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Bacteria linked to bowel disorder
Milk bottles
The condition may be passed on through milk

Scientists have identified a type of bacteria they believe may cause Crohn's disease.

The bowel disorder affects 100,000 Britons and can cause a variety of symptoms, ranging from a lack of appetite to chronic diarrhoea and abdominal pain.

Its cause is unknown, although one theory is that it can be passed to humans in milk, suggesting that it may be caused by a bacterium.

This discovery of a type of bacteria in patients with the disease will raise hopes of better treatments to fight the condition.

Professor John Hermon-Taylor and colleagues at St George's Hospital Medical School in London carried out tests on a group of patients with Crohn's disease.

They also carried out tests on another group without the condition.

The discovery that the MAP bug is present in the vast majority of Crohn's sufferers means it is almost certainly causing the intestinal inflammation
Action Research

They found Mycobacterium avium paratuberculosis (MAP) bacteria in 92% of patients with the disease.

However, they only found the bacteria in 26% of patients without the condition.

This has led the scientists to suggest that this bacteria may play a key role in causing the disease.

"The rate of detection of MAP in individuals with Crohn's disease is highly significant and implicates this pathogen in disease causation," said Professor Hermon-Taylor.

"The problems caused by the MAP bug are a public health tragedy," he said.

IBS clue

Professor Hermon-Taylor said an unexpected finding of the research showed that patients suffering from irritable bowel syndrome (IBS) may also be infected with MAP.

IBS is painful and can cause diarrhoea, or diarrhoea alternating with constipation.

Sufferers often desperately need to go to the toilet with little warning, which severely limits their lifestyle.

No-one knows what causes IBS, although it is suggested that stress can make it worse. More women are affected than men.

"In animals, MAP inflames the nerves of the gut," Professor Hermon-Taylor said.

"Recent work from Sweden shows that people with IBS also have inflamed gut nerves.

"There is a real chance that the MAP bug may be inflaming people's gut nerves and causing IBS."

The findings are published in the Journal of Clinical Microbiology. Professor Hermon-Taylor said he has sent a copy of the paper to Sir Liam Donaldson, chief medical officer for England.

The research was welcomed by the medical charity Action Research.

It said that previous studies have suggested that MAP is found in 2% of retail pasteurised milk cartons.

"The discovery that the MAP bug is present in the vast majority of Crohn's sufferers means it is almost certainly causing the intestinal inflammation," it said in a statement.

"Action Research does not recommend that anyone stops drinking milk.

"However, for those individuals with Crohn's disease or their close relatives who may feel particularly at risk, it may be sensible to start drinking UHT milk.

"As UHT involves higher pasteurisation temperatures, it is probable that MAP is destroyed," it said.

The charity called for Crohn's to be made a reportable disease, for more stringent milk pasteurisation, for tests for MAP in dairy herds, and procedures for reducing MAP infection on farms.



Chilling theory on bowel disease

Some bacteria can thrive in the fridge

The rising popularity of domestic fridges during the 20th century may be responsible for a similar rise in Crohn's disease, say French scientists.

Their theory, published in the Lancet, is that bugs which grow in the fridge may play a role in the gut disorder.

Traces of these have been found in the bowel ulcers of Crohn's patients.

However, other experts point out there is no proof these cause the illness - and say fridges prevent dangerous food poisoning cases.

The unusual theory was suggested by doctors at hospitals in Paris, who noticed an interesting trend in cases of Crohn's during the last century.

Crohn's is much more common today than it was at the turn of the 20th century, and there is no obvious explanation for this.

But the researchers noticed that as the domestic fridge became a fixture in more and more homes from the 1940s onwards, the numbers of Crohn's cases rose as well.

In the US, where the fridge came into fashion earlier than in Europe, the rise in cases of the disease came earlier too.

Now approximately one in a thousand people in the UK has Crohn's, which causes inflammation of the lower gut, leading to severe cramps, diarrahoea, and, in the long term, the need for surgery to remove damaged sections of bowel.

Cold bugs

The French theory centres on "psychrotrophic bacteria" - which, unlike most bugs, have the ability to carry on reproducing even at quite low temperatures.

We propose a specific candidate for the development of Crohn's disease: The refrigerator
Research team

Two in particular, Yersinia and Listeria, will grow in numbers even inside a fridge, although not sufficiently quickly to cause food poisoning.

There is other evidence Crohn's may be linked to some kind of immune system problem - many sufferers have a mutation in a gene linked to immunity.

