Elsevier

The Lancet

Volume 359, Issue 9300, 5 January 2002, Pages 62-69
The Lancet

Seminar
Crohn's disease

https://doi.org/10.1016/S0140-6736(02)07284-7Get rights and content

Summary

Crohn's disease is a disorder mediated by Tlymphocyteswhich arises in genetically susceptible individuals as a result of a breakdown in the regulatory constraints on mucosal immune responses to enteric bacteria. Regulation of immune reactivity to enteric antigens has improved understanding of the pathophysiological mechanisms of Crohn's disease, and has expanded therapeutic options for patients with this disorder. Disease heterogeneity is probable, with various underlying defects associated with a similar pathophysiological outcome. Although most conventional drug treatments are directed at modification of host response, therapeutic manipulation of the enteric flora is becoming a realistic option.

Section snippets

Interaction of genes, bacteria, and immunity

A simple cause and effect relation probably does not account for most cases of Crohn's disease. The pathogenesis of the disease is complex and consists of three interacting elements: genetic susceptibility factors, priming by the enteric microflora, and immune-mediated tissue injury.4, 5, 6 Experimental and observational data suggest that intestinal inflammation arises from abnormal immune reactivity to bacterial flora in the intestine of individuals who are genetically susceptible. Infectious

Therapeutic implications

A wide range of present and emerging drug treatments have been investigated for management of Crohn's disease.2, 3 Here, I discuss therapeutic implications of the more recent advances in pathogenesis.

Search strategy and selection criteria

The seminar is a personal overview and non-systematic synthesis analysis of articles published in English selected from a computer literature search (Medline/PubMed) over the past decade with the following key words: ulcerative colitis, Crohn's disease, and inflammatory bowel disease.

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