Application of Chinese Medicine Nursing Techniques in the Sequelae of Pelvic Inflammatory Diseases: A Review

Sequelae of Pelvic Inflammatory Diseases (SPID) is a common and frequent disease in gynecology, which adversely affects women’s reproductive health and quality of life due to its prolonged course. In recent years, traditional Chinese medicine (TCM) in China has gradually shown its clinical advantages in the treatment of SPID. Therefore, the present review summarizes the etiology and pathogenesis of SPID, the evidence typology, and the clinical application effects of moxibustion, herbal retention enema, acupoint compresses, external application of traditional Chinese medicine, auricular pressure beans, tuina massage, traditional Chinese medicine gongfu, and other commonly used Chinese medicine nursing techniques, with the aim of providing references and experiences for the subsequent related studies.

Role of MMP-2 and MMP-9 and their natural inhibitors in liver fibrosis, chronic pancreatitis and non-specific inflammatory bowel diseases

BACKGROUND： There is a growing evidence that matrix metalloproteinase （MMP）-2 and MMP-9 （gelatinases） play an important role in the pathogenesis of numerous disorders, especially with inflammatory etiology and extracellular matrix （ECM） remodeling. Despite the fact that gelatinases involve in liver cirrhosis is provided in the literature, their role in the pathogenesis of chronic pancreatitis and non-specific inflammatory bowel diseases is still under investigation. DATA SOURCES： We carried out a PubMed search of Englishlanguage articles relevant to the involvement of gelatinases in the pathogenesis of liver fibrosis, pancreatitis, and non-specific inflammatory bowel diseases. RESULTS： The decreased activity of gelatinases, especially MMP-2, is related to the development of liver fibrosis, probably due to the decrease of capability for ECM remodeling. Similar situation can be found in chronic pancreatitis; however, reports on this matter are rare. The presence of non-specific inflammatory bowel diseases results in MMP-9 activity elevation. CONCLUSION： The fluctuation of gelatinases activity during liver fibrosis, chronic pancreatitis and non-specific inflammatory bowel diseases is observed, but the exact role of these enzymes demands further studies.

Effect of Zhuang Yi Liu Fang Teng Fang on the Expression of TNF-αand NF-κB in Chronic Pelvic Inflammatory Disease(CPID)Model Rats

Objecrive:To investigate the expression of TNF-αand NF-κB in the uterus of chronic pelvic inflammatory disease(CPID)model rats.Methods:40 female rats that adaptive fed for 5 days were randomly divided into normal group,model group,high dose group,medium dose group and low dosegroup.In addition to the normal group:the rats in each group were made chronic pelvic inflammatory model by mechanical injuuy combined with implantation of bacteria.The rats in each group were administrated by gavage for 20days.After the last administration,the level of TNF-αand NF-κB in serum was measured by ELASA method.Results:(1)after the establishment of the model,the uterus of the chronic pelvic inflammatory model rats showed the pathological damage of chroic infilammation;the levels of lNF-αand NF-κB inserum were higher than those in the normal group,the difference was statistically significant(P<0.05).(2)After the drug intervention,the uterine tissue morphology of the rats in the Zhuang Yi Liu Fang Teng Fang Group was basically restored to normal,with only a small amount of inflammatory cell infiltration and other pathological changes;compared with the rats in the model group,the TNF-αin serum of the rats in each treatment group was lower,the difference was statistically significant(P<0.05).The expression of NF-κB in serum of each treatment group was lower fthan that of the model group(P<0.05).Conclusion:Zhuang Yi Liu Teng Fang can efectively improve the endometrial histomorphology of CPID model rats,and regulate the levels of TNF-αand NF-κB in the uterus of chronic pelvic inflammatory model rats.

