Weekday Links Part II: Anti-inflammatory herb for IBD, Stem Cell Crohn's, Detecting Crohn's With Laser, Sweden Highest Crohn's Rate in Europe

Endoscopic Balloon Dilation and Crohn's
So I wasn't familiar with what even a endoscopic balloon dilation (EBD) does. The procedure seems like it is mainly used for strictures and can be used as an alternative to surgery. In the study 43% of patients achieved long-term benefit from EBD.

Vitamin D and Crohn's: Sunlight Decreased of Crohn's Disease 
In a study that looked at over 90,000 women in France higher levels of sun exposure was associated with an decrease in Crohn's but not ulcerative colitis.

Anti-inflammatory herb for IBD?
So it seems as if a Chinese herbal drug may have some benefits in people. The trial looked at just mice however showed that FAHF-2 may be a novel treatment for Crohn's.

Hematopoietic stem cell transplantation in refractory Crohn's. 
Stem cells has been used for Crohn's (however it can be quite dangerous and even deadly). In this trial 26 patients were included. Many patients in this study (which just looked at toxicity) experienced infections and the study recommends to use the stem cells only in extraordinary situations.

Early Detection of Crohn's With Laser
Recently it was announced that a pill camera was approved by the FDA to be used as a colonoscopy. Now it seems as if researchers are taking colonoscopy to the next step by using blue laser which can magnify the intestinal wall and magnify it 1,000 times and see the earliest abnormal cells. The laser is being used by Ohio State Medical Center. Dr. Razvan Arsenescu has been using the laser and the hope is the laser will be used not only to treat IBD but also lung, bladder, and other diseases.

Sweden Highest Rates (In Europe) of Crohn's Disease 
Canada has the highest rates of Crohn's disease in the world and it looks like Sweden has the highest rate in Europe. The study showed that patients who had Crohn's for 40 years had an increased risk for surgery. The mean annual rate for Crohn's was 9.9 people/100,000/year (which is still a very small percentage of the population).

Crohn's and Stem Cells: Review of The Medical Literature

Recently I saw a story about how two HIV patients after bone marrow transplants  so far have no signs of the disease. People forget but HIV does involve the immune system just like Crohn’s disease. Four months after the transplant doctors could still detect HIV in the blood however 6-9 months later all the HIV was gone.

The first case for use of stem cells in Crohn’s was on Joy Weiss who underwent a stem cell treatment in 2001. It was performed by Dr. Richard Burt who is at Northwestern Medical School in Chicago, Illinois. The process for undergoing the stem cell transplant is not fun. Basically you have to undergo chemotherapy to “reboot” the immune system.  After the procedure though Weiss for the first time in 11 years had a remission of Crohn’s. Sadly 3 years after the procedure (in 2004) was performed Joy Weiss passed away.  Speaking of Northwestern in 2010, this study of 24 patients out of Northwestern by Dr. Burt and Dr. Craig showed the clinical free relapse rate was 96% at 1 year, 63% at 3 years, and 36% at 5 years.

This study from Barcelona by Dr. Julian Panes showed that 80% of patients were in remission after 6 years and 20% of patients have shown constant improvement after the transplant. Hospital Clinic de Barcelona has only done the treatment on 6 patients.

.A study from earlier this year in the journal Stem Cells showed that in 43 patients with Crohn’s that were treated using adipose tissue derived stem cells closed fistulas in 82% of patients.  70% of all patients had their fistulas closed after 1 year. I hope more studies are done on this to show that stem cells could really help close fistulas.  The video can be seen here.

A case study for a 36 year old male patient showed the patient was in complete clinical, endoscopical, and histological remission after 9 months of treatment.

This article talks about how at the Royal Perth Hospital in Australia 80% of patients responded to stem cell therapy with more than 50% going into remission. At DDW 2013 this year Dr. Christopher Hawkey from University of Nottingham showed some positive results with stem cells.  The study looked at 45 patients with Crohn’s who failed at least 3 immunosuppressive drugs (they also took patients who were extremely sick and for whom surgery did not help). What bothers me is that the study used a control group. I know scientists need a control group and treatment group. However, when patients are in dire straits with their health is it really ethical to do? The study showed that 50% of patients were in clinical remission and over 66% of the patients who received treatment stopped immunosuppressive therapy. The downside is there were some adverse effects. One patient did die during the study (from sepsis).

According to this article from the New England Journal of Medicine between 1993-1997 1418 people received allogenic hematopotietic cell transplantation. The mortality decreased 52% over this period of time (some of these people had very serious illnesses like cancer).

Stem cells to treat Crohn's looks like it might have an application for patients who have failed medical therapy, surgery, and all other treatments. It is important to note that stem cell therapy does carry risk. However, over time the treatment will become a lot less risky and hopefully become more effective.