In addition, say the researchers, studies of the contents of Crohn's disease "lesions" inside the gut found traces of Yersinia and Listeria.

This, they say, points to the possibility that some kind of inappropriate immune response to these bacteria may trigger or worsen Crohn's - and say that the role of the fridge in exposing consumers to larger concentrations of them could be historically important.

"We propose a specific candidate for the development of Crohn's disease: The refrigerator.

"By themselves, each line of evidence is quite convincing, but their association is even more persuasive."

However, the researchers conceded that the benefits of refrigeration both at home and in food production far outweighed the risk of Crohn's should their theory be proven true.

Only a theory

Dr Jeremy Sanderson, a consultant gastroenterologist at St Thomas' Hospital in London, and an adviser to the National Association for Crohn's and Colitis, said: "It is good to see that people are thinking about the link between Crohn's disease genetics and bacteria.

"However, this paper is just a hypothesis and there is no shortage of hypotheses in the hunt for the cause of Crohn's disease."

This paper is just a hypothesis and there is no shortage of hypotheses in the hunt for the cause of Crohn's disease
Dr Jeremy Sanderson, St Thomas' Hospital London

Professor Jonathon Rhodes, a researcher at the University of Liverpool, agreed, saying: "This is an interesting hypothesis but it is not backed by any new data.

"We would say that if this hypothesis is correct, we would expect to see better therapeutic responses to the antibiotics known to be effective against Yersinia and Listeria in people with Crohn's disease."

A spokesman for the Food Standards Agency stressed the importance of refrigeration in the fight against food poisoning - which can be fatal in the very young and old.

"If some foods are not kept refrigerated, harmful bacteria can grow and toxins form, causing food poisoning," said a spokesman.

Thursday, 18 October, 2001, 22:53 GMT 23:53 UK
Seasonal variation in Crohn's risk
The time of birth may be crucial
The month in which a baby is born may influence its risk of developing the bowel disorder Crohn's disease, research suggests.

Researchers in Denmark identified 627 cases of Crohn's disease from 1977 to 1992 in people aged less than 21.

Seasonally prevalent infectious agents should be expected to cause a seasonal variation in birth month


Professor Henrik Toft Sorensen

They analysed the month of birth of each case and found the greatest number of births took place in August, and the fewest in March.

Previous studies have suggested that exposure to certain infections before birth or in early childhood are important risk factors.

The researchers speculate that infectious agents potentially linked to Crohn's disease may be more common at certain times of year than others.

This variation may lead to seasonal peaks and troughs in the numbers of babies who develop the condition.

Different findings

Regrettably we are still searching avidly for the cause of Crohn's


Dr Simon Travis

The findings contrast with a recent British study, that reported slightly increased risk of Crohn's disease in people born in the first half of the year.

The difference in the findings may reflect the fact that babies are exposed to different infectious agents in the two countries.

Lead researcher Professor Henrik Toft Sorensen, of Aarhus and Aalborg University Hospital, told BBC News Online: "Prior studies have suggested that infections in utero (during the mother¿s pregnancy) may be a possible cause for Crohn's disease.

"Therefore seasonally prevalent infectious agents should be expected to cause a seasonal variation in birth month.

"We found such an variation, but our data did not allow us to point out any specific infection."

UK view

Dr Simon Travis is a consultant gastroenterologist at the John Radcliffe Hospital, Oxford, and medical adviser for the National Association for Colitis and Crohn's disease.

He told BBC News Online that the concept of seasonal variation in the risk of Crohn's disease had been studied on many occasions since the mid 1960s.

He said the most reliable study to date was on 420 patients with ulcerative colitis and 142 patients with Crohn's disease in South Eastern Norway.

This identified seasonal variations in the onset of ulcerative colitis, but not of Crohn's disease.

Dr Travis said: "Any association with pre- or perinatal [before or soon after birth] infection must be speculative.

"Indeed, the peak birth rate in mid-summer is rather at odds with what one would expect, because infections are more common in winter months.

"The Danish study is interesting and enters the large body of literature on this topic, but should not be overinterpreted.

"Regrettably we are still searching avidly for the cause of Crohn's: it may turn out to be an infection, but the infection seems more likely to be one of the bacteria ordinarily present in the gut that causes disease in people who are genetically susceptible to the condition."

The research is published in the British Medical Journal.



