Dr. Ron’s Research Review – May 14, 2013

© 2013

This week’s research review focuses on GI and autoimmune disease.

The Digestive System in Systemic Autoimmune Diseases represents the state-of-the-art in the field of digestive disorders in the most common systemic autoimmune diseases. The volume consists of an introductory chapter on imaging techniques in digestive diseases, followed by eight chapters on digestive manifestations in specific systemic autoimmune diseases. International in scope, the table of contents reads like a Who's who in clinical research on systemic autoimmune diseases. More than 20 contributors from the European Union, the United States, Mexico and South Africa share their knowledge in this detailed volume. (2011)

There is a wide variation of gastrointestinal manifestations from these autoimmune disorders including, but not limited to: oral ulcers, dysphagia, gastroesophageal reflux disease, abdominal pain, constipation, diarrhea, fecal incontinence, pseudo-obstruction, perforation and gastrointestinal bleeding. (Cojocaru, Cojocaru et al. 2011)

Zonulin is the only physiologic modulator of intercellular tight junctions described so far that is involved in trafficking of macromolecules and, therefore, in tolerance/immune response balance. When the zonulin pathway is deregulated in genetically susceptible individuals, autoimmune disorders can occur. (Fasano 2012)

Dr. Ron


Articles

Digestive Involvement in Systemic Autoimmune Diseases

         (2011) Download

The Digestive System in Systemic Autoimmune Diseases represents the state-of-the-art in the field of digestive disorders in the most common systemic autoimmune diseases. The volume consists of an introductory chapter on imaging techniques in digestive diseases, followed by eight chapters on digestive manifestations in specific systemic autoimmune diseases. The final five chapters deal with digestive diseases with an autoimmune pathogenesis and systemic manifestations. International in scope, the table of contents reads like a Who's who in clinical research on systemic autoimmune diseases. More than 20 contributors from the European Union, the United States, Mexico and South Africa share their knowledge in this detailed volume.

Gastrointestinal manifestations in systemic autoimmune diseases

         (Cojocaru, Cojocaru et al. 2011) Download

In an autoimmune disease, the immune system attacks and harms the body's own tissues. The systemic autoimmune diseases include collagen vascular diseases, the systemic vasculitides, Wegener granulomatosis, and Churg-Strauss syndrome. These disorders can involve any part of the gastrointestinal tract, hepatobiliary system and pancreas. They can cause a variety of gastrointestinal manifestations that are influenced by the pathophysiologic characteristics of the underlying disease process. There is a wide variation of gastrointestinal manifestations from these autoimmune disorders including, but not limited to: oral ulcers, dysphagia, gastroesophageal reflux disease, abdominal pain, constipation, diarrhea, fecal incontinence, pseudo-obstruction, perforation and gastrointestinal bleeding. Clinical workup should be initiated by the patient's subjective complaints. In this review, we analyze the effects of autoimmune diseases on the gastrointestinal tract.


Leaky gut and autoimmune diseases

         (Fasano 2012) Download

Autoimmune diseases are characterized by tissue damage and loss of function due to an immune response that is directed against specific organs. This review is focused on the role of impaired intestinal barrier function on autoimmune pathogenesis. Together with the gut-associated lymphoid tissue and the neuroendocrine network, the intestinal epithelial barrier, with its intercellular tight junctions, controls the equilibrium between tolerance and immunity to non-self antigens. Zonulin is the only physiologic modulator of intercellular tight junctions described so far that is involved in trafficking of macromolecules and, therefore, in tolerance/immune response balance. When the zonulin pathway is deregulated in genetically susceptible individuals, autoimmune disorders can occur. This new paradigm subverts traditional theories underlying the development of these diseases and suggests that these processes can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing the zonulin-dependent intestinal barrier function. Both animal models and recent clinical evidence support this new paradigm and provide the rationale for innovative approaches to prevent and treat autoimmune diseases.

References

(2011). Digestive Involvement in Systemic Autoimmune Diseases. Oxford, UK, Elsevier.

Cojocaru, M., I. M. Cojocaru, et al. (2011). "Gastrointestinal manifestations in systemic autoimmune diseases." Maedica (Buchar) 6(1): 45-51. [PMID: 21977190]

Fasano, A. (2012). "Leaky gut and autoimmune diseases." Clin Rev Allergy Immunol 42(1): 71-8. [PMID: 22109896]