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Crohns disease

Category: Illness or disabilities

Type

Involuntary

Introduction and description

The 34th President of the United States of America, President Dwight D
Eisenhower, was diagnosed with Crohn’s disease while in office. He was
hospitalized at Walter Reed Hospital and underwent surgery for a bowel
obstruction on June 9, 1956. He also had heart problems.
He died March 28, 1969

Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract, with increasing incidence worldwide.  It is the product of a complex interplay between pathogens, pharmaceuticals, toxins and other external environmental factors, and their effects in altering gut microbiota.

According to one paper, the incidence of Crohn's disease (CD) has increased overall in Europe from 1.0 per 100,000 person-years in CD in 1962 to 6.3 per 100,000 person-years in 2010, but we think this figure is an underestimate.  Crohn's disease is a good deal less common in Asia and Africa, for reasons which will become apparent shortly, though since 1970, the numbers have started to increase there too.  This chart shows the number of cases from eHealthme, which collects the Adverse Drug Reports from doctors to obtain its figures, the trends are very clear.

Unofficially, Crohn's Disease is said to affect nearly 1.6 million Americans, and celebrities are not immune to this terrible illness, so we have provided a few examples of well known people who suffer with you.  Several famous actors, politicians, musicians and athletes have been diagnosed with Crohn's Disease. Some continue to work despite their diagnosis, while others have been forced into retirement.
The disease was named after gastroenterologist Burrill Bernard Crohn, who, in 1932, together with two other colleagues at Mount Sinai Hospital in New York, described a series of patients with inflammation of the terminal ileum of the small intestine, the area most commonly affected by the illness.

Crohn’s disease and intestinal dysbiosis

 

Crohn’s disease is actually intestinal microbial dysbiosis. 

In effect, the intestinal flora of the intestine has somehow become severely disrupted.  There is a great deal of similarity between Crohn’s disease, ulcerative colitis, Behçet's disease and IBS because they are all largely caused by microbial dysbiosis.  And researchers are starting to realise that an absolute plethora of disease may be due to the same sequence of events

An "imbalance" of the microbiota, frequently also called a "dysbiosis," has been associated with different diseases in recent years. Crohn's disease and ulcerative colitis as two major forms of inflammatory bowel disease, irritable bowel syndrome (IBS) and some infectious intestinal diseases such as Clostridium difficile colitis feature a dysbiosis of the intestinal flora.
Whereas this is somehow expected or less surprising, an imbalance of the microbiota or an enrichment of specific bacterial strains in the flora has been associated with an increasing number of other diseases such as diabetes, metabolic syndrome, non-alcoholic fatty liver disease or steatohepatitis and even psychiatric disorders such as depression or multiple sclerosis. It is important to understand the different aspects of potential contributions of the microbiota to pathophysiology of the mentioned diseases.  PMID:  25563215

Theoren Fleury is an athlete, famous for his ice
hockey career. The retired Canadian hockey star is a
Stanley Cup champ and an Olympic gold medal
winner. In 1995,Fleury was diagnosed with Crohn’s
disease and today is a ‘motivational speaker’.

What is actually happening is that a pathogen manages to breach the defences of the mouth, and stomach and then enters the intestines where it completely disrupts the intestinal flora. 

Viruses, bacteria, parasites, fungi and various toxins can all do this.  If the body is unable to fight back effectively, then the pathogen may breach the intestinal wall and then it can wreak havoc, as it can effectively go anywhere in the body via the blood stream. 

The diseases it can cause are of course almost limitless, as it depends on how good the immune system is at fighting the pathogen and where the pathogen decides it would like to go.  Some like the heart, some like the spleen, some like the pancreas…. 

