PMID- 29754190
OWN - NLM
STAT- MEDLINE
DCOM- 20200226
LR  - 20200229
IS  - 1559-0267 (Electronic)
IS  - 1080-0549 (Linking)
VI  - 57
IP  - 2
DP  - 2019 Oct
TI  - Allergic and Immunologic Perspectives of Inflammatory Bowel Disease.
PG  - 179-193
LID - 10.1007/s12016-018-8690-3 [doi]
AB  - Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammatory 
      condition primarily involving the gastrointestinal tract. It includes Crohn's 
      disease (CD), ulcerative colitis (UC), and a less common phenotype-indeterminate 
      colitis. It is thought to result from a complex interplay of environmental, 
      microbial, and host factors including genetic factors, although the exact 
      mechanism is not known. Dietary factors have been shown to play a role in the 
      pathogenesis of IBD and can potentially alter the intestinal microbiota as well 
      as disrupt the immune function in the gut. CD is characterized by transmural 
      inflammation, sometimes associated with granulomatous lesions, and involves the 
      entire gastrointestinal tract but often spares the rectum. UC is characterized by 
      mucosal inflammation typically confined to the colon and rectum. Although IBD is 
      mostly seen in western world, recent data suggests that the incidence and 
      prevalence are increasing worldwide. Enteral nutrition has been shown to be 
      effective in inducing remission in pediatric population with CD; however, there 
      is mixed data in adult population. Nutritional deficiencies such as vitamin D and 
      zinc deficiency are often noted in IBD patients. Several extraintestinal 
      manifestations are noted in patients with IBD. Some of them parallel with the 
      disease activity and others are independent of the disease course. Assessment of 
      IBD disease activity clinically, radiologically, if indicated, biochemically and 
      endoscopically is important to guide therapy in IBD. To ensure comprehensive 
      care, it is important to assess associated conditions such as nutritional and 
      psychological well-being, as well as age appropriate health maintenance status 
      prior to starting treatment for IBD. Several biologic agents including anti-tumor 
      necrosis factor alpha (anti-TNF-alpha) drugs, anti-integrins, and antibodies to the 
      p40 subunit of IL12/23 are approved for induction and maintenance of remission of 
      IBD. Steroids are also often used for induction. Anti-metabolites and thiopurines 
      are also useful either as monotherapy or in combination regimens. Potential side 
      effects of anti-TNF-alpha drugs such as serious infections, malignancy, worsening of 
      heart failure, and infusion-related reactions should be considered prior to 
      starting these drugs. Anti-TNF-alpha drugs with or without immunomodulators 
      (azathioprine, 6-mercaptopurine, methotrexate) are often used for the induction 
      and maintenance of remission. Treating to target of endoscopic and clinical 
      remission provides the best long-term outcomes. Our knowledge and understanding 
      of IBD has grown significantly. However, there are several unanswered questions 
      on pathogenesis, disease behavior, and drivers of inflammation in various patient 
      subgroups which require further research.
FAU - Clarke, Kofi
AU  - Clarke K
AD  - Milton S Hershey Medical Center, Penn State College of Medicine, 500 University 
      Dr, Hershey, PA, 17033, USA. kclarke@pennstatehealth.psu.edu.
AD  - Division of Gastroenterology and Hepatology, Penn State Milton S Hershey Medical 
      Center, 500 University Dr, Hershey, PA, 17033, USA. 
      kclarke@pennstatehealth.psu.edu.
FAU - Chintanaboina, Jayakrishna
AU  - Chintanaboina J
AD  - Division of Gastroenterology and Hepatology, Penn State Milton S Hershey Medical 
      Center, 500 University Dr, Hershey, PA, 17033, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Clin Rev Allergy Immunol
JT  - Clinical reviews in allergy & immunology
JID - 9504368
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (IL12B protein, human)
RN  - 0 (Integrins)
RN  - 0 (Interleukin-12 Subunit p40)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Antibodies, Monoclonal/pharmacology/therapeutic use
MH  - Avitaminosis
MH  - Colitis, Ulcerative/*epidemiology/*immunology/pathology/therapy
MH  - Comorbidity
MH  - Crohn Disease/*epidemiology/*immunology/pathology/therapy
MH  - Diet
MH  - Gastrointestinal Microbiome/physiology
MH  - Humans
MH  - Integrins/antagonists & inhibitors
MH  - Interleukin-12 Subunit p40/antagonists & inhibitors
MH  - Melkersson-Rosenthal Syndrome/epidemiology
MH  - Nutrients/therapeutic use
MH  - Pyoderma Gangrenosum/epidemiology
MH  - Sweet Syndrome/epidemiology
MH  - Tumor Necrosis Factor-alpha/antagonists & inhibitors
OTO - NOTNLM
OT  - Colitis
OT  - Enteral nutrition
OT  - Granulomatous cheilitis
OT  - Melkersson-Rosenthal syndrome
OT  - Nutritional deficiencies
OT  - Sweet syndrome
OT  - Tumor necrosis factor
EDAT- 2018/05/14 06:00
MHDA- 2020/02/27 06:00
CRDT- 2018/05/14 06:00
PHST- 2018/05/14 06:00 [pubmed]
PHST- 2020/02/27 06:00 [medline]
PHST- 2018/05/14 06:00 [entrez]
AID - 10.1007/s12016-018-8690-3 [pii]
AID - 10.1007/s12016-018-8690-3 [doi]
PST - ppublish
SO  - Clin Rev Allergy Immunol. 2019 Oct;57(2):179-193. doi: 10.1007/s12016-018-8690-3.