Anti-mycobacterial therapy in Crohn's disease heals mucosa with longitudinal scars

BackgroundA possible causative link between Crohn's disease and Mycobacterium avium ss paratuberculosis has been suggested.AimTo report unique scarring in Crohn's disease patients treated with anti-Mycobacterium avium ss paratuberculosis therapy.PatientsA 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.MethodsPatients 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.ResultsTwenty-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.ConclusionsThe 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.