In Crohn’s disease there are some markers of the pathogens implicated, but research is still ongoing to find out what exactly is happening.  All that is known for sure is that, if we think of the intestine as a garden, disease is caused by native plants that have become weeds and exotics that have taken over. For example:

Using samples from multiple gastrointestinal locations collected prior to treatment in new-onset cases, we studied the microbiome in the largest pediatric CD cohort to date. An axis defined by an increased abundance in bacteria which include Enterobacteriaceae, Pasteurellacaea, Veillonellaceae, and Fusobacteriaceae, and decreased abundance in Erysipelotrichales, Bacteroidales, and Clostridiales, correlates strongly with disease status. Microbiome comparison between CD patients with and without antibiotic exposure indicates that antibiotic use amplifies the microbial dysbiosis associated with CD. Comparing the microbial signatures between the ileum, the rectum, and fecal samples indicates that at this early stage of disease, assessing the rectal mucosal-associated microbiome offers unique potential for convenient and early diagnosis of CD. PMID:  24629344

Seantrel Henderson is taking prescribed medical marijuana for both
his Crohn’s disease and the pain resulting from two intestinal surgeries
tied to the condition.

On the other hand

The relative abundance of Bacteroidetes is increased and Firmicutes decreased in Crohn's disease compared with healthy controls. Enterobacteriaceae, specifically Eschericia coli, is enriched in Crohn's disease. Faecalibacterium prausnitzii is found at lower abundance in Crohn's disease and in those with postoperative recurrence. PMID: 25844959

And we also have

Bacterial microbiota in Crohn's disease patients was characterised by a restriction in biodiversity. with an increase of Proteobacteria and Fusobacteria. Global fungus load was significantly increased in Crohn's disease flare compared with healthy subjects [p < 0.05]. In both groups, the colonic mucosa-associated fungal microbiota was dominated by Basidiomycota and Ascomycota phyla. Cystofilobasidiaceae family and Candida glabrata species were overrepresented in Crohn's disease. Saccharomyces cerevisiae and Filobasidium uniguttulatum species were associated with non-inflamed mucosa, whereas Xylariales order was associated with inflamed mucosa.  Our study confirms the alteration of the bacterial microbiota and is the first demonstration of the existence of an altered fungal microbiota in Crohn's disease patients, suggesting that fungi may play a role in pathogenesis.  PMID: 26574491

There are fungi, bacteria, viruses and even parasites already in the intestine, but they all have a role to play.  They keep one another in balance, and it is the growth of one type or species beyond their normal proportions or the invasion by other substances that have no role there that cause the problem.  We do not believe there is some sort of signature of flora one can state is Crohn’s disease.  It is a symptom of imbalance, - dysbiosis-  that is all.

Symptoms

People with Crohn's disease experience chronic recurring periods of flare-ups and remission. Symptoms include abdominal pain, diarrhoea (which may be bloody if inflammation is severe), fever, and weight loss.

  • Weight loss and failure to thrive - Paediatric patients [children] may show failure to thrive, growth impairment, and delayed puberty; other patients may simply lose weight.  This is because an intestinal flora that is severely disrupted no longer processes nutrients effectively – one is effectively being starved of nutrients.  People with Crohn's disease often have anaemia due to vitamin B12, folate, and iron deficiency.
  • Diarhoea – The body tries to rid itself of pathogens using vomiting and diarrhoea.  There are different sorts of gardens – flora – in different parts of the intestine and, up to a point, the diarrhoea that results from dysbiosis in these gardens tends to be slightly different.  Ileitis may result in large-volume, watery faeces, for example, whereas Colitis may result in a smaller volume of faeces of higher frequency. Fecal consistency may range from solid to watery. In severe cases, an individual may have more than 20 bowel movements per day and may need to awaken at night to defecate.  Remember that the body is doing its best to rid itself of the weeds, as such although this may be embarrassing and exhausting, it is far better to help the process using plenty of fluids. 
  • Flatulence and bloating may also add to the intestinal discomfort.  Often this is a sign of fungal infestation and overgrowth, in the same way that yeast when it ferments produces gas, especially if there are sugars present, then so can fungi and yeast in the intestine.  One can help oneself here by reducing all sugars to virtually zero and lowering carbohydrate intake.
  • Perianal discomfort may also be prominent in Crohn's disease. Itchiness or pain around the anus may be suggestive of inflammation, fistulization or abscess around the anal area or anal fissure. Perianal skin tags are also common in Crohn's disease and may appear with or without the presence of colorectal polyps.
  • Bloody bowel movements-  may be bright or dark red in colour. In the setting of severe Crohn's colitis, bleeding may be copious.  This may be a sign that the pathogens have damaged the intestinal wall. This is a serious symptom, as once the intestinal wall has been damaged, pathogens can enter the blood stream and symptoms of pathogen attack will start to appear in the rest of the body.
  • Other symptoms - Once the pathogens have entered the blood stream one may see skin rashes, arthritis, inflammation of the eye, and tiredness.  There may be mouth ulcers.  All these latter symptoms are an indication that the pathogens have travelled to other parts of the body, having probably broken through the intestinal wall.  And they may be the tip of the iceberg, as such more drastic measures are needed to stem the flood.
  • Neurological complications - Normally the blood brain barrier protects the brain from any pathogens lurking in the blood stream, but if it has been compromised, then one may even find that the escaped ‘weeds’ from the garden of the intestine have managed to enter the brain.  Crohn's disease can also cause neurological complications (reportedly in up to 15%). The most common of these are seizures, stroke, myopathy, peripheral neuropathy, headache and depression.

