Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12709
Revised: February 22, 2014
Accepted: April 21, 2014
Published online: September 21, 2014
Processing time: 235 Days and 19.3 Hours
In a recent review paper, Carroll and Maharshak discussed a critical role of enteric bacterial proteases in the pathogenesis of inflammatory bowel disease (IBD). I take a great interest in this paper as I also suspected proteases, not from the bacteria, but those originated from the pancreas that failed to be inactivated in the lower gut due to a reduction in gut bacteria, may have played a critical role in the pathogenesis of IBD, which was first published more than a decade ago and discussed again in more detail in a recent paper published in this journal. Antibiotics may result in a big reduction in gut bacteria and bacterial proteases, but multiple studies demonstrated dramatic increased of pancreatic proteases like trypsin and chymotrypsin in the feces of animals or patients treated with antibiotics. Multiple large-scale studies also demonstrated use of antibiotics caused an increase but not decrease in the risk of developing IBD, suggesting impaired inactivation and degradation of pancreatic proteases may have played a more critical role in the pathogenesis of IBD.
Core tip: This is letter commenting on the paper by Carroll and Maharshak recently published in this journal regarding the role of enteric bacterial proteases in the pathogenesis of inflammatory bowel disease (IBD). Here I provide some evidence suggesting that the proteases originated from the pancreas rather than gut bacteria may have played a more critical role in the development of IBD.