Research Progress on the Immunomodulatory Effect of Mesenchymal Stem Cells on Chronic Periodontitis

Periodontal disease is an inflammatory and destructive disease of periodontal support tissue caused by microorganisms in dental plaque. During the development of periodontal disease, host immune regulation plays an important role, and unnecessary excessive immune regulation often exacerbates the course of chronic periodontal disease. Mesenchymal stem cells (MSCs) are adult stem cells with self replication ability and multi-directional differentiation potential. Many studies have found that MSCs have strong immunosuppressive effects on both adaptive and innate immunity. In recent years, literature has reported that MSCs are involved in the immune regulatory effect of chronic periodontal disease, inhibiting its inflammatory response and alveolar bone resorption, but the specific regulatory mechanism has not been elucidated. This article reviews the current research status of the immune regulatory effects of MSCs on chronic periodontitis.

Insights into renal and urological complications of inflammatory bowel disease

Inflammatory bowel disease(IBD)is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract,which follows a relapsing and remitting course.Apart from affecting the gastrointestinal tract,IBD also has extra-intestinal manifestations(EIMs).While the etiology of extraintestinal manifestation remains unclear,it is theorized to be based on immunological responses influenced by genetic factors.Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn’s disease.The renal manifes-tations in IBD patients encompass a range of conditions including nephrolithiasis,amyloidosis,tubulointerstitial nephritis,glomerulonephritis(GN),obstructive pathologies,and chronic kidney disease(CKD).The incidence of CKD in IBD patients varies from 5%-15%.The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury,or from complications like recurrent stones,amyloidosis,or GN.Additionally,nephrotoxic medications used in treating IBD,such as TNF-αinhibitors,calcineurin inhibitors,and aminosalicylates,can exacerbate the decline in renal function.Currently,there is a lack of consensus regarding these patients'screening and renal function monitoring.This review aims to assess the existing literature on the different renal complications among individuals with IBD,shedding light on their pathophysiology and management.

Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study

BACKGROUND There is a growing evidence regarding an increased risk of inflammatory bowel disease(IBD)among patients with airway diseases.AIM To investigate the influence of chronic obstructive pulmonary disease(COPD)on the risk of IBD.METHODS A nationwide,population-based study was conducted using data from the National Health Insurance Service database.A total of 1303021 patients with COPD and 6515105 non-COPD controls were identified.The COPD group was divided into the severe and the mild COPD group according to diagnostic criteria.The risk of IBD in patients with COPD compared to controls was analyzed by Cox proportional hazard regression models.The cumulative incidences of IBD were compared between the groups.RESULTS The COPD group had higher incidences of IBD compared to non-COPD controls(incidence rate,9.98 vs 7.18 per 100000 person-years,P<0.001).The risk of IBD in the COPD group was increased by 1.38(adjusted hazard ratio(HR);95%CI:1.25-1.52).The incidence rate of IBD was higher in the severe COPD group than in the mild COPD group(12.39 vs 9.77 per 100000 person-year,P<0.001).The severity of COPD was associated with an increased risk of IBD(adjusted HR 1.70 in severe COPD,95%CI:1.27-2.21 and adjusted HR 1.35 in mild COPD,95%CI:1.22-1.49)CONCLUSION The incidences of IBD were significantly increased in COPD patients in South Korea and the risk of developing IBD also increased as the severity of COPD increased.

Clinical Study on Respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure

Objective:To explore the respiratory medicine treatment methods for treating chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:70 cases of COPD patients with combined respiratory failure admitted to our hospital from January 2021 to January 2023 were selected as the study subjects,and randomly divided into the control group and the experimental group,each with 35 cases.The control group received only conventional treatment,and the experimental group received non-invasive positive pressure ventilation,and the treatment effects and changes in the levels of IL-18,hs-CRP,and CES2 inflammatory factors were observed and evaluated in the two groups.Results:There was no significant difference between the general data of the two groups(P>0.05);after treatment,the total effective rate of clinical efficacy of the observation group(91.43%)was significantly higher than that of the control group(71.43%),and the difference showed a significant correlation(P<0.05);after treatment,the level of inflammatory factor of the observation group was significantly reduced compared with that of the control group,and the difference showed a highly significant correlation(P<0.001).Conclusion:The non-invasive positive pressure ventilation treatment program significantly improves the therapeutic effect,effectively controls the level of inflammatory factors,and improves the health status of patients when dealing with patients with chronic obstructive pulmonary disease accompanied by respiratory failure,showing a good clinical application prospect.

