Inflammatory bowel disease: clinical aspects and treatments
Fakhoury M et al. J Inflamm Res 2014;7:113–120.
IBD
Short summary
Inflammatory bowel disease (IBD) is a chronic disease for which there is no cure. This review describes the types and symptoms of IBD, the role of cytokines in the inflammation process and the diagnostic and treatment options.
Patients affected by IBD, primarily Crohn’s disease and ulcerative colitis, often have defects in the intestinal epithelial barrier function and experience abdominal symptoms, including diarrhoea, abdominal pain, bloody stools and vomiting. Although Crohn’s disease and ulcerative colitis are similar, Crohn’s disease can affect any point along the wall of the digestive tract, while ulcerative colitis is localised to the colon. Differential diagnosis is difficult as symptoms are similar.
There are several techniques and tests to aid the diagnosis of IBD, including capsule endoscopy, medical imaging using barium follow-through procedures, X-ray computed tomography and magnetic resonance. Levels of serological markers may aid diagnosis of IBD and help differentiate between Crohn’s disease and ulcerative colitis. Biopsy of the colon is a very effective method to confirm disease and differentiate the type of inflammation based on its intestinal pathology and pattern.
IBDs are associated with defects in the epithelial barrier, which increases the permeability of the intestine and adherence of toxins to intestinal cells. This is associated with a type 1 immune response, mediated by T-helper 1-type effector cells, that increase the production of proinflammatory cytokines leading to chronic inflammation of the gut.
The use of anti-inflammatory drugs and immunomodulators can significantly reduce symptoms and maintain the patient in remission. While oral delivery of these compounds has been shown to be successful in reducing intestinal inflammation, the high doses required are associated with undesirable side effects. Patient compliance is poor due to side effects such as headache, diarrhoea and nausea, which worsens the condition.
Monoclonal antibodies, such as infliximab, have shown significant positive results in the treatment of IBD. However, delayed hypersensitivity reactions and the risk of developing tuberculosis soon after infusion are major limitations.
Thalidomide dampens the production of proinflammatory cytokines but has severe limitations. Recent studies have shown that artificial cell microencapsulation of thalidomide can release the drug into the intestines and decrease the inflammation with limited side effects.
Results from ongoing studies and future trials will be critical in advancing the foundational understanding of the pathology of IBD and help to further improve patient outcomes.
Job number: JB57410GBp Date of Preparation: June 2019
