Pathogenesis of Crohn’s Disease

Abstract

There was a time when “pathogenesis” meant the genesis of the pathology, patho plus genesis. Today, however, the word is used to introduce topics such as immunodysregulation, alterations in the microbiome, or an imbalance of the two, some sort of disconnect between the patient’s flora and the immune system of the gastrointestinal tract. Pathogenesis, pathophysiology, and etiopathogenesis seem to be buzzwords, introduced to catch the eye of the reader or the editor. Few who use those words have seen any “pathology” since second year medical school, or perhaps they have viewed biopsies of the surface but not cut sections of resection specimens. Dalziel was the first to describe Crohn’s disease. Pathologists, or groups of pathologists, elucidated the pathogenesis, often referring to the granulomas, the obstructed lymphatics of the wall and the edema. Dalziel called this disease “chronic interstitial enteritis”. Those writing about microflora, immune dysregulation, cytokine cascades, fibrosis, and mouse models would do well to study the early pathology that is the essence of Crohn’s disease.