Effects of electroacupuncture at Zusanli(ST36) on inflammatory cytokines in a rat model of smokeinduced chronic obstructive pulmonary disease

OBJECTIVE： Improvement in lung function was reported after acupuncture treatment of chronic obstructive pulmonary disease （COPD）, but little is known about the underlying mechanisms. Because an immune response imbalance could be seen in COPD, we hypothesize that electroacupuncture （EA） may play a role in regulating inflammatory cytokines and contribute to lung protection in a rat model of smoke-induced COPD. METHODS： A COPD model using male Sprague-Dawley rats exposed to cigarette smoke was established. The rats were randomly divided into four groups （control, sham, COPD, and COPD plus EA）, and COPD model was evaluated by measuring pulmonary pathological changes and lung function. EA was applied to the acupuncture point Zusanli （ST36） for 30 min/d for 14 d in sham and COPD rats. Bronchoalveolar lavage fluid （BALF） was used to measure levels of tumor necrosis factor-a （TNF-a）, interleukin-113 （IL-113）, and malonaldehyde （MDA）. RESULTS： Compared with the control rats, COPD rats had significant changes in lung resistance （R,） and lung compliance （C,） （both P〈0.01）, bronchi and bronchiole airway obstruction （P〈0.01）, and levels of MDA, TNF-α, and IL-1β（P〈0.01）. There were no significant differences between the control and the sham groups. Compared with the COPD rats, the COPD plus EA rats had decreased R, and increased CL （both P〈0.05）, and reduced bronchi and bronchiole airway obstruction （P〈0.05, P〈0.01, respectively）, while levels of TNF-α, IL-1β, and MDA in BALF were lowered （P〈0.05 and P〈0.01, respectively）. However, TNF-α and IL-1β levels of the EA group rats remained higher than those of the control group （P〈0.05）. CONCLUSION： EA at ST36 can reduce lung injury in a COPD rat model, and beneficial effects may be related to down-regulation of inflammatory cytokines. The anti-inflammatory and antioxidant effects may prolong the clinical benefit of EA.

Management of inflammatory bowel disease in the pregnant patient

Inflammatory bowel disease (IBD) is a chronic disorder affecting young adults in their reproductive years. Many young women with IBD express concern about the effect their disease will have on fertility, pregnancy course and fetal development. This article presents an approach to management of IBD in the pregnant patient, including counseling and investigation, and summarizes existing data on the safety of medications used to treat IBD in pregnancy and breastfeeding.

Effect of sequential assist-control ventilation on cardio-pulmonary function and systemic inflammatory state of chronic pulmonary heart disease complicated with respiratory failure patients

Objective:To discuss the effect of sequential assist-control ventilation on cardio-pulmonary function and systemic inflammatory state of chronic pulmonary heart disease complicated with respiratory failure patients.Method: A total of 90 cases of chronic pulmonary heart disease complicated with respiratory failure patients, who were treated in our hospital between May, 2012 and Feb., 2016, were selected, and were divided into study group (n=45) and control group (n=45) based on random number table. Patients in control group were given auxiliary - control ventilation. (A/C) treatment during the whole course, while patients in study group were given A/C+BiPAP treatment. Cardio-pulmonary function and serum inflammatory factor content difference was compared inboth groups before and after operation.Results: Before treatment, difference ofcardiac function indicator, ABG level and inflammatory factor content in both groups had no statistical significance. After treatment, cardiac function indicator (PASP, RVd) levels in both groups were lower than before treatment, and EFRV levels were higher than before treatment, and changes in study group were more obvious than that in control group;ABG indicator (PaO2) levels in both groups were higher than before treatment, and PaCO2 levels werelower than before treatment, and changes in study group were more obvious than that in control group;serum inflammatory factor (hs-CRP, IL-6, TNF-α) content in both groups was lower than before treatment, and changes in study group were more obvious than that in control group.Conclusion: sequential assist-control ventilation could optimize the cardio-pulmonary function of chronic pulmonary heart disease complicated with respiratory failure patients and reduce the systemic inflammatory response.

Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

Exacerbation of chronic inflammatory diseases by infectious agents:Fact or fiction?

Chronic inflammatory diseases caused by obesity represent critical public health concerns worldwide. In these diseases such as metabolic syndrome,diabetes and atherosclerosis,adipose tissue acts as an endocrine organ that releases large quantities of inflammatory mediators into circulation.Besides classically recognized effectors on the development of obesity and resultant conditions,infection has attracted attention as an enhancer of chronic inflammatory diseases.Infectious diseases have long been associated with obesity,metabolic syndrome,diabetes and atherosclerosis.However,the infectious hypothesis for chronic inflammatory diseases has been challenged by inconclusive clinical trials.Nevertheless,the large body of evidence accumulated over decades on the association of infectious diseases with obesity,diabetes and cardiovascular disease should not be disregarded.Instead,re-formulation of hypothesesof the mechanisms by which microbes affect obesityassociated diseases may be required with an emphasis on the early events in the progression of such diseases and the multifactorial nature of pathogen-host interactions.This review focuses on pathogens that directly promote obesity and on pathogens that cause chronic infections and thereby enhance metabolic diseases in obese patients.A new perspective on the interaction between infections and obesity-related diseases may improve management of chronic inflammatory diseases that rank high among global threats to human health.

The Therapeutic Ways for Chronic Liver Diseases Accompanied by Diseases of the Endocrine and Mammary Glands

It is discovered by the authors of this article thatchronic hepatitis and hepatocirrhosis (hereinafterchronic hepatopathy for short) are often accompaniedby some diseases of endocrine and mammary glands.The authors have studied the pathogenesis andtreatment of the complications as presented in thefollowing.

Management of Patients with Inflammatory Bowel Disease during the Prevention of COVID-19

Objective: To explore the disease management methods and effects for patients with inflammatory bowel disease (IBD) in the special period of pandemic. Methods: Medical staffs carried out the management of patients with IBD on the inflammatory disease service platform of this center from February to May of 2020 in addition to routine clinical works. Results: None of the nearly 3000 IBD patients who are being followed up at our center were infected with COVID-19. During this period, no patients experienced drug-related serious side effects or disease recurrence that could not be treated in time due to failure to reach the medical staffs. Conclusion: The disease management methods based on IBD platform allow the patients to be properly managed during this special period.

Effects of smilax bockii warb polysaccharide on inflammatory mediators, apoptosis and immune cell function in rats with chronic pelvic inflammatory disease

Objective:To study the effects of smilax bockii warb polysaccharide on inflammatory mediators, apoptosis and immune cell function in rats with chronic pelvic inflammatory disease.Methods:Female SD rats were chosen as experimental animals and divided into control group, pelvic inflammation group and smilax bockii warb group, pelvic inflammation group and smilax bockii warb group were made into pelvic inflammation models, and smilax bockii warb group were given intragastric administration of smilax bockii warb. The contents of inflammatory mediators and the expression of apoptosis genes in uterine muscle as well as the contents of immune cells in peripheral blood were determined 21 d after molding and intervention.Results:TLR4, NF-κB, TNF-α, ICAM-1 and IL-8 levels as well as Fas, TNFR-1, GRP78, CHOP and Caspase-3 mRNA expression in uterine muscle tissue and CD3+CD8+T cell in peripheral blood of pelvic inflammation group were higher than those of control group whereas peripheral blood CD3+CD4+T cell, red blood cell C3b receptor rosette rate and erythrocyte immune complex rosette were lower than those of control group;TLR4, NF-κB, TNF-α, ICAM-1 and IL-8 levels as well as Fas, TNFR-1, GRP78, CHOP and Caspase-3 mRNA expression in uterine muscle tissue as well as CD3+CD8+T cell in peripheral blood of smilax bockii warb group were lower than those of pelvic inflammation group whereas peripheral blood CD3+CD4+T cell, red blood cell C3b receptor rosette rate and erythrocyte immune complex rosette were higher than those of pelvic inflammation group. Conclusion:Smilax bockii warb polysaccharide for chronic pelvic inflammatory disease intervention can inhibit the inflammatory mediator secretion, apoptosis and regulate the immune cell function.

