Inflammatory bowel disease approaching the 3rd millennium: pathogenesis and therapeutic implications?

The aetiology of inflammatory bower disease remains unknown, but genetic, i mmuno-inflammatory, infectious, vascular and neural factors play an importa nt role. All effective treatments in use today were introduced empirically and most have multiple action. Targeted therapy is very attractive, either with cell and gene therapy or by using specific cytokine inhibitors and inh ibitory cytokines. The role of the intestinal milieu, and enteric flora in particular, appears to have a much greater significance than previously app reciated. The reduction of any changes leading to pro-coagulant activity ma y be a promising line of therapeutic investigation, and measures to reduce platelet aggregation and endothelial cell adhesiveness are examples of ther apeutic potentials. Finally, there has been tangible demonstration of the a bility of nerves to alter the inflammatory process which will lead to new t herapeutic approaches in inflammatory bower disease. Eur J Gastroenterol He patol 11:27-32 (C) 1999 Lippincott Williams & Wilkins.