Chronisch entzündliche Darmerkrankungen – die letzten 50 Jahre

Zusammenfassung

Chronisch entzündliche Darmerkrankungen sind schon seit dem Altertum als nicht kontagiöse Kolitis bekannt und bleiben ein faszinierendes Enigma der Inneren Medizin. In den letzten 50 Jahren wurde klar, dass die Erkrankungsrate zunimmt, die Entstehung sowohl genetische als auch Umweltkomponenten hat und die intestinale Immunreaktion gegen die Darmflora und nicht Darmgewebe gerichtet ist. Basierend auf bahnbrechenden genetischen Arbeiten wanderte der Fokus von der adaptiven zur angeborenen Immunität und damit von der Autoimmunität zum Barrieredefekt. Dieser Paradigmenwechsel wird auch Auswirkungen auf die Therapie haben, die derzeit noch immunsuppressiv ist und sich vermutlich in Richtung einer Verbesserung der antibakteriellen Mukosaschranke entwickeln wird.

Abstract

Since ancient times chronic inflammatory bowel diseases have been known as non-contagious colitis and remain as an unsolved enigma of internal medicine. In the past 50 years it became clear that the incidence is increasing, the cause is multifactorial genetics as well as environment and the intestinal immune reaction is directed against the intestinal microbiota and not tissue antigens. Based on groundbreaking genetic studies the focus has moved from adaptive to innate immunity and thus from autoimmunity to a barrier defect. This paradigm shift will have a major impact on therapies which are traditionally immunosuppressive and will be developed to improve the antibacterial mucosal barrier in the future.

Schlüsselwörter

chronisch entzündliche Darmerkrankung - Colitis ulcerosa - Morbus Crohn

Key words

chronc inflammatory bowel disease - ulcerative colitis - Crohn’s disease

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