New translational and experimental insights into the role of proresolving lipid mediators in inflammatory bowel disease

The resolution of inflammation is an active process,guided by specialized proresolution lipid mediators(SPMs).These mediators originate from polyunsaturated fatty acids,such as omega-3.Sufficient evidence suggests that the beneficial effects attributed to omega-3 are,at least in part,the result of the immunomodulatory action of the SPMs,which act systemically by overcoming inflammation and repairing tissue damage,without suppressing the immune response.Recent studies suggest that an imbalance in the synthesis and/or activity of these compounds may be associated with the pathogenesis of several inflammatory conditions,such as inflammatory bowel disease(IBD).Thus,this review highlights the advances made in recent years with regard to the endogenous synthesis and the biological role of lipoxins,resolvins,protectins,and maresins,as well as their precursors,in the regulation of inflammation;and provides an update on the participation of these mediators in the development and evolution of IBD and the therapeutic approaches that these immunomodulating substances are involved in this context.

Correlation of Inflammatory Cells in Induced Sputum and Peripheral Blood of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a major chronic respiratory disease worldwide. Inflammatory cells reflect the inflammatory situation both in peripheral blood and induced sputum. Their correlation has not been reported. The correlation between neutrophils (Neu), eosinophils (Eos), and lymphocyte (Lym) in induced sputum and that in peripheral blood of COPD patients was evaluated to explore the consistency of inflammatory cells in peripheral blood and induced sputum. Peripheral blood and induced sputum were collected from 437 patients with acute exacerbation of COPD (AECOPD) who were hospitalized in the Department of respiratory and critical care medicine, Inner Mongolia People’s Hospital. The correlation analysis was performed by Spearman correlation analysis. The ratios of Neu, Eos, and Lym in induced sputum were (79.15 ± 22.60)%, (5.23 ± 12.74)%, and (1.69 ± 2.66)%. The ratios of Neu, Eos, and Lym in peripheral blood were (63.29 ± 11.44)%, (2.99 ± 3.60)%, and (25.16 ± 10.19)%. The results showed that the ratios of Neu and Eos in induced sputum were significantly correlated with the proportion of corresponding cells in peripheral blood (P < 0.05). There was no correlation between the ratio of Lym and Leu in induced sputum and corresponding cells in peripheral blood (P > 0.05). In patients with AECOPD, the tendency of Neu and Eos in induced sputum was consistent with the corresponding cells in peripheral blood. Neu and Eos in induced sputum and peripheral blood reflected the degree of inflammation to guide the individualized medication of patients.

Effects of low molecular weight heparin on the function of blood coagulation and serum levels of TNF-α, CK-MB, CRP of patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failur

