The role of Mycobacterium avium subspecies paratuberculosis (MAP) in the pathogenesis of Crohn’s disease (CD) has been strongly debated for many years. MAP is the known aetiological agent of Johne’s disease, a chronic enteritis affecting livestock. At present, due to the paucity of high-quality data, anti-MAP therapy (AMT) is not featured in international guidelines as a treatment for CD. Although the much-quoted randomised trial of AMT did not show sustained benefits over placebo, questions have been raised regarding trial design, antibiotic dosing and the formulation used. There are several lines of evidence supporting the CD and MAP association with uncontrolled and controlled trials demonstrating effectiveness, including a retrospective review of cases treated at our own institution. Here, we provide an overview of the evidence supporting and refuting AMT in CD before focussing on updates of the current research in the field, including the ongoing trials with the novel RHB-104 formulation and the MAP vaccine trial. While controversial, gastroenterologists are often asked about long-term combination antibiotic therapy for CD. There has been broadcast and social media coverage surrounding this, particularly with regard to current trials. Although patients should not be deterred from treatments of proven effectiveness, this review aims to help with commonly asked questions and highlights our own approach for the use of anti-MAP in specific circumstances.

中文翻译：

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克罗恩病的副结核分枝杆菌 (MAP) 治疗：概述和更新

鸟分枝杆菌副结核亚种 (MAP) 在克罗恩病 (CD) 发病机制中的作用多年来一直备受争议。MAP 是约翰氏病的已知病因，这是一种影响牲畜的慢性肠炎。目前，由于缺乏高质量的数据，抗 MAP 治疗（AMT）在国际指南中并未作为 CD 治疗的特色。尽管被广泛引用的 AMT 随机试验并未显示出优于安慰剂的持续益处，但关于试验设计、抗生素剂量和所用配方的问题已经提出。有几条证据支持 CD 和 MAP 与证明有效性的非对照和对照试验的关联，包括对我们自己机构治疗的病例的回顾性审查。这里，我们概述了支持和反驳 CD 中 AMT 的证据，然后重点关注该领域当前研究的更新，包括正在进行的新型 RHB-104 制剂试验和 MAP 疫苗试验。尽管存在争议，但胃肠病学家经常被问及 CD 的长期联合抗生素治疗。围绕这一点进行了广播和社交媒体的报道，特别是关于目前的试验。尽管不应阻止患者接受经证实有效的治疗，但本综述旨在帮助解决常见问题，并强调我们自己在特定情况下使用抗 MAP 的方法。尽管存在争议，但胃肠病学家经常被问及 CD 的长期联合抗生素治疗。围绕这一点进行了广播和社交媒体的报道，特别是关于目前的试验。尽管不应阻止患者接受经证实有效的治疗，但本综述旨在帮助解决常见问题，并强调我们自己在特定情况下使用抗 MAP 的方法。尽管存在争议，但胃肠病学家经常被问及 CD 的长期联合抗生素治疗。围绕这一点进行了广播和社交媒体的报道，特别是关于目前的试验。尽管不应阻止患者接受经证实有效的治疗，但本综述旨在帮助解决常见问题，并强调我们自己在特定情况下使用抗 MAP 的方法。