Mike McCready is an American musician who serves as the lead guitarist for the American grunge band Pearl Jam. He was diagnosed with Crohn’s disease at the age of 21.  After publicly announcing his condition, McCready took on the activist role, volunteering with the northwest chapter of the Crohn’s & Colitis Foundation of America, including lending his talents for fundraisers.

 

Causes

What causes this dysfunction – this disruption of the intestinal flora?  The main causes are

  • Stress and shock – which affect the immune system rendering it temporarily unable to fight any pathogens that enter the gastrointestinal system
  • Nutritional deprivation – which has the combined effect of suppressing the immune system’s ability to combat pathogens, and at the same time proviidng the intestinal flora with an imbalance of nutrients
  • Surgery   Removal of the gall bladder the source of bile acid, a key part of the protective immune response, is extremely unwise at the best of times.  Then there may be surgery which damages our intestines, for example gastric band which reduces gut flora; or surgery which leaves us open temporarily to invaders, or plastic surgery.
  • Pharmaceuticals – in medications and in farming, in this respect antibiotics have a very deleterious effect on the flora of the intestine, however, other pharmaceuticals are also implicated
  • Toxins – such as insecticides, pesticides etc on food

We will also take a look at parasites and their role.

Stress and shock

Elizabeth Caroline “Beth” Orton is an English singer-songwriter,
known for her ‘folktronica’ sound, which mixes elements of folk
and electronica. Beth was diagnosed with Crohn's disease
when she was 17 years old.

Grief, trauma, sudden shock, the death of a parent or child, the loss of a job, divorce, separation, fear and abuse, all can have an effect on the immune system by triggering the fight or flight system – the sympathetic nervous system.  Whilst we are in fight or flight mode the immune system becomes depressed.  It is only when we are content and relaxed and our parasympathetic nervous system starts to kick in that the immune system gets to work effectively.  At times of low but extreme emotion, many of the systems that protect us fail. 

If we swallow a pathogen infected meal, and we are stressed, gastric acid will not be released, the pathogens will not be killed and they, along with half digested food, will travel into the intestines. 

This article is a report of the authors' experience with a series of forty-six patients with Crohn's disease seen in psychiatric consultation over a nine year period. …. The most common reason that psychiatric consultation was requested was depression .... Factors which appeared to contribute to psychiatric morbidity were ….. current psychosocial stress unrelated to Crohn's disease and a history of traumatic childhood experiences. PMID:  7095983

Nutritional deprivation

Diet and poor nutrition may directly affect the intestines, by depriving the flora of the nutrients needed to grow a balanced flora.  But poor nutrition also has its effect by  rendering the body incapable of protecting itself.  Again, the full immunological protection provided by a healthy body is simply not there.  We can better see how important diet is by observing what happens when a poor diet is rectified:

Dietary therapy had independent and rapid effects on microbiota composition distinct from other stressor-induced changes and effectively reduced inflammation. These findings reveal that dysbiosis results from independent effects of inflammation, diet, and antibiotics and shed light on Crohn disease treatments.  PMID:  26468751

The writer of the script for the 70’s cult class, Alien, Dan O’Bannon, who died in 2009 battled Crohn’s disease. According to a recent book by colleague Zinoman;“The digestion process felt like something bubbling inside of [O’Bannon] struggling to get out. From his own torment came the idea for the alien bloodily punching its way out of John Hurt’s chest during dinner.”

