There are certain characteristics that Ankylosing Spondylitis and Crohns share together- genetically, clinically, immunologically, and even in a microbial sense.

 

Most, if not all Spondylitis associated conditions are believed to have a link with gut inflammation, lesions and intestinal microbes. Inflammatory Bowel Disease is commonly found in patients who are diagnosed with AS. In fact, gut inflammation could be demonstrated in 68% of patients with some form of Spondyloarthropathy, whether they had symptoms or not.

 

The association between AS and gut lesions has been recognized for many years. Approximately two thirds of patients who have a form of SpA, including Ankylosing Spondylitis, are not even aware that they have a compromised gut because they have not yet developed symptoms yet, although the signs of gut inflammation on a microscopic level is apparent upon biopsies.

 

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The Microbial Connection

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Antibodies against the gram-negative bacteria Klebsiella p. have been found in elevated levels in patients active with AS.    Likewise, studies also have shown that Klebsiella microbes have been isolated form the colon in more than 25% of patiients with Crohns Disease, and relapses of the disease in CD patients have been associated with Klebsiella.

 

Studies on the link between Klebsiella and patients with Inflammatory Bowel Disease were carried out by various groups from 6 different gastroenterological centers. Elevated levels of Klebsiella antibodies were observed in patients with CD from Birmingham. Patients with both CD and AS from Glasgow and Edinburgh were shown to have significantly elevated levels of Klebsiella antibodies when compared to healthy controls. Three consecutive studies from London and Winchester in the UK have shown similar results. In another study, antibodies against Klebsiella microbes and cross-reactive collagen types 1, 2, 3, 4 and 5 were found significantly elevated in patients with AS as well as in early and advanced cases of Crohn's Disease when compared to healthy subjects.

 

 

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In Conclusion

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Both Ankylosing Spondylitis and Crohn’s Disease are potentially disabling and very serious conditions. A large number of studies support the idea that the pathogen Klebsiella pneumoniae is most likely the triggering environmental factor that drives both of these diseases, especially in patients who are HLA-B27 positive.

 

Enhancing the growth and perpetuation of the Klebsiella microbes in the bowel by consuming the primary food source of Klebsiella p. (dietary starch) increases the propagation and activity of the microbe, leading to an immune response. The immune response results in the production of elevated levels of anti-Klebsiella antibodies. These antibodies cross react against the person’s own body and increase inflammation in types I, III, and IV of collagen, which is an important component of the spinal tissues where the lesions are located in AS. The immune response also results in increased bowel inflammation and lesions.

 

Since starch is the main substrate that is necessary for the growth of Klebsiella p., a descrease of starch in the diet could have a beneficial effect on both Crohn’s disease and Ankylosing Spondylitis, especially when used in conjunction with available medical therapies.

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For more information on how diet modification is a viable treatment option for both AS and Crohn's, click HERE!

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