Question

A database of current clinical. trials is found here:https://clinical trials.gov/.look for examples of clinical trials for Crohn's. Are there any trials using fecal transplant or helming therapy that Amelia might consider? Are there alternative treatments not on the list above that she might add to her table?

Answer 1

Various clinical trials have been conducted. Few of them are-

1.A study to develop the use of ultrasound to monitor treatment of Crohn`s disease- The  purpose of this study is to compare the effectiveness of ultrasound with magnetic resonance (MR) enterography in the diagnosing and monitoring of Crohn's disease.

2.The purpose of another study is to test the effects of an experimental medication GED-0301 (mongersen) in patients who have active Crohn's disease. The study will test GED-0301 compared to placebo for 52 weeks. The study treatment is blinded which means that patients and the study doctor will not know which treatment has been assigned. Patients in this study will be allowed treatment with stable doses of oral aminosalicylates, oral corticosteroids, immunosupressants and antibiotics for the treatment of Crohn's disease. After 12 weeks in the study until the end of the study, patients who do not have an improvement in their Crohns disease symptoms will have the option to enter a long term active treatment study.

Helminthic therapy, or less accurately worm therapy, is an idea derived from the hygiene hypothesis. It is impossible to understand helminthic therapy without first understanding the hygiene hypothesis. What the hygiene hypothesis tells us is that a lack of early childhood exposure to infectious agents and parasites increases susceptibility to allergic diseases by preventing the natural modulation of immune system development by those same infectious organisms and parasites.

To date two species of helminths have been tested for human helminth therapy as a clinical treatment, Trichuris suis, the pig whipworm, and the human hookworm Necator americanus. After ingestion of T.suisova (TSO), the eggs hatch and the worms colonise the caecum and colon of the human gut for only a short period of time (weeks) meaning that treatments need to be repeated at intervals, however, this species-specificity and lack of chronic infection is beneficial in the sense that it also removes any wider public health issues. Larvae of the human hookworm Necator, however, are administered percutaneously and migrate through the vasculature and lungs to the small intestine where they survive by feeding on blood from the mucosa, giving rise to long lasting infections (years) and may at higher doses cause clinical symptoms such as gastrointestinal symptoms and anemia. In its natural state this infection is a major public health problem across the globe and large-scale deworming programs are in place to combat the morbidity associated with natural infection .

A second approach to helminth therapy has been the slightly more controversial use of the human hookworm Necator, a pathogen responsible for much of the morbidity associated with intestinal helminth infections around the globe. In a small trial where 9 Crohn’s patients were infected with 25–50 larvae and followed over 20 weeks, 7 patients experienced improved disease score while 2 experienced a worsening effect.