If bacteria cause IBD, then it should be possible to target the bacteria with therapies and cure or at least treat the disease. Discovery of a successful intervention, unless found by chance, will depend on knowing more about which bacteria are involved, where they are and how to remove them. Some evidence for the possible role of bacteria has come from in vivo studies of the effects of diverting the faecal stream away from sites of IBD. Alternative hypotheses arise from the diversion studies that could incriminate other components of the faecal stream that include bile acids and dietary components. Antibiotics will only really be adequately tested when we know what the target bacteria are and where they are, e.g. whether in the lumen or mucosa and whether intracellular or extracellular. Some encouraging responses have been observed, however, with empirical antibiotic therapy.

Drenick EJ, Ament ME, Finegold SM, Passaro E Jr: Bypass enteropathy: an inflammatory process in the excluded segment with systemic complications. Am J Clin Nutr 1977;30:76–89.
Edwards CM, George B, Warren B: Diversion colitis – new light through old windows. Histopathology 1999;34:1–5.
Homan WP, Dineen P: Comparison of the results of resection, bypass, and bypass with exclusion for ileocecal Crohn’s disease. Ann Surg 1978;187:530–535.
Alexander-Williams J, Fielding JF, Cooke WT: A comparison of results of excision and bypass for ileal Crohn’s disease. Gut 1972;13:973–975.
Burman JH, Thompson H, Cooke WT, Williams JA: The effects of diversion of intestinal contents on the progress of Crohn’s disease of the large bowel. Gut 1971;12:11–15.
Lee E: Split ileostomy in the treatment of Crohn’s disease of the colon. Ann R Coll Surg Engl 1975;56:94–102.
Harper PH, Kettlewell MG, Lee EC: The effect of split ileostomy on perianal Crohn’s disease. Br J Surg 1982;69:608–610.
Harper PH, Truelove SC, Lee EC, Kettlewell MG, Jewell DP: Split ileostomy and ileocolostomy for Crohn’s disease of the colon and ulcerative colitis: a 20 year survey. Gut 1983;24:106–113.
Winslet MC, Andrews H, Allan RN, Keighley MR: Fecal diversion in the management of Crohn’s disease of the colon. Dis Colon Rectum 1993;36:757–762.
Harper PH, Lee EC, Kettlewell MG, Bennett MK, Jewell DP: Role of the faecal stream in the maintenance of Crohn’s colitis. Gut 1985;26:279–284.
Winslet MC, Allan A, Poxon V, Youngs D, Keighley MR: Faecal diversion for Crohn’s colitis: a model to study the role of the faecal stream in the inflammatory process. Gut 1994;35:236–242.
Rutgeerts P, Geboes K, Peeters M, Hiele M, Penninckx F, Aerts R, Kerremans R, Vantrappen G: Effect of faecal stream diversion on recurrence of Crohn’s disease in the neoterminal ileum. Lancet 1991;338:771–774.
D’Haens GR, Geboes K, Peeters M, Baert F, Penninckx F, Rutgeerts P: Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 1998;114:262–267.
Janowitz HD, Croen EC, Sachar DB: The role of the fecal stream in Crohn’s disease: an historical and analytic review. Inflamm Bowel Dis 1998;4:29–39.
Roberts CL, Keita AV, Duncan SH, O’Kennedy N, Söderholm JD, Rhodes JM, Campbell BJ: Translocation of Crohn’s disease E. coli across M-cells: contrasting effects of soluble plant fibres and emulsifiers. Gut 2010;59:1331–1339.
O’Morain C, Segal AW, Levi AJ: Elemental diets as primary treatment of acute Crohn’s disease: a controlled trial. Br Med J 1984;288:1859–1862.
Raouf AH, Hildrey V, Daniel J, Walker RJ, Krasner N, Elias E, Rhodes JM: Enteral feeding as sole therapy for Crohn’s disease: a controlled trial of whole protein versus amino-acid based feed and a case study of dietary challenge. Gut 1991;32:702–707.
Dickinson RJ, Ashton MR, Axon ATR, Smith RC, Yeung CK, Hill GL: Controlled trial of intravenous hyperalimentation and total bowel rest as an adjunct to the routine therapy of acute colitis. Gastroenterology 1980;79:1199–1204.
McIntyre PB, Powell-Tuck J, Wood SR, Lennard-Jones JE, Lerebours E, Hecketsweiler P, Galmiche JP, Colin R: Controlled trial of bowel rest in the treatment of severe acute colitis. Gut 1986;27:481–484.
IBD in EPIC Study Investigators, Tjonneland A, Overvad K, Bergmann MM, Nagel G, Linseisen J, Hallmans G, Palmqvist R, Sjodin H, Hagglund G, Berglund G, Lindgren S, Grip O, Palli D, Day NE, Khaw KT, Bingham S, Riboli E, Kennedy H, Hart A: Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested case-control study within a European prospective cohort study. Gut 2009;58:1606–1611.
Khan KJ, Ullman TA, Ford AC, Abreu MT, Abadir A, Marshall JK, Talley NJ, Moayyedi P: Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol 2011;106:661–673.
Rahimi R, Nikfar S, Rezaie A, Abdollahi M: A meta-analysis of antibiotic therapy for active ulcerative colitis. Dig Dis Sci 2007;52:2920–2925.
Subramanian S, Roberts CL, Hart CA, Martin HM, Edwards SW, Rhodes JM, Campbell BJ: Replication of colonic Crohn’s disease mucosal Escherichia coli isolates within macrophages and their susceptibility to antibiotics. Antimicrob Agents Chemother 2008;52:427–434.
Leiper K, Martin K, Ellis A, Watson AJ, Morris AI, Rhodes JM: Clinical trial: randomized study of clarithromycin versus placebo in active Crohn’s disease. Aliment Pharmacol Ther 2008;27:1233–1239.
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