As mentioned above, the PNEI system is a network strictly related to the controlled organ (the large bowel in this case) and modulated with feed back by the effector organ (the large bowel), being itself a site of nervous, hormonal and immunological output, as represented in Figure 1. There are nervous, endocrine and immunologic cells in the intestine.
We may add a "G" to PNEI, as genetic makeup has been strongly hypothesised to play a pivotal role on some occasions in IBD patients, e.g. in determining, together with cytokine production from colonic T cells, the onset of primary sclerosing cholangitis in some patients with ulcerative colitis . Moreover, gastrointestinal (GI) inflammation involves numerous genes, some of which directly modulate the expression pattern of inflammatory cells . It is now well established that clinical manifestation of IBD is determined by a multigenic background: low-power immunogenic agents can be hyperactivated by the presence of sterile mycobacterial fragments, thus allowing sufficient immune response. A disorder of this mechanism may be an important aetio-logical factor in IBD . There are strict connections among intestinal flora, genetic makeup and the immune system: the integrity of our "self" is guaranteed by the mucosal immune system, and entero-cytes transport to the lumen immunoglobulin (Ig)A antibodies, which cover the bowel surface as a protective film against bacteria and viruses. Disruption of this balance may cause IBD. Therefore, the con-
Fig. 1. The large bowel controls (and is controlled by) the P (psycho), N (neuro), E (endocrine) and I (immune) system. The altered balance between bacteria and cytokine may initiate the inflammatory bowel disease (IBD) process. IBD patients need a holistic approach, taking care of the whole psyche-body-enteric nervous system
Fig. 1. The large bowel controls (and is controlled by) the P (psycho), N (neuro), E (endocrine) and I (immune) system. The altered balance between bacteria and cytokine may initiate the inflammatory bowel disease (IBD) process. IBD patients need a holistic approach, taking care of the whole psyche-body-enteric nervous system nections between this protective system and the nervous system is of paramount importance in determining the role of psychiatric illness in the IBD process.
There is an impact of mind, central nervous system and neuromodulation on the overly active immune response in the intestinal mucosa, which may initiate IBD, and the degree to which mind-body influences and stress impact levels of local inflammation deserves closer attention by the clinician .
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