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. 2020 Dec 16;12(12):542-554.
doi: 10.4253/wjge.v12.i12.542.

Crohn's strictures open with anti-mycobacterial antibiotic therapy: A retrospective review

Rhys Collyer  1 , Annabel Clancy  1 , Gaurav Agrawal  1 , Thomas J Borody  2
Affiliations

Crohn's strictures open with anti-mycobacterial antibiotic therapy: A retrospective review

Rhys Collyer et al. World J Gastrointest Endosc. .

Abstract

Background: Medical therapy for strictures is limited and first-line treatment consists of endoscopic balloon dilatation, strictureplasty or surgical resection. Mycobacterium tuberculosis, Helicobacter pylori and Streptococcus can all cause stenosis, for which antibiotic treatment achieves stricture resolution. Mycobacterium avium ssp. paratuberculosis is a suspected causative agent in Crohn's disease (CD). Thus, specialized antimicrobial treatment, in particular, anti-mycobacterial antibiotic therapy (AMAT) has been proposed as a potential treatment option. To our knowledge, the opening of CD strictures has not been recorded using any form of antibiotic therapy. We hypothesized that AMAT would resolve strictures in patients with CD.

Aim: To investigate the effect and outcomes of AMAT in a cohort of CD patients with an ileal stricture.

Methods: A single center, retrospective, medical record case review was conducted on an observational cohort of patients with CD who had an ileal stricture on colonoscopy and were treated with AMAT. Forty patients meeting the inclusion criteria were identified from the internal medical database. Thirty (75%) patients had follow-up colonoscopy and clinical data available. The AMAT regimen was prescribed after the initial colonoscopy for a duration of at least six months until follow-up colonoscopy with the attending gastroenterologist. Patient demographics, symptoms, colonoscopy reports, inflammatory serum markers and concurrent medications were recorded at pre-treatment and follow-up between January 1995 and June 2018.

Results: Of the patients that returned for follow-up after > 24 mo of AMAT, twenty (67%) had complete resolution (CR) of their ileal strictures, three (10%) had partial resolution and seven (23%) had no resolution. Irrespective of stricture outcome, 21 patients (70%) demonstrated clinical response to AMAT and there was a statistically significant reduction in inflammatory serum markers C-reactive protein (P < 0.0001) and erythrocyte sedimentation rate (P = 0.04) from pre-treatment to follow-up. It was observed that 11 (37%) patients experienced side effects, but no serious adverse effects were attributable to AMAT. At follow-up there were 26 (87%) patients on concomitant medication for CD and a statistically significant association between CR and AMAT with a concomitant immunomodulator (P = 0.02).

Conclusion: This study demonstrated a high rate of stricture resolution (67%) similar to that seen in tuberculosis strictures (70%), suggesting a shared mycobacterial origin of strictures, and perhaps disease.

Keywords: Antibiotics; Colonoscopy; Crohn’s disease; Ileum; Inflammatory bowel disease; Stricture.

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Conflict of interest statement

Conflict-of-interest statement: Dr. Borody TJ reports personal fees from THE CENTRE FOR DIGESTIVE DISEASES, other from OTAKARO PATHWAY, other from FINCH THERAPEUTICS, other from REDHILL BIO, outside the submitted work; in addition, Dr. Borody TJ has a patent US16/233419 pending, a patent AU2018256633A1 pending, a patent WO2011050397A1 pending, a patent US20180344782A1 pending, a patent CA3003138A1 issued, a patent AU2011286165 issued, a patent AU20111286165B2 issued, a patent US9308226 issued, a patent US9198926 licensed, a patent US9072763 licensed, and a patent AU2010903474 issued.

Figures

Figure 1
Figure 1
Patient 37’s ileocecal valve stricture. Initially narrowed and stenosed lumen was shown.
Figure 2
Figure 2
After > 24 mo of anti-mycobacterial antibiotic therapy. Patent, healed lumen with evidence of clofazimine staining in the mucosa.
Figure 3
Figure 3
Patient 39’s ileocecal valve stricture. Initially inflamed and stenosed lumen was shown.
Figure 4
Figure 4
After 12 mo of anti-mycobacterial antibiotic therapy. Healed mucosa and patent opening were seen.
See this image and copyright information in PMC

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