Pharmaceuticals

A considerable number of pharmaceuticals can cause Crohn's disease - thousands.  Using the Adverse Drug Reports submitted to the FDA and SEDA in the USA and summarised on eHealthme this LINK shows drugs implicated in causing Crohn's disease.  If the link does not work, use the symptoms list to find Crohn's disease and then, scrolling down the page go to 'Drugs that can cause'.

Although exceptionally useful, this list does not provide an overall picture of the key types of pharmaceutical, nor the reason why they have this effect.  So we will now explore this.

Antacids and Proton Pump Inhibitors

Pathogens are normally sensitive to the stomach's production of hydrochloric acid: even if the food or water is infected badly, the stomach acid should kill the pathogens.  Stress and negative emotion – grief, trauma, and so on all suppress stomach acid as such this is why negative emotions destroy our first line of defence.  But so can pharmaceuticals.  If people take antacid medication or proton pump inhibitors, they are at higher risk of contracting disease from a smaller amount of organisms, since this type of medication inhibits normal gastric acid.

Antibiotics in farming and medicine

Antibiotics are used in farming, and have been used completely indiscriminately by the medical profession. 

 

They are used in farming to keep animals kept in inhumane conditions alive long enough so they can be sold as food; they are also used in farming to fatten animals – providing proof, if proof were needed, that antibiotics are implicated in obesity of people as well as animals.  

They are used as a ‘preventative’, when they have no ability to prevent anything. 

They are used for viral illnesses when they have no ability to tackle viruses. 

The mis-use of antibiotics is probably one of the medical and farming profession’s most negligent even evil acts.  Antibiotics destroy the balance of the intestinal flora and the mouth flora, as such they cause the dysbiosis mentioned above.

Antibiotic exposure was associated with increased dysbiosis., PMID:  26468751

And

…. a normal, healthy gut microbiota can generate conditions in the gut that disfavour colonization of enteric [relating to or occurring in the intestines] pathogens. This is termed colonization-resistance (CR).  Upon disturbance of the microbiota, CR can be transiently disrupted, and pathogens can gain the opportunity to grow to high levels. This disruption can be caused by

  • exposure to antibiotics,
  • changes in diet,
  • application of probiotics and drugs, and
  • a variety of diseases.

Breakdown of CR can boost colonization by intrinsic pathogens or increase susceptibility to infections. One consequence of pathogen expansion is the triggering of inflammatory host responses and pathogen-mediated disease. PMID:  26185088


British golfer James Morrison was diagnosed with Crohn’s disease
when he was 16 years old. During the 2011 French Open, a
flare-up landed him in the hospital, but Morrison rallied and
managed to finish the competition

Once the intestines are compromised, pathogens can destroy the lining of the intestines and enter the blood stream or cause the bloody diarrhoea that is a hallmark of Crohn’s disease.

Immunosuppressants

Immunosuppressants suppress the immune system, which must be one of the most bizarre actions the medical profession undertake. 

So called 'steroids' are immunosuppressants.  The name is a shortened form of glucocorticosteroid. GCs  reduce certain but not all aspects of immune function, neverthless you will have an immune function that no longer works.  Our doctors use symptom based medicine because it is easier, and they make more money from selling pharamaceuticals than they do healing people.  As such whenever the symptoms of the immune system working away most effectively are seen, they say the person does not have an 'effective' immune system, but an 'overactive' immune system, and classify the disease as an autoimmune disease.  Needless to say, people never get better on imunosuppressants, though they do die fairly quickly with their symptoms well suppressed.  Suppression of the immune system increases the risk of infestation of the entire body. 

