Crohn’s disease and the mycobacterioses: A quarter century later. Causation or simple association?

Abstract

It has been more than 25 years since Mycobacterium paratuberculosis was first proposed as an etiologic agent in Crohn’s disease based on the isolation of this organism from several patients. Since that time, a great deal of information has been accumulated that clearly establishes an association between M. paratuberculosis and Crohn’s disease. However, data are conflicting and difficult to interpret and the field has become divided into committed advocates and confirmed skeptics. This review is an attempt to provide a thorough and objective summary of current knowledge from both basic and clinical research from the views and interpretations of both the antagonists and proponents. The reader is left to draw his or her own conclusions related to the validity of the issues and claims made by the opposing views and data interpretations. Whether M. paratuberculosis is a causative agent in some cases or simply represents an incidental association remains a controversial topic, but current evidence suggests that the notion should not be so readily dismissed. Remaining questions that need to be addressed in defining the role of M. paratuberculosis in Crohn’s disease and future implications are discussed.

Keywords::

• Inflammatory bowel disease
• Crohn’s disease
• etiology
• Mycobacterium paratuberculosis
• infectious agents

Acknowledgments

Supported in part by the Texas Tech University Health Sciences Center and the Lizanell and Colbert Coldwell Foundation.

Declaration of interest

The authors report no declarations of interest.

Notes

1 The official name of this organism is Mycobacterium avium subspecies paratuberculosis, commonly abbreviated as MAP. The authors prefer the original approved name which more accurately reflects its’ clinical significance and phenotypic properties.