Background: Inflammatory bowel disease (IBD) refers to a group of disorders causing chronic relapsing inflammation of the gastrointestinal tract. The highest incidence of IBD occurs in Europe and North America with more than 2 million affected. The hygiene hypothesis suggests improved sanitation and eradication of parasitic infections in industrialized nations may explain the epidemiologic predilection of disease. Helminths are parasitic worms that diminish immune responsiveness and inflammation in animal studies. Epidemiologic data also suggests that helminths have a protective role in the development of IBD. Trichuris suis is a type of helminth traditionally found in pigs. In humans, it has never been found to cause disease. Is Trichuris suis helminth therapy (TSO) effective and safe in the treatment of inflammatory bowel disease?
Methods: An exhaustive literature search to identify relevant published papers was conducted using the databases Medline-OVID, CINAHL, Web of Science, and PubMed using the keywords: inflammatory bowel disease, Crohn’s disease, ulcerative colitis, helminths, and Trichuris. Articles with primary data were included if they addressed the safety and/or efficacy of Trichuris suis ova therapy for IBD. Relevant articles were assessed for quality using the GRADE criteria.
Results: Two randomized controlled trials and two observational case series reports fit the inclusion criteria. All of the studies demonstrated clinical improvement in the indices traditionally used to monitor disease activity in Crohn’s disease and ulcerative colitis. No adverse effects were associated with TSO therapy.
Conclusion: Epidemiologic data, animal studies, and the abovementioned human trials all demonstrate that TSO is an effective and safe therapy in the treatment of IBD. However, current clinical trials have released preliminary data that show lack of efficacy. Until data from these trials can be further evaluated, a strong recommendation for TSO cannot not be made.
Keywords: Trichuris suis, Crohn’s disease, ulcerative colitis, inflammatory bowel disease, helminths
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