P2725 - Antibiotics and FMT Can Achieve an Actual Cure of Crohn's Disease

Gaurav Agrawal, MBBS, MRCP, Portia Murphy, BSc, Margaux Torres, BSc, Encarnita Sitchon, BN, Teresita Tugonon, BN, Christelle Pagonis, BSc, Amrutha Varshini, , Antoinette LeBusque, NP, Jeffrey Tu, MBBS, Thomas Borody, MB, BS, BSc, MD, PhD, FACG
Centre for Digestive Diseases, Five Dock, New South Wales, Australia

Introduction: Crohn’s disease (CD) is an increasing chronic inflammatory bowel disease characterized by deep ulcerations with transmural inflammation and granulomas. CD is thought have autoimmune origins and is considered incurable. Mainstream treatments focus on reducing inflammation by suppressing immune responses . However, efficacy is often suboptimal with lifelong treatment required, relapse is common and surgery necessary at times.
An infectious etiology of CD was posited by Dalziel in 1913, who noted similarities with Johne’s disease while Burrill Crohn’s team attempted to culture a TB-like infective agent. Later, culture of a causal TB-like organism which satisfied Koch’s postulates, Chiodini identified a humanized strain of Mycobacterium avium ssp. paratuberculosis (MAP), which became the leading causal candidate of CD. Specialized Anti-MAP treatment with rifabutin, clofazimine, clarithromycin, with other possible components and restoration of the gut microbiome using fecal microbiota transplantation (FMT) has emerged as the only treatment with a documented cure of CD. Cure of CD has recently been defined as complete absence of CD in the absence of all therapy for a minimum of 3 years.


Case Description/Methods: We have previously reported ‘prolonged profound remission’ and now report 4 patients with initially severe and complicated CD, who achieved cure using a combination of Anti-MAP then FMT. The patients, treated between 1996-2017 are now on no treatment for CD ranging from 3-12 years with follow up colonoscopies and calprotectin as recent as 2023. Some patients’ follow ups have not been as recent as they no longer required ongoing treatment and have longer time periods between follow-ups.

Discussion: This shows the combination of anti-MAP and FMT can achieve a cure. However, at this stage the numbers are low, treatments are varied according to the individual, and so refinements of therapy are required for more patients to be cured. Further large-scale studies are required to determine a standard treatment of care to achieve cured status in a greater proportion of treated patients. An accurate diagnostic test of MAP is essential with the capability for antibiotic sensitivities. Together with the success of this antibacterial treatment seen here, the question of the etiology of CD with a potential bacterial or microbial imbalance component becomes prominent.
This study shows for the first time that a cure for Crohn’s is possible.



Disclosures:


Gaurav Agrawal, MBBS, MRCP, Portia Murphy, BSc, Margaux Torres, BSc, Encarnita Sitchon, BN, Teresita Tugonon, BN, Christelle Pagonis, BSc, Amrutha Varshini, , Antoinette LeBusque, NP, Jeffrey Tu, MBBS, Thomas Borody, MB, BS, BSc, MD, PhD, FACG. P2725 - Antibiotics and FMT Can Achieve an Actual Cure of Crohn's Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.