Inflammatory bowel disease

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Article contains incorrect information (psychosomatics) and individual aspects with little source evidence, so it is not suitable as a review article.

Classification according to ICD-10
K50 - K52	Non-infectious enteritis and colitis
ICD-10 online (WHO version 2019)

Under chronic inflammatory bowel diseases ( IBD ; English inflammatory bowel disease , IBD ) refers to repeating (recurrent) or continuous inflammatory diseases of the intestine . The two most common representatives are ulcerative colitis and Crohn's disease . Collagenic and lymphocytic colitis are less common than forms of microscopic colitis , which can only be diagnosed histologically .

May 19th is World IBD Day .

Typical symptoms and differential diagnosis

Diagnosis	Crohn's disease	Ulcerative colitis
Clinic: Bloody stool fistulas abscesses toxic megacolon	rarely often often rarely	often seldom occasionally occasionally
Roentgen: Infection of the colon (infestation) of the terminal ileum of the small intestine	discontinuous, often stiff, often affected	continuously always far normal
Colonoscopy: rectum affected	approx. 50 %	> 90%
Pathology: - Macroscopic morphology, mesenteric lymph nodes, fistulas - Histology, depth of involvement, granulomas, crypt abscesses, malignancies	Paving stone relief (discontinuous, English "skip lesions") Ulcerations (in the form of so-called "snail trails") Oedematous, often transmural (all layers), often rarely, rarely (small intestine)	Fibrosis, pseudopolyps Bicycle tube phenomenon not affected rarely mucosa and submucosa rarely often occasionally (large intestine)

Genetic disposition

In 2009, scientists working with Christoph Klein , then head of the Pediatric Clinic at the Hannover Medical School , and Bodo Grimbacher from the Royal Free Hospital in London discovered the first human genetic defect that causes inflammatory bowel disease. Due to a mutation in the two genes of the IL10 receptor ( IL10RA and IL10RB ), the immune cells can no longer receive the modulating signals of the messenger substance interleukin-10 . There are severe inflammatory changes in the intestinal wall with fistula formation and an accumulation of pus . This genetic defect can be permanently remedied by allogeneic stem cell transplantation .

Psychosomatics

It is assumed that in the case of inflammatory bowel diseases, psychosocial stress also leads to a dysregulation of the immune response and - with the appropriate predisposition - to activation of the disease. This stress can lead to re-inflammation in patients. In 1950, Franz Alexander describes inflammatory bowel disease as a psychosomatic illness in the Holy Seven .

literature

• Luca Pastorelli, Carlo De Salvo u. a .: Central Role of the Gut Epithelial Barrier in the Pathogenesis of Chronic Intestinal Inflammation: Lessons Learned from Animal Models and Human Genetics. In: Frontiers in Immunology. 4, 2013, doi: 10.3389 / fimmu.2013.00280 .
• ML Chen, MS Sundrud: Cytokine Networks and T-Cell Subsets in Inflammatory Bowel Diseases. In: Inflammatory bowel diseases. [Electronic publication before going to press] February 2016, doi: 10.1097 / MIB.0000000000000714 , PMID 26863267 .

Individual evidence

1. ↑ Baumgart DC, Carding SR: Inflammatory bowel disease: cause and immunobiology. In: The Lancet . tape 369 , no. 9573 , 2007, p. 1627-1640 , doi : 10.1016 / S0140-6736 (07) 60750-8 , PMID 17499605 .
2. ↑ DC Baumgart, WJ Sandborn: Inflammatory bowel disease: clinical aspects and established and evolving therapies. In: The Lancet . tape 369 , no. 9573 , 2007, p. 1641–1657 , doi : 10.1016 / S0140-6736 (07) 60751-X , PMID 17499606 .
3. ↑ RJ Xavier, DK Podolsky: Unraveling the pathogenesis of inflammatory bowel disease. In: Nature . tape 448 , no. 7152 , 2007, p. 427-434 , doi : 10.1038 / nature06005 , PMID 17653185 .
4. ↑ Gerd Herold and colleagues: Internal Medicine 2020. Self-published, Cologne 2020, ISBN 978-3-9814660-9-6 , p. 485.
5. ↑ EO Glocker, D. Kotlarz, K. Boztug, EM Gertz, AA Schäffer, F. Noyan, M. Perro, J. Diestelhorst, A. Allroth, D. Murugan, N. Hätscher, D. Pfeifer, KW Sykora, M Sauer, H. Kreipe, M. Lacher, R. Nustede, C. Woellner, U. Baumann, U. Salzer, S. Koletzko, N. Shah, AW Segal, A. Sauerbrey, S. Buderus, SB Snapper, B. Grimbacher, C. Klein: Inflammatory bowel disease and mutations affecting the interleukin-10 receptor. In: N Engl J Med. 361 (21), Nov 19, 2009, pp. 2033-2045. PMID 19890111

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