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Inflammatory bowel diseases: Microbiota versus the barrier
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
This book presents the proceedings of the Falk symposium 188 held in Stuttgart, Germany, in June 2013. The first section, “The Gut Microbiota and the Mucosa in IBD” covers evolution of inflammatory bowel disease (IBD), the evolution of human microbiome, host defenses, and the host-flora relationship.
Under the second section, “The Gut Barrier in IBD: The First Line of Defense” the chapter on intestinal stem cells provides an interesting insight into the topic and the roles of Paneth cells, Lgr5 receptor and Wnt pathway. In the chapter on “Innate Immune Functions of α-Defensins in the Small Intestine", the role of two α-defensins secreted by Paneth cells (HD5 and HD6) and how their reduction may be related to causation of ileal Crohn's disease are elucidated. The chapter on mucus and goblet cell details the importance of MUC2 protein and net-like inner mucus layer, which acts as a size exclusion filter excluding bacteria (important in ulcerative colitis). The chapter, “Defective Antibacterial Barrier in Inflammatory Bowel Disease” discusses the components of intestinal barrier including antimicrobial peptides (secreted by goblet and Paneth cells) and role of defective antibacterial barrier in the pathogenesis of IBD.
The third section, “The Gut Barrier in IBD: The Second Line of Defense” discusses the role of innate and adaptive immune systems and the role of granulocytes and T and B lymphocytes. The fourth section, “Diagnostics and Prognostics in IBD” deals with the role of faecal markers, calprotectin and lactoferrin, various imaging modalities in IBD and the role of endoscopy in prognostication in IBD.
The fifth section addresses the differences in treatment guidelines in IBD. It addresses three controversial issues in the management of IBD: the role of mesalamine in Crohn's disease, early use of anti-TNF (tumour necrosis factor) therapy in Crohn's disease and management of acute severe ulcerative colitis. The sixth section deals with well-known adverse events of drugs used in IBD, while the last section discusses the treatment of microbiota and/or the barrier. This includes the role of antibiotics and probiotics. There is an interesting chapter on the use of lecithin as a therapeutic agent in ulcerative colitis. The last chapter deals with the therapeutic use of Trichuris suis ova in IBD.
Overall, the book is well written and the first three sections are outstanding in that these contribute to the understanding of basic pathogenesis of IBD. The notable missing chapter is on faecal microbiota transplantation. However, it is a very useful book and may be of special interest in academic gastroenterology departments.
