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Crohn's disease is an inflammatory bowel disease affecting the intestine and its associated lymphoid tissue. Affected tissues, in particular the terminal ileum and colon, are associated with the presence of a hyperplastic and/or activated lymphoid tissue that is associated with both epithelial and non-epithelial cells. There is evidence that many of these cells are activated to produce proinflammatory cytokines and, as a result, the tissue surrounding the inflamed bowel may be considered as a peripheral site of an immunological reaction. The process may start when altered intestinal microflora induce a primary inflammatory response, initially mediated by macrophages, and then induce a secondary response in lymphocytes and fibroblasts. The systemic manifestations of Crohn's disease may be influenced by a combination of genetic predisposition and environmental factors, including, for example, gut-derived microbial products, such as the segmented filamentous bacterium (SFB), that may act as a ligand for Toll-like receptors on intestinal macrophages. The inflammatory bowel and its associated lymphoid tissue may be the primary site of an immunological reaction that may also be affected by other diseases of the gut, such as ulcerative colitis and ischaemic colitis. In Crohn's disease, an attack of arthritis may be the first manifestation of the disease.The number of so-called “natural gas” rigs in West Texas are closing in on 5,000, according to industry group.
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