Drinking Parasites or Fecal Transplant?

Parasite drinking

http://www.npr.org/2010/12/02/131753267/eat-your-worms-the-upside-of-parasites

Fecal Transplants

http://www.sciencedaily.com/releases/2011/10/111031114945.htm

Inflammatory bowel disease (IBD) is a group gut inflammatory conditions that affect the colon and small intestine. Two types exist, Crohn’s disease and ulcerative colitis. The main difference is the location and nature of the inflammation. Chron’s disease is usually classified as an autoimmune disease and can affect any part of the gastrointestinal tract from mouth to anus. Ulcerative colitis is a bowel disease in which the immune system appears to attack the lining of the colon, causing devastating ulcers. I will discuss the pros and cons of each treatment method.

Fecal microbiotoa transplants (FMT): The studies cited that treatment was effective in >80% (sometimes even 98%) of patients that suffered from diarrhea (caused by C. difficile infections) and did not have to remain on therapies post FMT. The cons to FMT were that some patients didn’t respond at all and for the case studies of IBD, multiple treatments (ie: daily rectal FMT for 1^st month, followed by weekly FMTs until 1FMT/6wks). However, it seems that the IBD patients are cured and even remained off therapy for the next four years.

Therapies for C. Difficile infection include antibiotics, probiotics, toxin-binding medications, and colonectomies (surgery to removed affected parts). Other studies by Furrie et al, and Kruis et al, have show that the use of probiotics have been effective in treating inflammation in patients with ulcerative colitis and even as successful as using antibiotics.

Parasite drinks – a drink with Trichuris suis ova taken 2x monthly decreased symptoms of IBD in many patients (Summers, et al 2003). Croese et al, 2006 also show that use of hookworms (Necator americanus) was effective in the treatment of IBD. There is increasing evidence, by Loke in the parasite drinking article and others, that the administration of worm eggs improves IBD symptoms. The possible mechanism is that worm ingestion causes the production of IL-22, which promotes epithelial growth and healing, and perhaps other ways to benefit the immune system. The con of this particular example is that once the worms begin to die, the disease comes back. Also, if the worms get too large, they can cause blockage of the GI tract and patients would then have to take medications to help expel them.

A possible mechanism of action is that the immune response is pushing more towards a TH2 response. Typically bacteria and viruses elicit a Th1 response, down regulating the Th2 response. The Hygiene hypothesis proposes that insufficient stimulation of Th1 can lead to an overactive Th2 response to self, thus infection with fecal matter or worms may positively select for genes, that historically and evolutionarily were beneficial wherein the contemporary, more sterile environment of today have deleteriously selected against that pressure. Fumagalli, et al (2009) studied autoimmune diseases and influences by interleukin gene polymorphisms and pathogens. They concluded that there were positive selective pressures induced by the presence of worms that had protective effects and identified potential IL-related SNPs for further study.

Croese J, O’neil J, Masson J, Cooke S, Melrose W, Pritchard D, Speare R. A proof of concept study establishing Necator americanus in Chrohn’s patients and reservoir donors. Gut. 2006, 55(1):136-7.

Fumagalli M, Pozzoli U, Cagliani R, Comi GP, Riva S, Clerici M, Bresolin N, Sironi M. Parasites represent a major selective force for interleukin genes and shape the genetic predisposition to autoimmune conditions. J Exp Med. 2009, 206(6):1395-408.

Furrie E, Macfarlane S, Kennedy A, Cummings JH, Walsh SV, O’neil DA, Macfarlane GT. Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patietns with active ulcerative colitis: a randomized controlled pilot trial. Gut. 2005, 54(2):242-9.

Kruis W, Fric P, Pokrotneiks J, Lukas M, Fixa B, Kascak M, Kamm MA, Weismueller J, Beglinger C, Stolte M, Wolff C, Schulze J. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalaine. Gut. 2004, 53(11):1617-23.

Summers RW, Elliott DE, Qadir K, Urban JF Jr, Thompson R, Weinstock JV. Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease. Am J Gastroenterol. 2003, 98(9):2034-41.