Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2020; 12(12): 542-554
Published online Dec 16, 2020. doi: 10.4253/wjge.v12.i12.542
Crohn’s strictures open with anti-mycobacterial antibiotic therapy: A retrospective review
Rhys Collyer, Annabel Clancy, Gaurav Agrawal, Thomas J Borody
Rhys Collyer, Annabel Clancy, Gaurav Agrawal, Thomas J Borody, Centre for Digestive Diseases, Five Dock 2046, NSW, Australia
Author contributions: All authors contributed to conceptualization, investigation and validation; Collyer R and Clancy A performed data curation and formal analysis; Clancy A, Agrawal G and Borody TJ contributed to project administration and provided supervision; Agrawal G and Borody TJ contributed to resources; Collyer R performed visualization; all authors wrote the original draft, reviewed and edited the manuscript, and issued the final approval of the submitted version.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee (STUDY NO. CDD19/C01) at Centre for Digestive Diseases, NSW, Australia.
Informed consent statement: A waiver of consent was granted for this study. Patients were not required to give informed consent for this study because the analysis used de-identified data that was obtained after each patient consented to the treatment.
Conflict-of-interest statement: Dr. Borody TJ reports personal fees from THE CENTRE FOR DIGESTIVE DISEASES, other from OTAKARO PATHWAY, other from FINCH THERAPEUTICS, other from REDHILL BIO, outside the submitted work; in addition, Dr. Borody TJ has a patent US16/233419 pending, a patent AU2018256633A1 pending, a patent WO2011050397A1 pending, a patent US20180344782A1 pending, a patent CA3003138A1 issued, a patent AU2011286165 issued, a patent AU20111286165B2 issued, a patent US9308226 issued, a patent US9198926 licensed, a patent US9072763 licensed, and a patent AU2010903474 issued.
Data sharing statement: All data relevant to the study are included in this article.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thomas J Borody, AGAF, BSc, DSc, FACG, FACP, FRACP, MBBS, MD, PhD, Professor, Centre for Digestive Diseases, Level 1, 229 Great North Road, Five Dock 2046, NSW, Australia. thomas.borody@cdd.com.au
Received: October 2, 2020
Peer-review started: October 2, 2020
First decision: October 17, 2020
Revised: November 2, 2020
Accepted: November 17, 2020
Article in press: November 17, 2020
Published online: December 16, 2020
Processing time: 72 Days and 1.2 Hours
ARTICLE HIGHLIGHTS
Research background

Crohn’s disease (CD) is a chronic, incurable inflammatory bowel disease located at any point from the mouth through to anus. Mycobacterium avium ssp. paratuberculosis is a suspected causative agent in CD and recent evidence has shown anti-mycobacterial antibiotic therapy (AMAT) to be highly effective in treating this condition. Due to the natural progression of CD, patients will often develop complications such as strictures which are inflammatory, fibrotic or mixed processes causing obstruction, for which endoscopic balloon dilatation, strictureplasty or surgical resection is currently first-line treatment.

Research motivation

Mycobacterium tuberculosis, Helicobacter pylori and Streptococcus can all cause stenosis and resolution can be achieved by specialized antimicrobial treatment. AMAT has proved to be an effective treatment in CD but its efficacy in opening strictures has not yet been investigated.

Research objectives

This study aimed to investigate the effect and outcomes of AMAT in a cohort of CD patients with an ileal stricture.

Research methods

A single center, retrospective, medical record case review was conducted on an observational cohort of patients with CD who had an ileal stricture on colonoscopy and were treated with AMAT. The AMAT regimen was prescribed after the initial colonoscopy for a duration of at least six months until follow-up colonoscopy with the attending gastroenterologist. Patient demographics, symptoms, colonoscopy reports, inflammatory serum markers and concurrent medications were recorded at pre-treatment and follow-up between January 1995 and June 2018. The primary outcome was the complete resolution (CR) of CD strictures.

Research results

The majority of our cohort (67%) had CR of their ileal strictures in response to AMAT. Improvement was observed through symptomatic clinical response and a reduction in inflammatory serum markers within the cohort. There were minimal side effects attributable to AMAT that were reported in the study.

Research conclusions

An unexpectedly high resolution of strictures in CD was observed following treatment with AMAT, reflecting the highest rate of CR reported in the literature. This rate is similar to that seen in tuberculosis strictures (70%), suggesting a shared mycobacterial origin of strictures, and perhaps disease.

Research perspectives

The findings of this study should be confirmed by further prospective studies of both ileal and colonic strictures, both with and without concomitant immunotherapy to determine the most successful combination in opening a stricture.