Immune mechanisms and natural history of inflammatory bowel disease

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Annals of Gastroenterology
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2007 (EN)
Immune mechanisms and natural history of inflammatory bowel disease (EN)

Katsanos, K.H.
Tsianos, E.V.

The gastrointestinal tract uses a system of tolerance and controlled inflammation to limit the response to dietary or bacteria-derived antigens in the gut. The triggering factor for this and cascade whether it represents an auto-antigen or an heteroantigen is still to be elucidated. It has been also demonstrated that a serologic anti-microbial response in CD patients exists. This response includes antibodies against saccharomyces cerevisiae (ASCA), E.coli outer membrane porin C (Omp-C), flagelin (cBir1) and pseudomonas aeroginosa (l2). Host response to microbial pathogens includes self-defense mechanisms such as defensins, pattern recognition receptors (PRRs) and TLRs (Toll Like Receptors). Natural history of IBD has been described mainly through studies in American and north European IBD cohorts. In general, 50-60% of IBD patients are in remission during any given year. The likelihood of steroid dependency remains high in IBD. The prediction of disease location seems quite safe as the location of the disease remains stable over time. By contrast the disease behaviour changes over time with increasing risk for structuring/penetrating disease with longer disease duration. The question whether currently available therapies are able to alter natural history of IBD still remains unanswered. The risk of colorectal cancer in UC patients begins to increase 8 years from diagnosis and high risk groups are patients with extensive colitis, young age at UC onset, familial cancer history and co-existing primary sclerosing cholangitis. In CD the risk of cancer seems to be comparatively smaller. Life expectancy of CD patients is slightly lower compared to healthy subjects while life expectancy in UC patients is generally normal. (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 19, No 2 (2006) (EN)

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