Bringing Crohn’s and Colitis out of the fog


IBD What is it?

Inflammatory bowel disease is the term used mostly for two conditions and their sub-variants:  Crohn’s Disease (approximately 115,000 people in the UK are affected) and Ulcerative Colitis (approximately 146,000 people in the UK are affected).  Although both involving inflammation of the gut lining and various similarity in symptoms, both carry separate diagnoses and treatment; albeit still life-long and ongoing conditions.  Diarrhoea, abdominal cramping, fatigue, loss of appetite and anaemia are common symptoms.  With there being no direct known cause for the development of the diseases, development is mostly looked upon to occur from genes, or an unusual reaction from the digestive system to the bacteria in the intestines.

Crohn’s Colitis

Crohn’s Disease (CD) can affect the entire digestive system and sufferers can experience inflammation throughout the whole of the alimentary tract (although the most commonly affected area is the ileum); whereas Ulcerative Colitis (UC) predominantly only occurs in the colon and rectum with ulcer development on the colon lining being a very common problem.  Unless in remission, flare-ups can be very frequent and can really disrupt the patient’s, in the sense of affecting relationships, work life, altering what foods are able to be eaten and generally causing exacerbated stress.

 

Treatments are varied; UC can often be managed with the correct medication or combination of drugs prescribed by a gastroenterologist.  Crohn’s sufferers, if mild, can sometimes effectively find relief from adjusting their diet.  The main aim of drug treatment is to reduce inflammation levels in the gut to potentially bring on remission and prevent any relapses.  Steroids and immunosuppressants are the most commonly used anti-inflammatory drugs for IBDs, with other drugs including antibiotics being used on occasions.  In severe cases, surgery is required to resect, or remove, the badly inflamed area and rejoin the unaffected tissues.   This does not always bring complete remission and new areas of inflammation can occur.

 

There have been plenty of studies completed to highlight the relationship between the gut microbiome and its pivotal role in the pathogenesis or aetiology of IBD (Saleh and Elson, 2011).  For both UC and CD patients, antibiotic use is heavily implicated in the imbalance of the natural microbial composition, which is a contributor to further disease.  Probiotics have been seen to show some efficacy in remission for UC patients; alternatively, faecal diversion (use of Colostomy bags to breach the normal transit route and bring the large intestine out through the abdominal wall into a stoma for elimination of stool) for CD patients is successful due to alleviating downstream inflammation (Ghouri et al., 2014).

 

FMT – Gut Flora Restoration

Fecal Microbiota Transplant (FMT) is a rapidly growing, newly re-discovered technique with many evolving aspects to it.  Taymount Clinic accepts both UC and CD patients for gut flora restoration but stringent admission protocols are applied to ensure that patients arrive not in an inflammatory flare and that they are currently in remission with or without medication, have a CRP level of under 10 and/or have no blood in their stool.

 

Not all IBD patients are suitable for gut flora restoration and it should not currently be considered as any kind of treatment or cure for IBD; restoring a good diversity of healthy gut flora has been shown to have beneficial effects on general health and some symptoms of the IBD condition have been shown to respond favourably – much more research is needed before conclusions about the efficacy of FMT for IBD can be established, however the following study is encouraging:

A recent FMT study consisting of 122 IBD patients, had an overall remission rate of 45%; a modest 22% rate in UC patient’s and a more advantageous 52% of CD patients experienced clinical remission (Colman and Rubin, 2014).

 

In conclusion, FMT has proven to have some successful effects for IBD sufferers, with differing outcomes depending on the severity of the individual case, but there is much ongoing research currently being undertaken to establish the efficacy and methods and the future will make it much clearer as to the correct protocols for use of FMT with IBD.

 

Ashleigh Howard

FMT Nutritional Therapist

Nutritionist BSc Hons ANutr.

Patient Testimonial

“Since I was diagnosed with Crohn’s Disease at the age of 16 (in 2009), I always had an inflammation that was difficult to stabilise in spite of a medicinal treatment with an anti-TNFalpha product.
It meant frequent abdominal pains, undone stools, regular fatigue and a CRP (C reactive protein C) blood value varying between 20 and 30.
In summer 2015, when I was 23 years old, I went to the private Taymount Clinic to receive 4 faecal implants, before returning home with 6 other implants that I could take myself. After these 10 implants, my disease showed quickly a very positive evolution. The CRP value fell down to consistently stay between 5 and 10, for more than 2 years now, my pains decreased, my fatigue also and stools became normal only a few months after implants.
In autumn, 2016, I decided to undercome an endoscopy control. It showed a complete healing of my colon, but a persistent inflammation of the small intestine.
I followed the dietary advice given by Taymount in 2015 and decided to eat gluten-free most of the time gluten-free and excluded totally all dairy products of my food.
I also took again half-a-dozen implants in 2017 to try to improve the healing of my small intestine. I was able to do them myself at home thanks to the remarkable service of Taymount Clinic which sent the implants to me.
I am very grateful for all the help that the Taymount Clinic was able to offer, and for the dialogue always maintained up to this day. The staff is very devoted and careful, and understand what being sick means.”

 

References:

 

Crohn’s and Colitis Awareness, 2017.

 

Saleh M, Elson CO. Experimental inflammatory bowel disease: insights into the host-microbiota dialog. Immunity. 2011;34(3):293–302.

 

Ghouri YA, Richards DM, Rahimi EF, Krill JT, Jelinek KA, DuPont AW. Systematic review of randomized controlled trials of probiotics, prebiotics, and synbiotics in inflammatory bowel disease. Clin Exp Gastroenterol. 2014;7:473–487

 

Colman RJ, Rubin DT. Fecal microbiota transplantation as therapy for inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2014;8(12):1569–1581.