OJIM> Vol.2 No.2, June 2012

The many faces of Crohn’s Disease: Latest concepts in etiology

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ABSTRACT

The notion that Crohn’s Disease (CD) occurs as a result of an aberrant reaction to the commensal microbiota in genetically susceptible hosts is widely regarded by physicians and scientists as fact. Yet although it is undisputed that Crohn’s Disease is immune-mediated, an aberrant reaction to one’s own native flora is far from proven. The aim of the current review is to present a summary of the known infectious causes of Crohn’s Disease, whilst highlighting the limitations of using outdated methods to attempt to classify the disease as a single entity. We propose a re-classification of Crohn’s Disease, and suggest that the disease is best conceptualized as a syndrome, an “umbrella-like” term comprising a group of diseases with varying infective etiologies, which clinically, endoscopically and histologically are indistinguishable from CD.

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Cite this paper

Campbell, J. , Borody, T. and Leis, S. (2012) The many faces of Crohn’s Disease: Latest concepts in etiology. Open Journal of Internal Medicine, 2, 107-115. doi: 10.4236/ojim.2012.22020.

References

[1] Lesniowski, A. (1904) Pamietnik towarzystwa lekarskiego warszawskiego. Polish Surgeon, 100, 630-631.
[2] Dalziel, T.K. (1913) Chronic Interstitial enteritis. British Medical Journal, 2, 1068-1070.
[3] Crohn, B.B., Ginzburg, L. and Oppenheimer, G.D. (1932) Regional Ileitis, a pathological and clinical entity. Journal of the American Medical Association, 99, 1323-1329.
[4] Podolsky, D.K. (2002) Inflammatory bowel disease. New England Journal of Medicine, 347, 417-429.
[5] Bull, T.J., McMinn, E.J., Sidi-Boumedine, K., et al. (2003) Detection and verification of Mycobacterium avium subsp. paratuberculosis in fresh ileocolonic mucosal biopsy specimens from individuals with and without Crohn’s Disease. Journal of Clinical Microbiology, 41, 2915-2923.
[6] Van Kruiningen, H.J., Chiodini, R.J., Thayer, W.R., et al. (1986) Experimental disease in infant goats induced by a Mycobacterium isolated from a patient with Crohn’s Disease. A preliminary report. Digestive Diseases and Sciences, 31, 1351-1360.
[7] Barrett, J.C., Hansoul, S., Nicolae, D.L., et al. (2008) Genome-wide association defines more than 30 distinct susceptibility loci for Crohn’s Disease. Nature Genetics, 40, 955-962.
[8] Prantera, C. (2007) Mycobacteria and Crohn’s Disease, The endless story. Digestive & Liver Disease, 39, 452-454.
[9] Golden, M.P. (2005) Extrapulmonary tuberculosis, an overview. American Physician, 72, 1761-1768.
[10] Marshall, B.J. (1995) Helicobacter pylori in puptic ulcer, have Koch’s postulates been fulfilled? Annals of Medicine, 27, 565-568.
[11] Porter, R.S. and Kaplan, J.L. (2008) The Merck Manuals Online Medical Library. http://www.merck.com/mmpe/sec05/ch052/ch052b.html
[12] Chamberlin, W., Borody, T. and Naser, S. (2007) MAP-associated Crohn’s disease, MAP, Koch’s postulates, causality and Crohn’s Disease. Digestive & Liver Disease, 39, 792-794.
[13] Johnson, C., Wannemuehler, M.J. and Hostetter, J.M. (2011) Persistent enteric mycobacterial infection enhances sensitivity to acute mucosal injury. Experimental Biology and Research, 236, 36-43.
[14] Autschbach, F., Eisold, S., Hinz, U., et al. (2005) High prevalence of Mycobacterium avium subspecies paratuberculosis IS900 DNA in gut tissues from individuals with Crohn’s Disease. Gut, 54, 944-949.
[15] Schwartz, D., Shafran, I., Romero, C., et al. (2000) Use of short term culture for identification of Mycobacterium avium subsp. paratuberculosis in tissue from Crohn’s Disease patients. Clinical Microbiology & Infection, 6, 303-307.
[16] Sartor, C. (2005) Does Mycobacterium avium subspecies paratuberculosis cause Crohn’s Disease? Gut, 54, 898-898.
[17] Prantera, C. (2007) Mycobacteria and Crohn’s Disease, The endless story. Digestive & Liver Disease, 39, 452-454.
