There are many theories out there regarding what causes Crohn’s disease. Though ultimately most physicians and scientists acknowledge that we don’t know the cause, there is a small subgroup that believe Crohn’s disease is caused by a specific bacteria called mycobacterium avium paratuberculosis which we will abbreviate as MAP. MAP mainly comes from infected cattle but is now ubiquitous in our environment and all of us are likely exposed to it on a regular basis. The treatment paradigm for Crohn’s has mainly been the use of immunosuppressive medications which target a dysregulated immune system thought to be central to the pathophysiology of the disease. However, there are some that treat Crohn’s by targeting MAP with the use of antibiotics, fecal transplants and hyperbaric oxygen. There is even an anti-MAP vaccine in development. In my opinion, this is the biggest controversy in the IBD field right now. In fact, the Crohn’s Disease guidelines published by the American College of Gastroenterology in 2018 explicitly state that anti-MAP therapy has not been shown to be effective for induction or maintenance of remission or mucosal healing in patients with Crohn’s disease and should not be used as primary therapy. This led to subsequent letters being published in the American Journal of Gastroenterology both criticising and defending this statement.
Today I interviewed gastroenterologist Gaurav Agrawal and microbiologist John Aitken who are MAP experts and will give us a comprehensive overview of this topic. As a disclaimer, I am not formally endorsing this therapy for Crohn’s disease as it has not been FDA approved for this purpose in the US. This podcast should not be interpreted as medical advice. This is an open discussion in order to encourage more research and awareness of this topic.
ACG Clinical Guideline: Management of Crohn’s Disease in Adults: https://pubmed.ncbi.nlm.nih.gov/29610508/
Comment on 2018 ACG Clinical Guideline: Antibiotics in Crohn's Disease: https://pubmed.ncbi.nlm.nih.gov/30333546/
Response to Chamberlin and Borody https://pubmed.ncbi.nlm.nih.gov/30633034/
Two-year Combination Antibiotic Therapy With Clarithromycin, Rifabutin, and Clofazimine for Crohn's Disease: https://pubmed.ncbi.nlm.nih.gov/17570206/
Targeted Combination Antibiotic Therapy Induces Remission in Treatment-Naïve Crohn's Disease: A Case Series: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC71424…
Combining infliximab, anti-MAP and hyperbaric oxygen therapy for resistant fistulizing Crohn's disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC51379…
Profound Remission in Crohn's Disease Requiring No Further Treatment for 3-23 Years: A Case Series https://www.ncbi.nlm.nih.gov/pmc/articles/PMC71443…
Website regarding Crohn’s Disease Vaccine: http://www.crohnsmapvaccine.com
John Aitken’s Website: https://otakaropathways.co.nz/about.php