe have the highest likelihood (Watt, 2014).
The cause of Crohn’s development is unknown. In fact, Crohn’s disease is often termed as “idiopathic”, meaning that it has no known cause. However, recent studies have shown that the bacterium Mycobacterium avium subspecies paratuberculosis may contribute to the causation of Crohn’s development.
Mycobacterium avium subspecies paratuberculosis, often called MAP, is a bacterium that often infects livestock with Johne’s disease. Johne’s disease is an inflammatory bowel disease that affects animals and is very similar to Crohn’s disease. In fact, it is estimated that up to 91% of dairy cows are infected with MAP, although not all go on to develop Johne’s disease. It is hypothesized that humans who develop Crohn’s disease may have developed it to due having MAP in their gut from eating or drinking milk products infected with MAP (Herman-Taylor, 2015).
It is estimated that in countries where the incidence of Crohn’s disease is high, up to one-third of the population will have serum antibodies to MAP antigens. People that have these antibodies can be identified by the identification of IS900 PCR (polymerase chain reaction) in body tissues and in the bloodstream. Acid fast stains can also be visualized to detect the presence MAP; in one study, 60% of tissues from Crohn’s patients studied detected the presence of MAP (Pierce, 2010).
MAP can be passed from livestock to human via two routes: fecal-oral transmission or ingesting contaminated milk products. Fecal-oral transmission happens when feces contaminates drinking water, which a human then ingests. This often happens if contaminated fertilizer comes in contact with drinking water. Milk products become contaminated by MAP when the milk is produced by a MAP infected animal. Unpasteurized milk products hold the greatest risk of being contaminated with MAP (Pierce, 2010).
Conventional treatment of Crohn’s disease is individualized to the patient. According to Mayo Clinic (2014), “Doctors use one of two approaches to treatment – either ‘step-up,’ which starts with milder drugs first, or ‘top-down,’ which gives people stronger drugs earlier in the process.” Regardless of which approach is taken, the ultimate objectives are to minimize inflammation of the problem area and reduce the chance of complications.
Medication therapy may include drugs from a variety of drug classes; anti-inflammatory medications such as corticosteroids and oral 5-aminosalicylates are often used initially. Immunosuppressant medications may also be administered; these medications also reduce inflammation. There are multiple sub-categories of immunosuppressant medications, but some of the more common medications are methotrexate (Rheumatrex), adalimumab (Humira), infliximab, (Remicade), and azathioprine (Imuran). Antibiotics can be administered if there is an infectious process involved, or to reduce drainage. Additional medications that may be administered are aimed at symptom management rather than symptom reversal. Anti-diarrheal medications, pain relievers, and vitamin supplements are examples of over-the-counter medications that alleviate symptoms. In addition to medication therapy, nutrition therapy is often utilized. The aim of nutrition therapy is to educate about a low-residue diet; however, a dietitian would also be consulted should supplemental feeding be necessary. Supplemental feeding may be administered through a feeding tube or through an intravenous line. Surgery is the final option of conventional treatment. Once other options have been exhausted, a surgery may be performed to remove damaged areas of the gastrointestinal tract. However, it is important to note that surgery does not cure Crohn’s; it is a temporary fix and symptoms will often reoccur at some point (Mayo Clinic, 2014).
If the practitioner recognizes that Crohn’s disease may be caused by a MAP infection, treatment can be individualized and aimed at remission due to ridding the body of the MAP infection. This therapy is termed “anti-mycobacterium avium paratuberculosis therapy,” or anti-Map therapy. In a study discussed by Medscape, a team of researchers grouped together twenty Crohn’s patients that tested positive for a MAP infection. Half of these patients attained remission by being prescribed an antibiotic that targets MAP, such as rifampicin. In yet another study, about 85% of Crohn’s patients had their disease in a state of remission by being prescribed either ethambutol, clofazimine, dapsone and a one-time dose of rifampicin. These studies, coupled with multiple others, have shown that in order to treat Crohn’s possibly caused by a MAP infection, at least dual therapy is indicated; the initial drug should be a macrolide antibiotic. The medications should be prescribed for at least six months (Chamberlin et al, 2011).
A team of researchers from St. George’s University of London and at the Jenner Institute University of Oxford have been able to create a vaccine that targets MAP, which could ultimately decrease the incidence of Crohn’s disease. This vaccine is still in need of funding from a pharmaceutical company and clinical trials to determine its efficacy. However, the vaccine does seem promising; tests have been performed on mice and cattle. The data collected suggests long-term immunity against MAP. Professor John Herman-Taylor (2015), who is heading the research, notes that this vaccine has worked significantly well in cattle. According to his website, he states, “The vaccine could be given to those at higher risk of developing Crohn’s Disease (e.g. children of those with Crohn’s) to prevent them from ever getting the disease. It could also be given to domestic livestock to prevent MAP getting into the food chain in the first place.”
While research still needs to be performed on anti-MAP treatment, the MAP vaccine, and on MAP infections in general, studies have shown that there is likely a strong correlation between MAP and Crohn’s disease. MAP may also have a correlation with other inflammatory bowel diseases, such as ulcerative colitis. The outlook remains hopeful that Crohn’s sufferers may find relief, and that Crohn’s may even be eradicated at some point in time.
Chamberlin, C., Borody, T.J., & Campbell, J. (2011). Primary treatment of Crohn’s disease. Expert Review of Clinical Immunology, 7(6); 751-760. Retrieved from http://www.medscape.com/viewarticle/752223_4
Crohn’s disease: treatment and drugs. (2014). Retrieved from http://www.mayoclinic.org/diseases-conditions/crohns-disease/basics/treatment/con-20032061
Herman-Taylor, J. (2015). The Crohn’s Vaccine. Retrieved from http://crohnsmapvaccine.com/vaccine/
Herman-Taylor, J. (2015). What is Mycobacterium avium subspecies Paratuberculosis (MAP)? Retrieved from http://crohnsmapvaccine.com/map/
Pierce, E.S. (2010). Ulcerative colitis and Crohn’s disease: is Mycobacterium avium subspecies paratuberculosis the common villain? Gut Pathogens, 2(21). Retrieved from http://www.gutpathogens.com/content/2/1/21
Watt, A. (2014). What do you want to know about Crohn’s disease? Retrieved from http://www.healthline.com/health/crohns-disease