Understanding inflammatory bowel disease at the millennium: tentative answers and future questions

Considerable progress has been made in recent years in the delineation of important factors that contribute to the development of inflammatory bowel disease (IBD), as well as the wide spectrum of key mediators. This progress enables a more focused assessment of the goals necessary to arrive at an understanding of the processes initiating IBD. Identification of specific disease-associated genes building on recent progress achieved through genomic screening with microsatellite markers is a key priority. Already concerted efforts are focused in areas identified by initial screening of multiply-affected kindreds. It remains to be determined whether identification of these genes will make insights into disease mechanisms self-evident, or whether these same factors are also important in the vast majority of patients who have no family history.