IOWA CITY, Iowa, Jun 30, 2001 (United Press International via COMTEX) -- Doctors at the University of Iowa are testing whether a treatment regimen of worms may help patients with Crohn's disease and ulcerative colitis.

Every three weeks, 15 to 20 patients of Dr. Joel Weinstock and colleagues swallow a mixture of 2,000 eggs of the helminth or parasitic worm, known as porcine whipworm, suspended in Gatorade. Some of them have been on this treatment for more than two years, with excellent results.

"There have been no treatment failures yet and no one has gotten worse," said Weinstock, professor of internal medicine. "The data suggest they seem to get better."

In fact, most of the patients did so well on the therapy they were able to throw away their other drugs, including steroids, which can have serious side effects. The symptoms returned when the patients stopped drinking the mixture.

The worm research represents perhaps the most extreme example of a field known as probiotics: the use of living organisms to treat diseases of the gastrointestinal tract and other organs.

Crohn's disease and ulcerative colitis, often lumped together under the rubric of inflammatory bowel disease or IBD, are disorders of modern, industrialized nations with stringent standards of public hygiene, Weinstock explained. He believes people have sanitized their environments too well, eliminating organisms such as worms that actually may be essential for healthy function of the immune system.

The theory, known as the "hygiene hypothesis," contends overzealous cleaning of the environment prevents the human immune system from interacting with worms, bacteria and other pathogens necessary for it to develop properly.

The importance of contact with environmental organisms is supported by studies of mice specially bred to be germ-free, said Dr. Fergus Shanahan, of the National University of Ireland, Cork. Their gut movements are slower and the blood supply to that area differs from that seen in normal mice.

Shanahan described a recent study of 40 people who had undergone a colostomy, or removal of part of the colon, to treat severe ulcerative colitis. They developed infections in the remaining area of the colon.

Doctors got the infections under control and then gave 20 patients a "cocktail" consisting of four different strains of bacteria. The other 20 patients got a placebo. Within nine months, all 20 patients on the placebo experienced a resurgence of their infection compared to only three of those who received the bacteria mixture.

Probiotic therapies also have been tried in the management of eczema and Weinstock said the helminth eggs he uses have shown promise in treating multiple sclerosis in mice.

Shanahan predicted some day scientists would create organisms genetically engineered to produce vaccines and drugs to treat IBD and other diseases. Weinstock said even genetically engineered helminths are a possibility.

But doctors face at least two potential hurdles before probiotics with genetically modified organisms becomes a reality: controlling the reproduction of the organisms once they are in the body, and preventing them from producing too much of the drug or vaccine they are engineered to make.

Shanahan warns any consideration of these treatments in routine medical care is premature anyway until researchers learn more about the bacteria normally present in the gut. Until then, "we won't be able to fully realize the potential (of probiotics)."

Unfortunately, Shanahan added, some proponents already have made claims for probiotic products, such as pharmafoods or nutraceuticals, that "have far exceeded the actual evidence of their efficacy."

"In fact they may have set the field back with their wildly exaggerated claims," he said.

For Weinstock, however, there is no question helminths play an important if not essential role in the maintenance of human health.

The bottom line is that deworming for the general population probably is not a good thing," he said.

From Healthy.net