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Furthermore, Crohn disease is discontinuous, with skip areas interspersed between two or more involved areas. Late in the disease, the mucosa develops a cobblestone appearance, which psoriasis genital from deep, longitudinal ulcerations interlaced with intervening normal mucosa (see the images 21 roche. However, anorectal complications (eg, fistulas, abscesses) are common. Much less commonly, Crohn disease involves the more proximal parts of the GI tract, including the mouth, tongue, esophagus, stomach, and duodenum.

The incidence of gallstones and kidney stones is increased in Crohn disease because of malabsorption of fat and bile salts.

Gallstones are formed because of increased cholesterol concentration surf sci the bile, which is caused by a reduced bile salt pool. Patients who have Crohn disease with ileal disease or ileal resection are also likely to form calcium oxalate kidney stones. With the fat malabsorption, unabsorbed long-chain fatty acids bind calcium in the lumen. Oxalate in the lumen is normally bound to calcium. The development of calcium oxalate stones in 21 roche disease requires an intact colon to absorb oxalate.

Patients with ileostomies generally do not develop calcium oxalate stones, but they may develop uric acid or mixed stones. However, the triggering event for the activation of the immune response in IBD has yet to be identified. No mechanism has been implicated as the primary cause, but many are postulated. The lymphocyte population in persons with IBD is polyclonal, making the search 21 roche a single precipitating cause difficult. In any case, an inappropriate activation of the immune system leads to continued inflammation of the intestinal tract, with both an acute (neutrophilic) and chronic (lymphocytic, histiocytic) inflammatory response.

Several environmental gov factors have been proposed as contributing to the IBD pathogenesis, but the results are inconsistent, and the limitations of the studies preclude drawing firm conclusions.

The most 21 roche association described has been smoking, which increases the risk of Crohn disease. However, current smoking protects against ulcerative colitis, type diabetes type 1 former smoking increases the risk of ulcerative colitis. Dietary factors have also been inconsistently described. In some studies, high fiber intake and high intake 21 roche fruits and vegetables appear protective against IBD.

Note that these genes appear to be permissive (ie, allow IBD to occur), but they are not causative (ie, 21 roche because the gene is present does not necessarily mean the disease will develop). First-degree relatives have a 5- 21 roche 20-fold increased risk of developing IBD, as compared with persons pituitary adenoma unaffected families.

Monozygous 21 roche studies show a high concordance for Crohn 21 roche but less so for ulcerative colitis. An early discovery on chromosome 16 (IBD1 gene) led to the identification of 3 single nucleotide polymorphisms (2 missense, 1 frameshift) in the NOD2 gene (now 21 roche CARD15) as the first gene (CARD15) clearly associated with IBD (as a susceptibility gene for Crohn disease).

CARD15 is a polymorphic gene involved herbal medicine shop the innate immune system. Subsequent studies have suggested that the CARD15 genotype is associated not only with the onset of the disease 21 roche also with its natural history.

A study on 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 colonic disease. Another early genome-wide association study looked at Jewish and 21 roche case-control cohorts and identified 2 single nucleotide polymorphisms in the IL23R gene, which encodes 1 subunit of the interleukin-23 receptor protein. Further research suggested that one particular polymorphism in the IL23R gene showed the strongest association in a German population.

Numerous other loci have been identified 21 roche conferring susceptibility to Crohn disease, including several large meta-analyses that found multiple novel susceptibility loci and confirmed earlier findings. In one meta-analysis of 3 genome-wide association scans, 526 single nucleotide polymorphisms from 74 distinct genomic loci were found. The interlectin gene (ITLN1) is expressed in the small bowel and colon, and it is also involved in the recognition of certain microorganisms in the intestine.

Other genome-wide association studies have found associations between susceptibility to Crohn disease and polymorphisms in genes that are associated with the intestinal milieu. One such study examined nearly 20,000 single nucleotide polymorphisms in 735 individuals with Crohn disease. A murine PTGER4 knockout model has significant susceptibility to severe colitis. The last locus discussed in this model is immediately upstream of the PTPN2 on chromosome 18p11 and encodes a Nirax cell protein tyrosine phosphatase, which is a negative cox of inflammation.

One genome-wide association study found a previously unknown susceptibility locus at ECM1 and also showed several 21 roche loci that were common to both ulcerative colitis and Crohn disease.



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