Autoimmune Diseases in Pediatric Gastroenterology

ISBN-13: 9780792387787 / Angielski / Twarda / 2002 / 262 str.

F. Hadziselimovic

Opis

This book is the proceedings of the Falk Symposium No. 127 on Autoimmune Diseases in Paediatric Gastroenterology' (IV International Falk Symposium on Paediatric Gastroenterology), held in Basel, Switzerland, on November 8-9, 2001. The symposium focused on the role of the immune system, both the acquired and the innate systems, in inflammatory bowel disease (IBD) in children and adolescents. The innate system has an important fundamental role in host defence by initiating immune responses against potentially deleterious matter. However, a mutation within the innate system may elicit an immune response against the host: hence, an autoimmune response. Chronic autoimmune hepatitis occurs predominantly in young people, and especially in women. Immunological changes are conspicuous. Tissue antibodies are found in a large number of patients. This is a disease of disordered immunoregulation marked by a deficit in suppressor T cells causing the production of autoantibodies against specific hepatocyte surface antigen. Liver membrane protein is found in the sera of patients with autoimmune chronic acute hepatitis and with primary biliary cirrhosis (PBC). The latter condition of progressive granulomatous destruction of intrahepatic bile ducts is, in many respects, analogous to the graft-versus-host syndrome where the immune system has become sensitized to foreign HLA-molecules. Primary sclerosing cholangitis (PSC) is another condition of unknown origin. All parts of the biliary tree can be involved in a chronic, fibrosing, inflammatory process that results in obliteration of the biliary tree and ultimately in biliary cirrhosis. About half of the patients also suffer from ulcerative colitis and rarely from Crohn's disease. Circulating antibodies to some antigens are found in obstructed portal tracts, as well as increased concentrations of biliary immune complexes in patients with PBC.
In all three previous Falk symposia on paediatric gastroenterology, attention was focused on the role of the innate immune system in the aetiology of IBD. It has become increasingly clear in recent years that the innate system has a much more important and fundamental role in host defence. The decision to initiate an immune response is one of the major roles of the innate system. Mutations within this system could transform it into becoming constitutively active, resulting in an inflammatory reaction and thus eliciting an autoimmune response. Following an introduction to the basic phenomena of autoimmunity, the proceedings discuss clinical aspects of autoimmune diseases. In particular, current knowledge and the state of the art about the diagnosis and treatment of the autoimmune diseases of the gastrointestinal tract are described by world-renowned experts. The book also contains the short presentations on selected topics, as well as abstracts of the mini-posters read by title, which were included in the symposium.

Spis treści

Preface. List of Principal Authors. Section I: Autoimmunity of the Gastrointestinal Tract. 1. Dynamics of T lymphozyte responses: Intermediates, effectors and memory cells; A. Lanzavecchia. 2. Gut-oriented immune response and oral tolerance to dietary antigens; O. Alpan. 3. Role of molecular mimicry in viral and autoimmune liver disease; D. Vergani. 4. Autoantibodies in autoimmune hepatitis; W.B. Storch. Section II: Pathology and Clinical Manifestations. 5. Pathology of autoimmune hepatitis; D. Huff. 6. Autoimmune hepatitis and sclerosing cholangitis; G. Mieli-Vergani. 7. Primary biliary cirrhosis; U. Leuschner. Section III: Treatment. 8. Paediatric liver transplantation. Geneva experience from 1989 to 2001; C. Le Coultre. 9. Patient management after paediatric liver transplantation; M. Burdelski, et al. 10. De novo autoimmune hepatitis after liver transplantation; N. Hadzic, et al. 11. Ursodeoxycholic acid: its cytoprotective action in liver disease; E.L. Renner. 12. Alopecia associated with anti-LKM antibody-positive AIH; D. Belli. Section IV: Pathology and Aetiology of gut autoimmunity. 13. Acute portal vein thrombosis: treatment by the transjugular approach - A case report; M. Rössle. 14. Pathology of ulcerative colitis and Crohn's disease; J.-O. Gebbers. Section V: Clinical manifestations and treatment of inflammatory bowel disease. 15. Novel perspective on the possible role of enterocytes in intestinal and systemic autoimmunity; E.M. Eisenstein, E. Lebenthal. 16. Long-term outcome of autoimmune enteropathy (AE); P.J. Milla. 17. Aetiology of inflammatory bowel disease; A.J. Wakefield. 18. Medical therapies from inflammatory bowel disease: an overview; G.R. Lichtenstein. 19. Azathioprine in the treatment of paediatric ulcerative colitis; H.K. Harms, et al. 20. Molecular mechanisms of steroid resistance in chronic inflammatory bowel disease; H. Bantel, K. Schulze-Osthoff. 21. Treatment with budesonide in inflammatory bowel disease; R. Behrens. 22. Clinical outcome of IBD during long-term 5-ASA treatment, and gender-related differences in children; F. Hadziselimovic, et al. 23. Anti-TNF strategies in paediatric Crohn's disease; C.P. Braegger. 24. Side-effects associated with use of oral budesonide in children and adolescents; A. Levine. Section VI: Short presentations of selected topics. Section VII: Mini-posters read by title; Case Reports: I: Liver. II: Intestine &endash; Crohn's disease. III: Intestine: &endash; Crohn's disease. Index.