Moreover, an impaired extra-adrenal glucocorticoid synthesis might contribute to the pathogenesis of intestinal inflammation [33], and genes encoding steroid metabolizing enzymes exhibit altered expression in inflamed colonic mucosa of IBD patients [34], i.e., an upregulation of HSD11B1 (reactivation of cortisol) and a downregulation of HSD11B2 (inactivation of cortisol). This evidence concerns the gene HSD11B1 and inflammatory bowel disease.