    BIOCOCKTAIL �NK� (1997-1998) 

     Medicinal and preventive efficacy of probiotics (representing indigenous human flora) in cases of intestinal tract disorders had been proven beyond doubt in recent decades by numerous experimental and clinical research works.  Authors of the most recent publications (within 5 recent years) have produced proofs of positive effect of probiotics on traveler�s diarrhea, antibiotics - associated diarrhea, acute rotavirus and child diarrhea, acute pancreatitis, and peritonitis (1).  A number of research works have proved that probiotics are capable of correcting intestinal function and micro - ecology in chronic inflammatory disorders, in malabsorption, СРК, diarrhea, AIDS, and malignant tumors of large intestine (2).   

     According to the data of the researchers the positive effect is largely due to the ability of an active and functionally complete indigenous flora to increase colonization resistance of intestinal tract and to participate in the synthesis of biologically active substances and elimination of toxins, and its ability to exercise immune - modulating effect (3, 4, 5). Thus, at present, in general terms a positive effect of probiotics in promoting health and functional integrity of intestinal tract may be considered a proven fact (1, 5, 6). However there are considerable gaps in the proof - based argumentation in favor of application of probiotics in the abovementioned disorders.  This is due to the difficulty when it comes to selection of adequate criteria in evaluation of clinical efficacy as a high level of efficacy is not characteristic of all probiotics, and another reason is, it is true only for a number of nosologies (7).  

     Thus a majority of research works meeting modern requirements in terms of level of factual support are dedicated to Lactobacillus sp., Bifidobacillus sp. and В. Subtilis that constitute  part of the medications most popular in the pharmaceutical market (2).  

     Apart from that, the conducted research lacks sufficient study of the risk of translocation of indigenous culture and of the development of generalized septic complications in treatment of patients with probiotics containing microorganism necessary for human body.  

     Application of preparations of non-pathogenic E. cоli (Nissle 1917) in intestinal tract disorders meets all requirements for modern probiotics: 


     At present time there are publications on high clinical efficacy and safety of application of E. coli (Nissle 1917) preparations in non-specific ulcerating colitis and in functional intestinal disorders (8, 9), in pseudo-membranous colitis,  (10, 11, 15, 16), and as  part of combined treatment of prematurely born infants (12, 17). 

     A number of scientific publications prove efficacy of E. cоli (Nissle 1917) in experimental salmonellosis, bacilli dysentery (2, 13), listeriosis and fungal infections (14). 

     Summing up the published experimental and clinical data permits to maintain that the principal advantage of the preparations containing E. cоli (Nissle 1917) is their ability to exercise a considerable and “physiologically” safe influence in acute and chronic diarrhea, with genesis of the disease in some way related to infectious process or to adulterated immune reaction of a human.  

     It is due to these qualities that E. cоli (Nissle 1917) continues to attract attention of numerous researches in the 21 century, in the century of new food technologies free of borders, in the time of unprecedented new situation when it comes to epidemics around the globe.  

     The above reasons have brought to life the main directions of the present research dedicated to the study of clinical efficacy and safety of “NK” Bio - cocktail application containing E. cоli М-17, analogous to E. cоli  (Nissle 1917) and widely and traditionally applied in the USSR, presently used in the CIS and Russian Federation. 

     1 ml of “NK” Bio – cocktail contains > 3x107 КОЕ/ml E. cоli. An advantage of “NK” Bio - cocktail as compared to other E. cоli М-17 (Nissle 1917) preparations is that it contains active (non - lyophilized) E. coli culture. Theoretically it promotes earlier development of therapeutic efficacy.  

     �NK� Bio - cocktail also contains extracts of parsley, cabbage, mint, and propolis (bee-glue) that improve E. coli adaptation in intestinal tract. On the other hand these biologically active substances may cause development of allergic reactions. 

     The present report contains results of the research of safety and influence of �NK� Bio - cocktail on the course and outcome of the following diseases: 


A total of 325 patients of Moscow hospitals with the above disorders participated in the research in 1997 - 1998. At the same time the efficacy of �NK� Bio - cocktail was studied in the patients of the Institute of R&D of Pediatrics of the Russian Academy of Science; in Republican Center of Rehabilitation and Remedial Therapy of Disabled Children, in a number of medical institutions of Kazakh Republic, Republic of Belarus, and Ukraine.  However it�s not possible to generalize the obtained results for the reason of insufficient number of observed patients of each nosology, for lack of continuity in processing minutes and individual patient�s charts, and for variations in the basic criteria in evaluation of the results.