Crohn’s strictures open with anti-mycobacterial antibiotic therapy:A retrospective review  

作　　者：Rhys Collyer Annabel Clancy Gaurav Agrawal Thomas J Borody 

机构地区：[1]Centre for Digestive Diseases,Five Dock 2046,NSW,Australia

出　　处：《World Journal of Gastrointestinal Endoscopy》2020年第12期542-554,共13页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：BACKGROUND Medical therapy for strictures is limited and first-line treatment consists of endoscopic balloon dilatation,strictureplasty or surgical resection.Mycobacterium tuberculosis,Helicobacter pylori and Streptococcus can all cause stenosis,for which antibiotic treatment achieves stricture resolution.Mycobacterium avium ssp.paratuberculosis is a suspected causative agent in Crohn’s disease(CD).Thus,specialized antimicrobial treatment,in particular,anti-mycobacterial antibiotic therapy(AMAT)has been proposed as a potential treatment option.To our knowledge,the opening of CD strictures has not been recorded using any form of antibiotic therapy.We hypothesized that AMAT would resolve strictures in patients with CD.AIM To investigate the effect and outcomes of AMAT in a cohort of CD patients with an ileal stricture.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.Forty patients meeting the inclusion criteria were identified from the internal medical database.Thirty(75%)patients had follow-up colonoscopy and clinical data available.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.RESULTS Of the patients that returned for follow-up after>24 mo of AMAT,twenty(67%)had complete resolution(CR)of their ileal strictures,three(10%)had partial resolution and seven(23%)had no resolution.Irrespective of stricture outcome,21 patients(70%)demonstrated clinical response to AMAT and there was a statistically significant reduction in inflammatory serum markers C-reactive protein(P<0.0001)and erythrocyte sedimentation rate(P=0.04)from pretreatment to follow-up.It was observed that 11(37%)p

关 键 词：ANTIBIOTICS COLONOSCOPY Crohn’s disease ILEUM Inflammatory bowel disease STRICTURE 

分 类 号：R574[医药卫生—消化系统]