A Country Doctor Writes:

Are Crohn’s and Ulcerative Colitis Infectious Diseases?

This week, an article in JAMA by Costello and colleagues describes a successful, brief protocol for fecal transplants in ulcerative colitis:

“In this preliminary study of adults with mild to moderate UC, 1-week treatment with anaerobically prepared donor FMT compared with autologous FMT resulted in a higher likelihood of remission at 8 weeks. Further research is needed to assess longer-term maintenance of remission and safety.”

Last year I had a patient with refractory clostridium difficile colitis go to Portland for a single fecal transplant and return home cured, with a normal bowel movement the next day.

So, we understand clostridium difficile as an infection, but are Crohn’s Disease and ulcerative colitis also infections? We have thought of them as autoimmune. Now many thinkers are proposing that diet influences bacterial homeostasis and intestinal permeability, which in turn causes our immune system to become exposed to antigens it normally doesn’t encounter. This in turn triggers an inflammatory response that manifests itself as autoimmune disease in any of many organs.

In recent years there have been several articles published about the use of fecal transplants in Crohn’s disease, including a 2017 paper by Bak and colleagues, which expands a bit on the concept of DYSBIOSIS, altered gut flora. The idea is apparently quite old:

“The concept of FMT for treatment of human intestinal diseases was described in China during 4th century, and human fecal suspension by mouth was used to treat patients who had food poisoning or severe diarrhea.”

The paper continues:

“Increasing evidence suggests that specific changes in the composition of gut microbiota, termed as dysbiosis, are a common feature in patients with inflammatory bowel disease (IBD). Dysbiosis can lead to activation of the mucosal immune system, resulting in chronic inflammation and the development of mucosal lesions. Recently, fecal microbiota transplantation, aimed at modifying the composition of gut microbiota to overcome dysbiosis, has become a potential alternative therapeutic option for IBD. Herein, we present a patient with Crohn’s colitis in whom biologic therapy failed previously, but clinical remission and endoscopic improvement was achieved after a single fecal microbiota transplantation infusion.”

What Causes “Leaky Gut?”

“Leaky Gut” has been triggered by any degree of gluten intolerance and many other things.

Chris Kresser, a prominent Functional Medicine practitioner wrote last summer:

“Obesity, diabetes, and metabolic syndrome have long been associated with gut barrier dysfunction and an altered gut microbiota composition”.

He goes on to quote work on how ingested sugar causes leaky gut, but also points out that leaky gut has been noted to cause insulin resistance, an apparent vicious cycle:

To many, dysbiosis and leaky gut are at the root of many of today’s chronic diseases, while others downplay the importance of these mechanisms even though they acknowledge that they exist. The conservative British National Health Service states:

“Alcohol, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are well-known irritants of the bowel lining. They can damage the seals between cells, allowing some substances to pass through the gaps and into the bloodstream.”

Other causes of increased gut permeability listed by the NHS are chemotherapy drugs, radiation, immunosuppressants, HIV/AIDS and Cystic Fibrosis. They also list Inflammatory Bowel Disease as a cause of leaky gut, but it now seems it’s the other way around.

Once considered “fringe” theories, leaky got and dysbiosis are rapidly becoming mainstream.