The authors report a case of disseminated tuberculosis following treatment with Anti-tumor necrosis factor (TNF) therapy [an immunosuppressant] with the following features: pulmonary tuberculosis, left supra clavicular cervical and meditational lymphadenopathy, bilateral pleural effusion, peritoneal and splenic involvement. This disseminated tuberculosis was observed in a 39-year-old woman who was treated by infliximab for refractory Crohn's disease. The evolution with antituberculosis drugs was fatal, the death of the patient was due to hepatic encephalitis.  PMID:  25131370

Shannen Maria Doherty (born April 12, 1971) is an American actress,
producer, author, and television director. She is known for her roles
as Heather Duke in Heathers (1988), Brenda Walsh in Beverly Hills,
90210 (1990–1994) and as Prue Halliwell in Charmed.  Doherty
announced in 1999 that she was diagnosed with Crohn's disease. 
Doherty was diagnosed with breast cancer in March 2015, which
had spread to her lymph nodes.

Mouthwashes

Mouthwashes with antibacterial properties affect the mouth's natural protection against pathogens.

Anti-emetics 

Anti-emetics stop us vomiting out pathogens.  If we get an overdose of any pathogens, parasites or anything else and use anti-emetics, then the parasite simply enters the stomach and intestines.

Anti-diarrhoea medication

Diarrhoea is the natural flushing mechanism of the body, enabling it to remove parasites or other pathogens.  By using any medication that stops us pooing out pathogens we have effectively given them free access to do as much damage as they wish.

Diuretics

Diuretics are intended to flush water away from the body.  But that water may be needed and be being used to flush pathogens away.  The body may actually be storing water in cells in order to have enough supplies to do the flushing.  Use a diuretic and your oedema – a symptom after all not a cause – may appear to be better.  On the other hand, the parasites now in your intestines may be breeding like crazy because the body has no water to flush them away.

Laxatives

Natural laxatives, found as food, present no risk, as it is highly unlikely anyone would want to overdose on prunes, for example.  But it is all too easy to overdose on over the counter or doctor prescribed laxatives.  Those impatient at the time it is taking for anything to happen, may decide in a fit of pique to ‘have just a bit more’.  It may well work a treat, but by forcing the intestines to expel much harder and more quickly, we may also find that a large portion of our intestinal flora disappears too.

Toxins -Pesticides, insecticides, defoliants and herbicides

 

There are now very clear links between the use of pesticides, insecticides, herbicides and the sorts of defoliants used to harvest peas and potatoes on non organic farms; and the destruction of the intestinal flora of animals – including humans.  There are a considerable number of published papers on this now, this is a recent one:

The gut microbiota: a major player in the toxicity of environmental pollutants? - Sandrine P Claus, Hervé Guillou & Sandrine Ellero-Simatos npj Biofilms and Microbiomes 2, Article number: 16003 (2016) doi:10.1038/npjbiofilms.2016.3

Exposure to environmental chemicals has been linked to various health disorders, including obesity, type 2 diabetes, cancer and dysregulation of the immune and reproductive systems, whereas the gastrointestinal microbiota critically contributes to a variety of host metabolic and immune functions.
We aimed to evaluate the bidirectional relationship between gut bacteria and environmental pollutants and to assess the toxicological relevance of the bacteria–xenobiotic interplay for the host. We examined studies using isolated bacteria, faecal or caecal suspensions—germ-free or antibiotic-treated animals—as well as animals reassociated with a microbiota exposed to environmental chemicals.
The literature indicates that gut microbes have an extensive capacity to metabolise environmental chemicals that can be classified in five core enzymatic families (azoreductases, nitroreductases, β-glucuronidases, sulfatases and β-lyases) unequivocally involved in the metabolism of >30 environmental contaminants.
There is clear evidence that bacteria-dependent metabolism of pollutants modulates the toxicity for the host. Conversely, environmental contaminants from various chemical families have been shown to alter the composition and/or the metabolic activity of the gastrointestinal bacteria, which may be an important factor contributing to shape an individual’s microbiotype.
…. pollutant-induced alterations of the gut bacteria are likely to contribute to their toxicity. In conclusion, there is a body of evidence suggesting that gut microbiota are a major, yet underestimated element that must be considered to fully evaluate the toxicity of environmental contaminants.