Objective:To study the effects of low molecular weight heparin on the function of blood coagulation and serum levels of tumor necrosis factor-α(TNF-α), creatine kinase isoenzyme (CK-MB), C-reactive protein (CRP) of patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure.Methods:A total of 80 patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure in our hospital from June 2014 to October 2016 were enrolled in this study. The subjects were divided into the control group (n=40) and the treatment group (n=40) randomly. The control group were treated with conventional treatment, the treatment group were treated with the conventional treatment combined with low molecular weight heparin. The two groups were treated for 7 d. The D-dimer (D-D), fibrinogen (FBG), pro thrombin time (PT), thrombin time (TT), TNF-α, CK-MB and CRP of the two groups before and after treatment were compared.Results:There were no significantly differences of the blood levels of D-D, FBG, PT and TT of the two groups before treatment. After treatment, the blood levels of D-D and FBG of the two groups were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group, the PT and TT of the two groups were significantly higher than before treatment, and that of the treatment group were significantly higher than the control group. There were no significantly differences of the serum levels of the TNF-α, CK-MB and CRP of the two groups before treatment. After treatment, the serum levels of the TNF-α, CK-MB and CRP of the two groups were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group.Conclusion:Low molecular weight heparin can significantly reduce the inflammatory factors of the patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure, can alleviath the patients conditions and reduce the myocardial damage.

Patients with inflammatory bowel disease have increased risk of autoimmune and inflammatory diseases

AIM To investigate whether immune mediated diseases(IMD) are more frequent in patients with inflammatory bowel disease(IBD).METHODS In this population based registry study,a total of 47325 patients with IBD were alive and registered in the Danish National Patient Registry on December 16,2013. Controls were randomly selected from the Danish Civil Registration System(CRS) and matched for sex,age,and municipality. We used ICD 10 codes to identify the diagnoses of the included patients. The IBD population was divided into three subgroups: Ulcerative colitis(UC),Crohn's disease(CD) and Both the latter referring to those registered with both diagnoses. Subsequently,odds-ratios(OR) and 95%CI were obtained separately for each group and their respective controls. The use of Bonferoni post-test correction adjusted the significance level to P < 0.00125. P-values were estimated using Fisher's exact test.RESULTS There were significantly more women than men in the registry,and a greater percentage of comorbidity in the IBD groups(P < 0.05). Twenty different IMDs were all significantly more frequent in the IBD group. Sixteen were associated with UC versus twelve with CD. In both UC and CD ORs were significantly increased(P < 0.00125) for primary sclerosing cholangitis(PSC),celiac disease,type 1 diabetes(T1D),sarcoidosis,asthma,iridocyclitis,psoriasis,pyoderma gangrenosum,rheumatoid arthritis,and ankylosing spondylitis. Restricted to UC(P < 0.00125) were autoimmune hepatitis,primary biliary cholangitis,Grave's disease,polymyalgia rheumatica,temporal arteritis,and atrophic gastritis. Restricted to CD(P < 0.00125) were psoriatic arthritis and episcleritis. Restricted to women with UC(P < 0.00125) were atrophic gastritis,rheumatoid arthritis,temporal arteritis,and polymyalgia rheumatica. Restricted to women with CD were episcleritis,rheumatoid arthritis,and psoriatic arthritis. The only disease restricted to men(P < 0.00125) was sarcoidosis. CONCLUSION Immune mediated diseases were significantly more frequent in patients with IBD. Our results strengthen the hypothesis that some IMDs and IBD may have overlapping pathogenic pathways.

Etiopathogenesis of inflammatory bowel diseases

Theories explaining the etiopathogenesis of inflammatory bowel disease （IBD） have been proposed ever since Crohn＇s disease （CD） and ulcerative colitis （UC） were recognized as the two major forms of the disease. Although the exact cause（s） and mechanisms of tissue damage in CD and UC have yet to be completely understood, enough progress has occurred to accept the following hypothesis as valid： IBD is an inappropriate immune response that occurs in genetically susceptible individuals as the result of a complex interaction among environmental factors, microbial factors, and the intestinal immune system. Among an almost endless list of environmental factors, smoking has been identified as a risk factor for CD and a protective factor for UC. Among microbial factors, no convincing evidence indicates that classical infectious agents cause IBD, while mounting evidence points to an abnormal immune response against the normal enteric flora as being of central importance. Gut inflammation is mediated by cells of the innate as well as adaptive immune systems, with the additional contribution of non-immune cells, such as epithelial, mesenchymal and endothelial cells, and platelets.