Current concept of pathophysiological understanding and natural course of ulcerative colitis.
BACKGROUND
According to the current paradigm both ulcerative colitis (UC) and Crohn's disease (CD) result from a complex interplay of genetic susceptibility factors, environmental factors, alterations of the physiological intestinal flora and a defective regulation of the intestinal immune system.


CONCLUSIONS
The objective of this review is to give an overview of these factors and mechanisms, including genetic, environmental and microbial factors, with special alterations of relevant cellular components of the intestinal immune system such as T cells, macrophages and epithelial cells will then be addressed. In addition, the most relevant animal model systems that have contributed to our current pathogenetic understanding will be introduced. Clinically, the natural course of UC with special reference to the risk of colorectal cancer will be addressed.


CONCLUSIONS
The elucidation of pathomechanisms at the level of the intestinal immune system provides the potential for novel, effective treatment strategies. Best surgical management of patients with UC, however, still remains a challenge.
Holtmann
Martin H
MH
Department of Medicine, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany. mholtman@mail.uni-mainz.de
Galle
Peter R
PR
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications / Q000209:etiology / Q000235:genetics / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D018849:Controlled Clinical Trials as Topic; D004195:Disease Models, Animal; D020022:Genetic Predisposition to Disease; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008264:Macrophages / Q000276:immunology; D019804:Mesalamine / Q000627:therapeutic use; D051379:Mice; D018345:Mice, Knockout; D008822:Mice, Transgenic; D008875:Middle Aged; D011379:Prognosis; D013601:T-Lymphocytes / Q000276:immunology
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D019804:Mesalamine