Parasites

Juliet Anderson (July 23, 1938 – January 11, 2010) was an
American pornographic actress. ‘She was said never to have
faked an orgasm in any of her films’.  On the morning of
January 11, 2010, a friend discovered Anderson's body,
having arrived at Anderson's residence to take her to a
doctor's to help her with the treatment of Crohn's Disease.

Superficially, there appears to be no evidence that parasites, despite their ability to colonise the intestine and attack the intestinal wall, are the cause of Crohn’s disease.  But we may be overlooking some vital evidence. 

Parasites such as Taenia crassiceps, - a parasitic tapeworm which is related to Taenia solium, the pork tapeworm, and to Taenia saginata, the beef tapeworm – hides its presence by suppressing inflammatory responses, as such although damage may be underway, the pain associated with Crohn's disease may not at first be present.

Chronic inflammation of the intestinal mucosa is characteristic of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Helminth parasites have developed immunomodulatory strategies that may impact the outcome of several inflammatory diseases…………………… T. crassiceps infection limits the pathology of ulcerative colitis by suppressing inflammatory responses mechanistically associated with AAMФs [alternatively activated macrophages] and prostaglandins. PMID:  26090422

In effect, by suppressing the inflammatory response, parasites can also suppress the immune response and thus have the effect of causing dysbiosis.

 

Treatment

Diagnosis

Try to find out what has caused the dysbiosis, because if it is a parasite it needs to be treated and removed from your intestines.  Diagnosis is at the moment quite problematic, but is likely to be made easier in the future with the advances in Metagenomic testing

Using shotgun metagenomic sequencing, we analyzed fecal samples from a prospective cohort of pediatric Crohn's disease patients …. to reveal the full complement and dynamics of bacteria, fungi, archaea, and viruses during treatment. Bacterial community membership was associated independently with intestinal inflammation, …., whereas dysbiosis decreased with reduced intestinal inflammation. Fungal proportions increased with disease and antibiotic use.  PMID:  26468751

Ultimately the only treatment that can be recommended is to address the causes –manage stress, improve nutrition, avoid pharmaceuticals especially those listed, rest, sleep and drink plenty of clean water.  Keep warm at all times.  Refuse surgery.

Eating for health

Although great play is made of probiotics , there is no evidence that probiotics help in this area at all, in fact there is the risk they exacerbate the problem by adding yet more bacteria to a mix that is already wholly out of balance. 

Reduction in sugar and carbohydrate intake may help those with fungal blooms.  Go organic , avoid all factory farmed food.

Food is the only real cure, simply because it is the only safe method of delivering the nutrients our intestinal flora needs to get back into balance, directly to where it is needed.  The real advantage of organically grown food, is that it contains nutrients needed by the flora of which we may not be aware.  There is some evidence, for example, that the flora thrives on  truly minute doses of arsenic and cyanide!!   Fruit such as apricots and apples contain just the right amount of these two chemicals to help the flora, without poisoning you.

Homeopathic medicine

There may be a role for homeopathic medicine here.  The homeopathists long ago found out that extremely minute doses of certain substances which were poisonous, actually cured people.  Homeopathic medicine works by either priming the immune system with a protein that is similar to a pathogen.  [In effect it is like vaccination but with none of the side effects].  Or it feeds the intestinal flora so that it is restored to full immunological effectiveness.

