Commentary
See article on page 819Intolerance of the dirty intestine
| The first 150 words of the full text of this article appear below. |
The mucosal immune system faces the delicate task of co-existence with a luxuriant commensal intestinal bacterial flora (1012 bacteria/g faeces in the colon, and roughly 103 different species, with anaerobes predominating). Yet a protective immune response to invasive enteric pathogens is also mandatory. Of course, any commensal organism can become a pathogen in appropriate circumstances, and the magnitude of this balancing act is illustrated by the similarity between proteins of the harmless commensal Escherichia coli and its pathogenic derivatives (or the Shigella genus). The essential differences between innocent and harmful bacteria reside in toxin production and qualities of adherence to, or penetration of, the intestinal epithelial cell layer.
The barrier function of the intestine is clearly disrupted in active
inflammatory bowel disease (IBD), with evidence for greater systemic
penetration by commensal organisms. Whether abnormal intestinal
permeability precedes intestinal inflammation in individuals predisposed to IBD, is still unclear, although it is
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