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Crohn's Disease is an inflammatory bowel disease
that can cause chronic diarrhea, malnutrition, weight loss, fatigue and
in some cases death.
There are over 500,000 diagnosed Crohn's patients
in the U.S. Some estimate that there are another 500,000 people that have
not been diagnosed, but still suffer from Crohn's Disease.
Crohn's Disease is prevalent in developed countries,
and where milk is consumed, except for India where milk is boiled before
being consumed. Crohn's Disease is also more prevalent in families where
one or more relatives have IBD.
For many years Crohn's Disease was thought to
be an autoimmune disease where the body rejects it's self.
A growing number of researchers believe that some
Crohn's Disease is not a purely autoimmune disease but may have a pathogenic
cause or trigger. The most likely candidate is mycobacterium avium ss.
paratuberculosis (MAP), a bacteria that causes a Crohn's like disease (Johne's)
in most species of animals. Dr. Shafran has coined the term Mycobacterium
Induced Regional Enteritis (MIRE) to describe this form of Crohn's Disease.
MAP has been isolated in the tissue of some Crohn's
disease patients. As well as antibodies to MAP in the blood stream.
Possible Sources of MAP:
MAP infects up to 20% of the dairy herds in the
U.S. MAP is shed in the milk and pasteurization may not kill all of it.
A study of the milk supply in the U.K. showed 25% of the retail milk tested
was positive for MAP. Dairy cows that are MAP positive are routinely slaughtered
for hamburger meat. Safe cooking temperature and time to eliminate the
MAP threat from infected meat are not know at this time. Vegetables fertilized
with MAP infected cow manure can also carry the bacteria.
The Crohn's Disease, MAP Link:
Dr. Burrill B. Crohn suggested a infectious cause,
of the disease that bears his name, in the early 1930's. A lack of technology
prevented him and others from making this link provable. Research to find
an infectious cause stopped for all practical purposes until the 1980's.
Early attempts to control this infection with
antibiotics for tuberculosis failed. It was not until the mid 1980's, when
macrolide antibiotics were invented, that there was an effective treatment
MAP is a difficult bacteria to work with. It is
slow growing and becomes "wall-less". MAP also survives very well in macrophages
(white blood cells) making it difficult to eliminate. With effort and patience
MAP can be detected.
Resistance and Research:
Do to the past failure to isolate and control
MAP with the technology of the time, many researchers and Gastroenterologist
are reluctant to accept this form of Crohn's Disease. This is similar to
the reluctance to prescribe antibiotics for H. Pylori, the cause of 80%
This reluctant mindset has severely limited the
resources and funding available to study and treat this form of Crohn's
Researchers and physicians such as Dr. Shafran
have been pursuing this research, often times paying out of their own pockets.
This dedication has brought forth a treatment for the MIRE form of Crohn's
Disease called RMAT (Rifabutin and macrolide antibiotic therapy).
A recent trial of RMAT showed a 77.1% remission
rate (Remission = CDAI score of 150 or less) with endoscopic
healing. A small trial showed RMAT to be effective in healing fistulas,
a problem that plagues many Crohn's Disease suffers.
Currently Dr. Shafran has 200 patients in an open trial with RMAT. While
still early in the treatment the results to date are very promising. Many
of these patients have stated that RMAT has given their lives back to them.