University of Rouen Normandie, INSERM, ADEN UMR 1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, Rouen F-76000, France.
CHU Rouen, Department of Gastroenterology, Rouen University Hospital-Charles Nicolle, Rouen F-76000, France.
World J Gastroenterol. 2023 Jun 7;29(21):3222-3240. doi: 10.3748/wjg.v29.i21.3222.
Crohn's disease (CD) is an inflammatory bowel disease characterized by immune-mediated flares affecting any region of the intestine alternating with remission periods. In CD, the ileum is frequently affected and about one third of patients presents with a pure ileal type. Moreover, the ileal type of CD presents epidemiological specificities like a younger age at onset and often a strong link with smoking and genetic susceptibility genes. Most of these genes are associated with Paneth cell dysfunction, a cell type found in the intestinal crypts of the ileum. Besides, a Western-type diet is associated in epidemiological studies with CD onset and increasing evidence shows that diet can modulate the composition of bile acids and gut microbiota, which in turn modulates the susceptibility of the ileum to inflammation. Thus, the interplay between environmental factors and the histological and anatomical features of the ileum is thought to explain the specific transcriptome profile observed in CD ileitis. Indeed, both immune response and cellular healing processes harbour differences between ileal and non-ileal CD. Taken together, these findings advocate for a dedicated therapeutic approach to managing ileal CD. Currently, interventional pharmacological studies have failed to clearly demonstrate distinct response profiles according to disease site. However, the high rate of stricturing disease in ileal CD requires the identification of new therapeutic targets to significantly change the natural history of this debilitating disease.
克罗恩病（CD）是一种炎症性肠病，其特征是免疫介导的发作，影响肠道的任何区域，与缓解期交替出现。在 CD 中，回肠经常受到影响，约三分之一的患者表现为单纯回肠型。此外，CD 的回肠型具有特定的流行病学特征，如发病年龄较早，常与吸烟和遗传易感基因有关。这些基因大多数与潘氏细胞功能障碍有关，潘氏细胞是一种存在于回肠隐窝中的细胞类型。此外，西方饮食在流行病学研究中与 CD 的发病有关，越来越多的证据表明饮食可以调节胆汁酸和肠道微生物群的组成，进而调节回肠对炎症的易感性。因此，环境因素与回肠的组织学和解剖学特征之间的相互作用被认为可以解释在 CD 回肠炎中观察到的特定转录组谱。事实上，回肠和非回肠 CD 之间的免疫反应和细胞修复过程存在差异。综上所述，这些发现支持针对回肠 CD 采用专门的治疗方法。目前，干预性药理学研究未能根据疾病部位清楚地显示出不同的反应谱。然而，回肠 CD 中狭窄性疾病的高发生率需要确定新的治疗靶点，以显著改变这种使人衰弱的疾病的自然病程。