[18] Hermon-Taylor, J. (2009) Mycobacterium avium subspecies paratuberculosis, Crohn’s Disease and the doomsday scenario. Gut Pathogens, 1, 15.
[19] Selby, W., Pavli, P., Crotty, B., et al. (2007). Two-year combination antibiotic therapy with clarithromycin, rifabutin and clofazamine for Crohn’s Disease. Gastroenterology, 132, 2313-2319.
[20] Behr, M.A. and Hanley, J. (2008) Antimycobacterial therapy for Crohn’s Disease, a reanalysis. The Lancet Infectious Diseases, 8, 344.
[21] Gui, G.P, Thomas, P.R., Tizard, M.L., et al. (1997) Two-year outcomes analysis of Crohn’s Disease treated with rifabutin and macrolide antibiotics. Journal of Antimicrobial Chemotherapy, 30, 393-400.
[22] Shafran, I., Kugler, L., El-Zaatari, F.A., et al. (2002) Open clinical trial of rifabutin and clarithromycin therapy in Crohn’s Disease. Digestive & Liver Disease, 34, 22-28.
[23] Borody, T.J., Leis, S., Warren, E.F., et al. (2002) Treatment of severe Crohn’s Disease using antimycobacterial triple therapy—Approaching a cure? Digestive & Liver Disease, 34, 29-38.
[24] Hanauer, S.B., Feagan, B.G., Lichtenstein, G.R., et al. (2002) Maintenance infliximab for Crohn’s Disease, the ACCENT I randomised trial. Lancet, 359, 1541-1549.
[25] Hanauer, S.B. (2007) More likely than not. Nature Clinical Practice Gastroenterology & Hepatology, 4, 469.
[26] St Jean, G. (1996) Treatment of clinical paratuberculosis in cattle. Veterinary Clinics of North America, Food Animal Practice, 12, 417-430.
[27] Sibartie, V., Kirwan, W.O., O’Mahony, S., et al. (2007). Intestinal tuberculosis mimicking Crohn’s Disease, lessons relearned in a new era. European Journal of Gastroenterology & Hepatology, 19, 347-349.
[28] Akbar, I. (2009) Intestinal tuberculosis and Crohn’s Disease, the dilemma of similarities and misdiagnosis. BMJ Case Reports.
[29] Al Kawari, M.A., Mohamed, A.E., Yasawy, M.l., et al. (1995) Protean manifestation of gastrointestinal tuberculosis, report on 130 patients. Journal of Clinical Gastroenterology, 20, 225-232.
[30] Bhargava, D., Kushwaha, A.K., Dasarathy, S., et al. (1992) Endoscopic diagnosis of segmental colonic tuberculosis. Gastrointestinal Endoscopy, 38, 571-574.
[31] Shah, S., Thomas, V., Mathan, M., et al. (1995) Colonoscopic stuy of 50 patients with colonic tuberculosis. Gut, 33, 347-351.
[32] Singh, V., Kumar, P., Kamal, J., et al. (1995) Clinicocolonoscopic profile of colonic tuberculosis. American Journal of Gastroenterology, 20, 225-232.
[33] Marshall, J.B. (1993) Tuberculosis of the gastrointestinal tract and peritoneum. American Journal of Gastroenterology, 88, 989-999.
[34] Lau, C.F., Wong, A.M.C., Yee, K.S., et al. (1998) A case of colonic tuberculosis mimicking Crohn’s Disease. Hong Kong Medical Journal, 4, 63-66.
[35] Lamps, L.W., Madhusudhan, K.T., Havens, J.M., et al. (2003) Pathogenic Yersinia DNA is detected in bowel and mesenteric lymph nodes from patients with Crohn’s Disease. The American Journal of Surgical Pathology, 27, 220-227
[36] Lockhart-Mummery, H.E. and Morson, B.C. (1960) Crohn’s Disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis. Gut, 1, 87-105.
[37] Payne, M., Girdwood, A.H., Roost, R.W., et al. (1987) Yersinia enterocolitica and Crohn’s Disease, a case report. South African Medical Journal, 472, 53-55.
[38] McMorrow Tuohy, A.M., O’Gorman, M., Byington, C., et al. (1999) Yersinia Enterocolitis mimicking Crohn’s Disease in a toddler. Pediatrics, 104, 1-4.
[39] MacFarlane, P.I. (1986) Yersinia enterocolitica mimicking Crohn’s Disease. Journal of Pediatric Gastroenterology & Nutrition, 5, 671-672.
[40] Treacher, D.F. and Jewell, D.P. (1985) Yersinia colitis associated with Crohn’s Disease. Postgraduate Medical Journal, 61, 173-174.
[41] Ibbotson, J.P., Pease, P.E. and Allan, R.N. (1987) Serological studies in Crohn’s Disease. Eur Journal of Clinical Microbiology, 6, 286-290.
[42] Kaya, M., Aydin, F. and Buyukbayram, H. (2005) A rare cause of colonic stricture, amebiasis. Turkish Journal of Gastroenterology, 16, 236-239.
