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Comment by drewg123 | Hacker News Reader

I'm curious if there is a similar bacteria that triggers Crohn's disease and/or Ulcerative Colitis.

I'm wondering this because there is a large crossover in the biologic "TNF Blocker" drugs that treat RA, Crohn's and UC (Humira, Remicade, etc).

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Crohn's and several forms of arthritis are closely linked to the HLA-B27 gene. (And I should know, because I have the whole shebang :P)

There have been some (tenuous) hypotheses suggesting that certain types of otherwise-benign gut infections in HLA-B27+ people basically short-circuit your immune system and teach it to attack its own tissues. So if you're HLA-B27+ you're not guaranteed to have an autoimmune disease, but you're potentially one bad stomach bug away from developing one.

Which, to be fair, all of this is still highly speculative, and it seems like even the hypotheses treat the resulting arthritis/IBD as an immune condition rather than a bacterial condition—Remicade et al are our best bet either way. But I'd love to one day unravel how a single gene can singlehandedly mess up your spine and your gut and your eyes and your skin!

Does HLA-B27 increase gut permeability? IIRC gut microbes should only be presented to the immune system if they migrate into the bloodstream?

As someone that's been dealing with SIBO (small intestinal bacterial overgrowth), I'm confident that most diseases are the result of your gut microbiome.

Really looking forward to research in this field and I hope the US starts putting more focus on phage therapy.

I agree. The frustrating thing with a lot of this is that microbiota seem to follow the Anna Karenina principle: every healthy microbiota is alike, but every dysfunctional one is dysfunctional in its own way. FWIW, I have a friend whose SIBO spontaneously went into remission almost immediately after travelling to a tropical country. Of course, that probably wouldn't work for you.

Did you take rifaximin, and did it work? I'm currently on my fourth day, and am finding that all of my joint pain has disappeared. Could be coincidental, but now there's the coincidence of this story in Science.

Been dealing with it 3 years now, took the first 1.5 years to figure out what it was. So far took 2 rounds of rifaximin. The first round didn't do much, but the second round (with neomycin) got rid of my methane overgrowth. I still have a hydrogen overgrowth and waiting on insurance to improve another round of just rifaximin.

Do you have a methane or hydrogen overgrowth?

You could try some over the counter herb-based supplements:

Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/

  Subjects with newly diagnosed SIBO by lactulose breath testing (LBT) were given two open-label treatment choices based upon individualized treatment preference; either two 200 mg rifaximin tablets three times daily (TID) or 2 capsules twice daily of the following commercial herbal preparations; Dysbiocide and FC Cidal (Biotics Research Laboratories, Rosenberg, Texas) or Candibactin-AR and Candibactin-BR (Metagenics, Inc, Aliso Viejo, California) for 4 consecutive weeks immediately followed by a repeat LBT.

I have been taking Candibactin-AR and Candibactin-BR with my meals and have seen an improvement in my stool consistency (I have recently diagnosed SIBO/Crohn's). I was given the metronidazole for one week and it helped as well, but symptoms came back.

I've been taking low dose herbals as maintenance since my last round while I wait for the next round

> I was given the metronidazole for one week and it helped as well, but symptoms came back.

Make sure you focus on gut motility. A lot of people have it come back due to poor MMC which causes the food to sit for longer, ferment, foster the overgrowth, and cause inflammation. Here's a good thread with some options: https://www.reddit.com/r/SIBO/comments/11ac3ic/list_of_possi...

Thanks. I noticed that cannabis use makes it worse, and it turns out that it slows gut motility.

That sounds alike a pain to have to wait. Out of interest: when people compare US medicine with socialised medicine like the NHS, does the time spend waiting for insurance paperwork get included in comparisons?

Probably not. People in the USA have been brainwashed to be terrified of social programs so they'll never give them a fair comparison. They just talk about the worst cases where it takes months to be seen by the doctor, which funnily enough is exactly how it is here if you're trying to see a specialist.

Only hydrogen.

Similar sufferer of recurrent uveitis here (spent 10 years doing several tests none of which ever explained what I have, only excepting HLA-B27 which occurs with several of these auto-immune diseases). The only thing that helps me now is Humira. I wonder if gut bacteria has anything to do with my condition and how I can even go about digging into this :/

Interesting. I have Crohn's, and I've gotten uveitis during really, really, really bad flare ups. I've had Crohn's for 40 years, and I wasn't even aware there was a link until my gastroenterologist told me about it.

>Antibiotic exposure was associated with an increased risk of IBD as compared with no antibiotic exposure for all age groups, although was greatest among individuals aged 40–60 years and ≥60 years (age 10–40 years, IRR 1.28, 95% CI 1.25 to 1.32; age 40–60 years, IRR 1.48, 95% CI 1.43 to 1.54; age ≥60 years, IRR 1.47, 95% CI 1.42 to 1.53). For all age groups a positive dose–response was observed, with similar results seen for both ulcerative colitis and Crohn’s disease. The highest risk of developing IBD was seen 1–2 years after antibiotic exposure, and after use of antibiotic classes often prescribed to treat gastrointestinal pathogens.

https://gut.bmj.com/content/72/4/663

So people who were more likely to use antibiotics because there was a suspected infection were more likely to have Crohn's disease, possibly underlying at the time

I'd wager yes, for that very reason. Years ago I was in hospital and a registrar told me that guts are smelly but they're the next big frontier of medicine. I didn't immediately know what she meant, but having thought about it since, she was absolutely right. The biome has a lot to answer for.

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