Inflammatory Bowel Diseases and Intestinal Microbiota

Öz

The cause of Crohn’s Disease (CH) and Ulcerative Colitis (UC) is infl ammatory bowel disease (IBD) in which the genetic and environmental factors play a role in the pathogenesis. The incidence of UC in the whole world has been reported as 6.3-24.3 / 100.000, and the incidence of CH 5-20.2 / 100.000 (1). In Turkey, the prevalence of IBD is 36 / 100.000 according to the data of 2007. There are still signifi cant unmet needs in the treatment strategies for infl ammatory bowel disease, along with the growing developments in recent years. Patients are seeking safer, immunomodulatory and immunosuppressive treatment alternatives, and modulation of intestinal microbiota in IBD seems conceptually attractive and realistic (2). However, the inconsistent results in the studies and publications still do not provide suffi cient evidence on the subject and therefore studies are insuffi cient to assess the clinical fi ndings of the findings obtained. In this article, the etiopathogenetic and therapeutic relationship between IBD and intestinal microbiota has been tried to be observed in the light of current knowledge

Anahtar Kelimeler

• Infl ammatory Bowel Diseases,IBD,Microbiota

İnflamatuar Barsak Hastalığı Ve Barsak Mikrobiyotası

Öz

Crohn Hastalığı (CH) ve Ülseratif Kolit (ÜK) nedeni kesin olarak bilinmeyen, patogenezinde genetik ve çevresel faktörlerin rol aldığı infl amatuar barsak hastalıklarıdır (İBH). Tüm dünyada ÜK insidansı, 6,3-24,3/100.000, CH insidansı 5-20,2/100.000 olarak bildirilmiştir (1). Türkiye’de ise İBH derneğinin 2007 yılındaki verilerine göre İBH prevalansı, 36/100.000 dır. İnfl amatuar barsak hastalığı için tedavi stratejilerinde son yıllarda artan gelişmeler olmakla beraber hala karşılanmamış önemli ihtiyaçlar mevcuttur. Hastalar daha güvenli, immünmodülatör ve immünsüpresif tedaviye alternatif olabilecek tedaviler aramakta olup bu anlamda İBH’da barsak mikrobiyotasının modülasyonu kavramsal olarak çekici ve gerçekçi gözükmektedir (2). Fakat çalışma ve yayınlardaki ikna edici olmayan sonuçlar konu ile ilgili halen yeterli kanıtları gösterememiştir ve bu nedenle çalışmalar elde edilen bulguların klinik pratiğe yansımasını değerlendirme konusunda yetersiz kalmaktadır. Bu yazıda İBH ile barsak mikrobiyotası arasındaki etyopatogenetik ve terapötik ilişki güncel bilgiler ışığında gözden geçirilmeye çalışılmıştır.

Anahtar Kelimeler

• İnfl amatuar Bağırsak Hastalıkları,İBH,Mikrobiyota

Kaynakça

1. 1. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the infl ammatory bowel diseases with time, based on systematic review.Gastroenterology. 2012 Jan;142(1):46-54
2. 2. Sheehan D, Shanahan F. The Gut Microbiota in Infl ammatory Bowel Disease. Gastroenterol Clin North Am. 2017 Mar;46(1):143-154.
3. 3. Buttó LF, Haller D. Dysbiosis in intestinal infl ammation: Cause or consequence. Int J Med Microbiol. 2016 Aug;306(5):302-9.
4. 4. Shanahan F, Quigley EM. Manipulation of the microbiota for treatment of IBS and IBD-challenges and controversies. Gastroenterology 2014;146:1554–63.
5. 5. Gevers D, Kugathasan S, Denson LA, et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe 2014;15:382–92.
6. 6. Sokol H, Pigneur B, Watterlot L, et al. Faecalibacterium prausnitzii is an antiinfl ammatory commensal bacterium identifi ed by gut microbiota analysis of Crohn disease patients. Proc Natl Acad Sci USA 2008;105:16731–6.
7. 7. Kernbauer E, Ding Y, Cadwell K. An enteric virus can replace the benefi cial function of commensal bacteria. Nature 2014;516: 94–8.
8. 8. Becker C, Neurath MF, Wirtz S. The Intestinal Microbiota in Infl ammatory Bowel Disease. ILAR J. 2015;56(2):192-204.

9. 9. Bringiotti R, Ierardi E, Lovero R, Losurdo G, Di Leo A, Principi M. Intestinal microbiota: The explosive mixture at the origin of infl ammatory bowel disease? World J Gastrointest Pathophysiol. 2014 Nov 15;5(4):550-9.
10. 10. Gionchetti P, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations. J Crohns Colitis. 2017 Feb;11(2):135-149.
11. 11. Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D, Bazzocchi G, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology2000;119:305–9
12. 12. Dignass A, Lindsay JO, Sturm A, et al. Second European evidencebased consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis. 2012 Dec;6(10):991-1030
13. 13. Kumar H, Salminen S, Verhagen H, Rowland I, Heimbach J, Bañares S, et al. Novel probiotics and prebiotics: road to the market. Curr Opin Biotechnol. 2015 Apr;32:99-103
14. 14. Moayyedi P, Surette MG, Kim PT, Libertucci J, Wolfe M, Onischi , et al. Fecal Microbiota Transplantation Induces Remission in Patients With Active Ulcerative Colitis in a Randomized Controlled Trial. Gastroenterology. 2015 Jul;149(1):102-109.e6.
15. 15. Rossen NG, Fuentes S, van der Spek MJ, et al. Findings from a randomized controlled trial of fecal transplantation for patients with ulcerative colitis. Gastroenterology 2015;149:110–8.e4.
16. 16. Suskind DL, Brittnacher MJ, Wahbeh G, et al. Fecal microbial transplant effect on clinical outcomes and fecal microbiome in active Crohn’s disease. Infl amm Bowel Dis 2015;21:556–63.