References and further reading

  • Cell Host Microbe. 2014 Mar 12;15(3):382-392. doi: 10.1016/j.chom.2014.02.005.  The treatment-naive microbiome in new-onset Crohn's disease.  Gevers D1, Kugathasan S#2, Denson LA#3, Vázquez-Baeza Y4, Van Treuren W5, Ren B6, Schwager E6, Knights D7,8, Song SJ5, Yassour M1, Morgan XC6, Kostic AD1, Luo C1, González A5, McDonald D5, Haberman Y3, Walters T9, Baker S10, Rosh J11, Stephens M12, Heyman M13, Markowitz J14, Baldassano R15, Griffiths A16, Sylvester F17, Mack D18, Kim S19, Crandall W19, Hyams J17, Huttenhower C1,6, Knight R5,20,21, Xavier RJ1,22,23.
  • Cell Host Microbe. 2015 Oct 14;18(4):489-500. doi: 10.1016/j.chom.2015.09.008.  Inflammation, Antibiotics, and Diet as Environmental Stressors of the Gut Microbiome in Pediatric Crohn's Disease.  Lewis JD1, Chen EZ2, Baldassano RN3, Otley AR4, Griffiths AM5, Lee D6, Bittinger K7, Bailey A7, Friedman ES8, Hoffmann C7, Albenberg L3, Sinha R7, Compher C9, Gilroy E2, Nessel L2, Grant A4, Chehoud C7, Li H2, Wu GD10, Bushman FD11.
  • Comp Immunol Microbiol Infect Dis. 2015 Dec;43:36-49. doi: 10.1016/j.cimid.2015.10.005. Epub 2015 Oct 25.  Dysbiotic gut microbiome: A key element of Crohn's disease.  Øyri SF1, Műzes G2, Sipos F3.
  • Eur J Pediatr. 2015 Feb;174(2):151-67. doi: 10.1007/s00431-014-2476-2. Epub 2015 Jan 7.  The intestinal microbiota: its role in health and disease.  Biedermann L1, Rogler G.
  • ILAR J. 2015;56(2):192-204. doi: 10.1093/ilar/ilv030.  The Intestinal Microbiota in Inflammatory Bowel Disease.  Becker C1, Neurath MF1, Wirtz S1. Christoph Becker, PhD, is associated professor, Markus F. Neurath, MD, is director, and Stefan Wirtz, PhD, is senior scientist at the Department of Medicine 1 at the Friedrich-Alexander University Erlangen-Nuremberg in Erlangen, Germany.
  • Inflamm Bowel Dis. 2015 Jun;21(6):1219-28. doi: 10.1097/MIB.0000000000000382.  Recent advances in characterizing the gastrointestinal microbiome in Crohn's disease: a systematic review. Wright EK1, Kamm MA, Teo SM, Inouye M, Wagner J, Kirkwood CD. *Department of Gastroenterology, St Vincent's Hospital Melbourne, Australia; †Department of Pathology, University of Melbourne, Australia; ‡Imperial College, London, United Kingdom; and §Enteric Virus Group, Murdoch Children's Research Institute, Melbourne, Australia.
  • Inflamm Bowel Dis. 2015 Jun;21(6):1419-27. doi: 10.1097/MIB.0000000000000344.  Metagenomic analysis of microbiome in colon tissue from subjects with inflammatory bowel diseases reveals interplay of viruses and bacteria. Wang W1, Jovel J, Halloran B, Wine E, Patterson J, Ford G, OʼKeefe S, Meng B, Song D, Zhang Y, Tian Z, Wasilenko ST, Rahbari M, Reza S, Mitchell T, Jordan T, Carpenter E, Madsen K, Fedorak R, Dielemann LA, Ka-Shu Wong G, Mason AL.  1*Center of Excellence in Gastrointestinal Inflammation and Immunity Research, Department of Medicine, University of Alberta, Edmonton, Canada; and †Beijing Genomics Institute, Shenzhen, China.
  • J Crohns Colitis. 2016 Mar;10(3):296-305. doi: 10.1093/ecco-jcc/jjv209. Epub 2015 Nov 15. Fungal Dysbiosis in Mucosa-associated Microbiota of Crohn's Disease Patients. Liguori G1, Lamas B2, Richard ML3, Brandi G4, da Costa G3, Hoffmann TW3, Di Simone MP1, Calabrese C1, Poggioli G1, Langella P3, Campieri M1, Sokol H5.

Is the Gut the Gateway to Disease? | Yousef Elyaman | TEDxOcala

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