[43] Merino, E., Glender, W., Del Muro, R., et al. (1990) Evaluation of the ELISA test for detection of Entamoeba histolytica in feces. Journal of Clinical Laboratory Analysis, 4, 39-42.
[44] Joos, L., Loosli, J., Spichtin, P., et al. (1999) Am?ebenleberabszess bei chronischer Kolitis: Revision der diagnose “Morbus Crohn”. Schweiz Med Wochenschr, 129, 1656-1659.
[45] Borody, T.J., Campbell, J., Torres, M., et al. (2009). Entamoeba histolytica, another cause of Crohn’s Disease. American Journal of Gastroenterology, 104, 990.
[46] Pai, S. (2009) Amebic colitis can mimic Tuberculosis and Inflammatory Bowel Disease on endoscopy and biopsy. International Journal of Surgical Pathology, 17, 116-121.
[47] Purnomo, H.J., Tarius, A., Simadibrata, M., et al. (2007). Chronic diarrhea caused by amebic colitis and Inflammatory Bowel Disease. Indonesian Journal of Gastroenterology, Hepatology & Digestive Endoscopy, 8.
[48] Croxen, M.A. and Finlay, B. (2010) Molecular mechanisms of Escherichia coli pathogenicity. Nature Reviews Microbiology, 8, 26-38.
[49] Barnich, N. (2007) Adherent invasive Escherichia coli and Crohn’s Disease. Current Opinion in Gastroenterology, 23, 16-20.
[50] Darfeuille-Michaud, A., Neut, C., Barnich, N., et al. (1998) Presence of adherent Escherichia coli strains in ileal mucosa of patients with Crohn’s Disease. Gastroenterology, 115, 1405-1413.
[51] Darfeuille-Michaud, A., Boudeau, J., Bulois, P., et al. (2004) High prevalence of adherent-invasive Escherichia coli associated with ileal mucosa in Crohn’s Disease. Gastroenterology, 127, 412-421.
[52] Martin, H., Campbell, B.J., Hart, A., et al. (2004). Enhanced Escherichia coli adherence and invasion in Crohn’s Disease and colon cancer. Gastroenterology, 127, 80-93.
[53] Giaffer, M.H., Holdsworth, C.D. and Duerden, B.I. (1992) Virulence properties of E. coli strains isolated from patients with inflammatory bowel disease. Gut, 33, 646-650.
[54] Glasser, A.L., Boudeau, J., Barnich, N., et al. (2001) Adherent invasive Escherichia coli strains from patients with Crohn’s Disease survive and replicate within macrophages without inducing host cell death. Infection and Immunity, 69, 5529-5537.
[55] Kelly, R.P., Lee, G., Collins, J.K., et al. (2004) Bacterial DNA within granulomas of patients with Crohn’s Disease-detection by laser capture microdissection and PCR. American Journal of Gastroenterology, 99, 1539-1543.
[56] Man, S.M., Zhang, L., Day, A.S., et al. (2010) Campylobacter concisus and other Campylobacter species in children with newly diagnosed Crohn’s Disease. Inflammatory Bowel Disease, 16, 1008-1016.
[57] Gradel, K.O., Nielson, H.L., Sch?nheyder, H.C., et al. (2009) Increased short and long-term risk of Inflammatory Bowel Disease after Salmonella or Campylobacter gastroenteritis. Gastroenterology, 137, 495-501.
[58] Dionisio, D., Esperti, F., Vivarelli, A., et al. (2001) Acute terminal ileitis mimicking Crohn’s Disease caused by Salmonella venezian. International Journal of Infectious Diseases, 5, 225-227.
[59] Alberti-Flor, J. and Granda, A. (1986) Ileocaecal histoplasmosis mimicking Crohn’s Disease in a patient with Job’s syndrome. Digestion, 33, 176-180.
[60] DiLauro, S. and Crum-CIanflone, N.F. (2010) Ileitis, when it is not Crohn’s Disease. Current Gastroenterology Reports, 12, 249-258.
[61] Khan, F.N., Prasad, V. and Klein, M.D. (2009) Cytomegalovirus enteritis mimicking Crohn’s Disease in a lupus nephritis patient, a case report. World Journal of Gastroenterology, 15, 4327-4330.
[62] Sheikh, M.A. and Ashraf, S.A. (2007) Terminal ileum schistosomiasis with perianal fistula mimicking Crohn’s Disease. Saudi Medical Journal, 28, 1449-1452.
[63] Gutierrez, Y., Bhatia, P., Garbadawala, S., et al. (1996). Strongyloides stercoralis eosinophilic granulomatous enterocolitis. American Journal of Surgical Pathology, 20, 603-612.

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