Analysis of disease distribution, activity and complications in the patient with inflammatory bowel disease.
Management strategies in Crohn's disease and ulcerative colitis should be based on up-to-date information on disease distribution, extent, activity and complications. A system of structured analysis is suggested, with separate consideration of destructive ulceration, inflammatory activity and other factors. Direct investigation of gut immunity by using whole gut lavage fluid (WGLF) is a valuable new technique of clinical investigation in IBD and related disorders. Recent studies have shown that the concentrations of plasma-derived proteins in WGLF provide objective measures of disease activity; and that this activity is a separate phenomenon from destructive ulceration and fibrosis. Neutrophils in the lumen can be in- investigated by cytology, or by assay of neutrophil elastase in WGLF. Cytokines and other immuno-regulatory mediators can also be detected. These new techniques can provide a description of intestinal immunity and inflammation, based on a non-invasive test of 2-4 h duration. Work in progress shows that patients who respond clinically to elemental diet treatment have unusually high concentrations of soluble IL2 receptor in WGLF; cytokine profiles may facilitate the selection of patients suitable for other new treatment modalities.
Dept. of Medicine, Western General Hospital, Edinburgh, UK.
A
A
Ferguson
S
S
Ghosh
L M
LM
Harny
C
C
Choudari
O
O
Mwantembe
M A
MA
McIntyre
D002648:Child; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D007422:Intestines / Q000276:immunology / Q000473:pathology; D019272:Leukocyte Elastase / Q000378:metabolism; D008297:Male; D009504:Neutrophils / Q000201:enzymology; D010196:Pancreatic Elastase / Q000378:metabolism; D011504:Protein-Losing Enteropathies / Q000209:etiology; D007507:Therapeutic Irrigation
D016207:Cytokines; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase