Immunopathological characteristics of cryptoglandular and Crohn's anorectal fistulas.

摘要: Anorectal fistulas are quite common proctologic disorders. They can be either of cryptoglandular origin or associated with Crohn's disease and chronic ileocolitis. Mechanical obstruction local infections prime causes this pathological condition. Genetic predisposition inadequate immune response overproduction pro-inflammatory cytokines appear prominently in the course disease. Interferon-gamma, a Th1 type cytokine, reflecting engagement cellular mechanisms, is first to produced intestinal mucosa. The inflammatory process colon mucosa induced by abundant microbial flora sustained turned gradual elevation TNF-a regulatory levels (interleukin-10, transforming growth factor-beta). number activated memory T cells CD4+CD45RBl0 increases significantly. CD4+CD25+ lymphocytes producing interleukin-10 increase also trying counterbalance cytokine reaction. infiltrates represented lymphocytes, plasma cells, macrophages. long-term activation macrophages released interferon-gamma leads tissue damage potentiation angiogenesis--a risk factor for carcinoma development. Management anorectal abscesses complex aiming alleviate symptoms, prevent relapses, reduce sphincter improve quality life. main approach (surgery) should combined antimicrobial infection control immunomodulation intravenous administration anti-TNF-alpha antibodies.