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Allergic and Immunologic Perspectives of Inflammatory Bowel Disease

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Abstract

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-α) 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-α drugs such as serious infections, malignancy, worsening of heart failure, and infusion-related reactions should be considered prior to starting these drugs. Anti-TNF-α 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.

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Authors and Affiliations

  1. Milton S Hershey Medical Center, Penn State College of Medicine, 500 University Dr, Hershey, PA, 17033, USA

    Kofi Clarke

  2. Division of Gastroenterology and Hepatology, Penn State Milton S Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, USA

    Kofi Clarke & Jayakrishna Chintanaboina

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  1. Kofi Clarke
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Correspondence to Kofi Clarke.

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There are no conflicts of interest relevant to this manuscript. However, for full disclosure, Dr. Clarke is on the speakers’ bureau for AbbVie, Takeda, and Janssen. In addition, he has served on an Ad Board for Pfizer.

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This is a review article; no patients were involved, and informed consent was not required. Permission was obtained for all images used and appropriate attribution/acknowledgement stated.

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Speakers Bureau for Abbvie, Janssen and Takeda; Ad Board for Pfizer.

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Clarke, K., Chintanaboina, J. Allergic and Immunologic Perspectives of Inflammatory Bowel Disease. Clinic Rev Allerg Immunol 57, 179–193 (2019). https://doi.org/10.1007/s12016-018-8690-3

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