The human faecal flora and Crohn's disease.

The aetiology of Crohn's disease (CD), a chronic inflammatory disease of the intestines, is not known but a genetic predisposition to CD has been well demonstrated. Studies on the isolation of bacteria from tissues and the faecal flora from CD patients are reviewed and their results compared with those from our laboratory. Serum antibodies against a variety of bacteria have been described but none has been found to be specific for CD. In our laboratory, higher numbers of coccoid anaerobes have been found in the faecal flora of CD patients. The use of agglutination reactions with four coccoid anaerobes as a diagnostic aid for CD is reviewed. No evidence has been found, however, for a primary role of the agglutinating antibodies in the pathogenesis of CD. On the other hand, one of the coccoid strains has been found to have several characteristics suggesting a role in CD, such as activation of the alternative pathway of complement, the failure of opsonization by specific IgG antibody and the binding of (non-specific) IgG onto the bacteria by the Fc portion. The composition of the faecal flora has been found to depend on genetic characteristics of the host. It is suggested that the genetic predisposition to CD is based on the genetically determined indigenous faecal flora present.