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Fungi are abundant on skin, in the oral cavity and in food (bread, cheese, sausages, etc). Compared to bacteria, they are rare in the intestine due to the harsh anaerobic conditions. Less than 1% of the intestinal biome would be fungi (if they are transient or not is actively being debated)...

The reason why several studies on fungal populations found in crohn's disease are seemingly in constant disagreement with each other, and end up having to contradict their own studies they did not long ago, likely reflect differences in dietary patterns in patients, and the transient nature of...

Fungi found in stool or biopsies don't necessarily indicate they have a permanent presence in the gut. When doctors or researchers find fungi in biopies or stool samples, they tend to overhastily conclude that they have colonized the gut just like bacteria. But there's no good evidence fungi...

A GI objecting to Stelara for whatever reason is incomprehensible to me. When Infliximab/Humira and Biosimilars fail, the only other 2 options that have a good track record are Stelara and EN(ileal disease). You can look over all the other medication out there, and remission rates are...

Made a quick drawing if it helps. Anti-inflammatory medication for crohn's disease blocks inflammatory pathways. Anti-TNF and anti IL-23 block primary inflammatory pathways occuring in intestinal tissue. When other companies want to compete with these, they need to find different pathways...

My 2 cents. Remicade/infliximab and its biosimilars have always had slightly higher remission rates than Humira, but the difference is small. What infliximab seems particularly good at, and why it is often preferred over Humira, is fistula closure. The addition of EN has shown it can avoid loss...

Calprotectin becomes less accurate the more proximal inflammation is. Maybe that's a factor, I have no idea. For me, in the past my calprotectin has always been pretty accurate in representing ileal inflammation which would later show up on MRI. I have been in remission for a long time now, so I...

Note the high prevalence of additives in EN, which I've pointed out many times. Many theorized those to be harmful for crohn's disease patients, like emulsifiers, polypolysorbate 80 and matodextrin. In reality, they have absolutely no effect on remission rates.

Logal et al analysed 61 EN formulas, including those specifically used for crohn's disease. Fat sources were mainly derived from Sunflower oil, Canola oil, Soybean oil and Coconut oil. Only 3% of EN formulas (2/58) were free of fat. 49% of those who content reported, contained MCT. The...

Interestingly, in a follow up study, they determined that even though MCT drastically lowered fungal load, 3 weeks of MCT supplementation had no effect on the bacterial microbiome (dominated by Enterobacteriaceae in infants). 3099×2040 632,5 kB

Effect of fat composition in enteral nutrition for Crohn's disease in adults: A systematic review Background & aims: The role of enteral nutrition (EN) fat composition in regulating inflammation in Crohn's disease (CD) is not clear. There is, moreover...

These aren't crohn's patients, but it's very interesting to see MCT reduce gastrointestinal candida growth. Considering most EN uses MCT to increase absorption. It isn't explained in the study, but MCT are able to suppress biofilm formation of candida and limit hyphal growth. There's a debate...

Note the prevalence of ASCA seropositivity in both ileal Crohn's disease and Celiac disease. But lack of ASCA in Crohn's disease involving the colon and UC. You could blame this on increased ileal permeability, but when you look at the data on celiac diseae, the high prevalence of celiac among...

ASCA testing tests for antibodies against a carbohydrate cell wall of S. cerevisiae, it binds what is commonly known as baker's yeast. But it also binds to other yeasts like candida. ASCA is very specific to crohn's disease. About 60% with crohn's disease are ASCA+. In UC it is around 5%-10%...

Discuss your worries with the GI. Anti-TNF and EN are both very effective in inducing remission and reversing fistula in ileal crohn's disease, and can be used in combination. Combination of anti-TNF and EN can prevent loss of response https://link.springer.com/article/10.1007/s10620-014-3493-8...

I think the positive data for CDED has been weak so far. While CDED is more restrictive, previous studies where a 50% EN and 50% free diet was tried failed. Still, the idea of only having to consume 50% EN combined with a less restrictive diet is appealing to increase compliance with patients...

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-fungal communities differed between healthy children and those with CD -faecal samples showed EN caused dramatic changes in fungal communities and diversity, more so than in bacterial communities -fungus S. cerevisiae (ASCA yeast) significantly decreased during EEN -subjects with lower...