DISCUSSION
CD is a chronic inflammatory disease of unknown etiology characterized by chronic, granulomatous, segmental transmural inflammation that may occur in any part of the alimentary tract from mouth to anus. In the human upper digestive tract, the oesophagus is the least common segment involved in CD.[10,11] It is not difficult to diagnose oesophageal CD if other segments of the digestive tract are also involved or in patients with a previous history of crohn’s disease. The typical endoscopic and radiographic appearance combined with histological examination contribute to a definitive diagnosis.[11,12]
It seems that environmental factors do play an important role in the manifestation, course and prognosis of CD. Epidemiological studies …show more content…
Although genetic susceptibility, luminal antigenic drive, and environmental triggers are also important factors, animal models demonstrate that no single factor is sufficient to induce intestinal inflammation. The pathogenesis of Crohn’s disease is due to chronic inflammation from T-cell activation leading to tissue injury. After activation by antigen presentation, unrestrained responses of type 1 T helper (Th1) cells predominate in Crohn’s disease as a consequence of defective regulation. The inflammatory response is stimulated by Th1 cytokines such as interleukin (IL)-12 and TNF-α . These cytokines recruit inflammatory cells which release nonspecific inflammatory substances, such as arachidonic acid metabolites, proteases, platelet activating factor, and free radicals, which result in direct injury to the intestine. NOD2/CARD15 is a polymorphic gene involved in the innate immune system. Of its more than 60 variations, 3 play a role in 27% of patients with Crohn’s disease, primarily in those with ileal disease. Subsequent studies suggest that CARD15 genotype is associated not only with the onset of disease but also with its natural history. A study in a German and Norwegian cohort showed that patients with 1 of the 3 identified risk alleles for CARD15 were more likely to have either ileal or right-colon
CD is a chronic inflammatory disease of unknown etiology characterized by chronic, granulomatous, segmental transmural inflammation that may occur in any part of the alimentary tract from mouth to anus. In the human upper digestive tract, the oesophagus is the least common segment involved in CD.[10,11] It is not difficult to diagnose oesophageal CD if other segments of the digestive tract are also involved or in patients with a previous history of crohn’s disease. The typical endoscopic and radiographic appearance combined with histological examination contribute to a definitive diagnosis.[11,12]
It seems that environmental factors do play an important role in the manifestation, course and prognosis of CD. Epidemiological studies …show more content…
Although genetic susceptibility, luminal antigenic drive, and environmental triggers are also important factors, animal models demonstrate that no single factor is sufficient to induce intestinal inflammation. The pathogenesis of Crohn’s disease is due to chronic inflammation from T-cell activation leading to tissue injury. After activation by antigen presentation, unrestrained responses of type 1 T helper (Th1) cells predominate in Crohn’s disease as a consequence of defective regulation. The inflammatory response is stimulated by Th1 cytokines such as interleukin (IL)-12 and TNF-α . These cytokines recruit inflammatory cells which release nonspecific inflammatory substances, such as arachidonic acid metabolites, proteases, platelet activating factor, and free radicals, which result in direct injury to the intestine. NOD2/CARD15 is a polymorphic gene involved in the innate immune system. Of its more than 60 variations, 3 play a role in 27% of patients with Crohn’s disease, primarily in those with ileal disease. Subsequent studies suggest that CARD15 genotype is associated not only with the onset of disease but also with its natural history. A study in a German and Norwegian cohort showed that patients with 1 of the 3 identified risk alleles for CARD15 were more likely to have either ileal or right-colon