FUTURE ASPECTS ON INFLAMMATORY BOWEL-DISEASE

Inflammatory bowel diseases (IBD) are probably multifactorial diseases caused by an interplay of the external and internal environment. Exte rnal environmental factors revealed in the literature so far can be gr ouped into four major groups or hypotheses: (a) the sheltered child, ( b) infectious agents, (c) dietary factors, and (d) vascular factors. I nternal environmental factors mainly concern genetics which have been studied in families or twins. At present, HLA class II antigens are mo st in focus but also genetic markers such as pANCA. However, the inter nal environment can be changed by external factors changing the balanc e of the faecal or mucosa related flora, such as infectious agents or antibiotic treatment. This in turn may upset the building up and degra dation of colonic mucin, making the mucosa more vulnerable. The increa sing knowledge of external and internal environmental factors might af fect our way of treatment in the future. So also may our increasing kn owledge of immunology which will probably lead to targeted treatment d irected against individual components within the inflammatory cascade.