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Plenty of Relief ... and Skepticism

Increasing numbers of Crohn's sufferers are benefiting from antibiotics, but most scientists say there's not enough evidence to prove bacterial infection is the culprit.

September 18, 2000|THOMAS H. MAUGH II | TIMES MEDICAL WRITER

Nine years ago, Barbara Perkins thought she had stomach cancer. She developed intestinal bleeding and diarrhea and lost 90 pounds from her 5-foot, 10-inch frame in six weeks.

"I was unable to get out of bed and could barely walk," said the 48-year-old homemaker from El Paso. "I was very, very sick."

Eventually, she was diagnosed with Crohn's disease, an intractable, debilitating condition that afflicts half a million Americans.

Though most people may be unfamiliar with it, Crohn's disease affects more people than multiple sclerosis, Duchenne muscular dystrophy and Huntington's disease combined. Resulting from an immune attack on the intestines, Crohn's is extremely painful, characterized initially by abdominal pain and disabling diarrhea, followed by loss of appetite and weight, joint pains and fever.

Crohn's is normally treated with drugs that suppress the immune system, but those have limited effectiveness. However, a new regimen of antibiotics--based on the revolutionary idea that Crohn's is caused by a bacterial infection--has Perkins and a growing number of others free of Crohn's symptoms for the first time in years.

For the Record
Los Angeles Times Monday September 25, 2000 Home Edition Health Part S Page 3 View Desk 2 inches; 44 words Type of Material: Correction
Wrong disorder--A graphic that accompanied a story in Health last Monday incorrectly said that Crohn's disease and a disorder known as ulcerative colitis are commonly referred to as types of irritable-bowel disease. The graphic should have said that both illnesses are types of inflammatory-bowel disease.

In 1996, Perkins was hospitalized 23 times for kidney infections and intestinal blockages, among other problems, spending nearly a full nine months in confinement.

Then she went to Dr. William Chamberlin of the William Beaumont Army Medical Center in El Paso, one of a small but increasing number of physicians who believe that Crohn's is caused by a microorganism called MAP.

He began her on a cocktail of antibiotics that targeted the bug.

Within 18 months, she was in complete remission, leading the active life she once thought was impossible. "I really think it saved my life," she said.

Perkins is one of perhaps 200 Crohn's sufferers around the world who have received a new antibiotic treatment that Chamberlin and others predict will revolutionize treatment of the disease.

Reports presented at a recent Digestive Diseases Week meeting in San Diego indicate the antibiotic cocktails have successfully induced long-term remissions in as many as two-thirds of those treated. Those preliminary studies have been so successful that researchers in Australia and the United States are gearing up for much larger trials.

"We've never had a treatment like this before," said Dr. Tom Borody of the Digestive Diseases Centre in Sydney, Australia. The patients not only stop having symptoms, he said, but their intestines heal--an unprecedented achievement. "If this were cancer, we would be calling these long remissions a cure."

Although the idea that MAP causes Crohn's is still highly controversial, the success of the treatment is making many critics take notice.

The successes are impressive, no matter what the cause of the disease, said Dennis Lang, a Crohn's expert at the National Institute of Allergy and Infectious Diseases in Bethesda, Md. "If I were a Crohn's patient, I would bring this information to my doctor," he said. The treatment "seems to be helping clinically . . . and that's the important thing."

At the same time, the incidence of Crohn's is increasing, most researchers believe. Overall numbers are not available--Crohn's does not have to be reported--but some regional figures suggest an increase. The incidence of Crohn's went up 46% in Olmstead County, Minn., from 1980 to 1991, for example. In Spokane, Wash., it rose 49% between 1971 and 1981. Every day, an additional 55 people in the United States are diagnosed with the disease.

Many people with the illness are unable to leave their homes because of the diarrhea; others drive around in recreational vehicles and mobile homes to keep a bathroom handy.

Roughly half of Crohn's sufferers require one or more surgeries to remove affected areas of the bowel, but new problems almost always occur.

No one knows precisely what causes Crohn's, but MAP (for Mycobacterium avium subspecies paratuberculosis) has been a suspect for nearly a century. The purported link "has been out there for a long time, but the research to date is not clear-cut," said Dr. Charles O. Elson III of the University of Alabama, medical director of the Crohn's and Colitis Foundation.

"The bottom line is, their case is not proved," he said.

The drugs the researchers are using can kill a broad variety of bacteria in the gut, added Dr. R. Balfour Sartor of the University of North Carolina. "It's very difficult to say that response to these agents proves this mycobacterium is involved" in Crohn's, he said.

"Our critics outnumber us 99 to 1," conceded Dr. Ira Shafran of the University of Central Florida. "But our work shows that you can identify [a Crohn's patient with MAP] and put him on a treatment that is safe, effective and cheaper than existing therapies and that he will get better."

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