Pathogenesis of Crohn’s Disease
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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.
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2. Warren S, Sommers SC. Cicatrizing enteritis (regional ileitis) as a pathologic entity: analysis of one hundred and twenty cases. Am J Pathol. 1948 1948;24:475-501.
3. Van Patter WN. Pathology and pathogenesis of regional enteritis. PhD Dissertation, University of Minnesota, Minneapolis. 1952;
4. Van Patter WN, Bargen JA, Dockerty MB, Feldman WH, Mayo CW, Waugh JM. Regional enteritis. Gastroenterology. Mar 1954;26(3):347-450.
5. Van Kruiningen HJ. What the early pathologists got wrong, and right, about the pathology of Crohn's disease: a historical perspective. APMIS. Dec 2020;128(12):621-625. doi:10.1111/apm.13081
6. Bamias G, Cominelli F. Exploring the Early Phase of Crohn's Disease. Clin Gastroenterol Hepatol. Dec 2021; 19(12): 2469-2480. doi:10.1016/j.cgh.2020.09.023
7. DuPont HL, Pickering, L. K. Infections of the Gastrointestinal Tract. 1 ed. Current Topics in Infectious Disease. Springer; 1980, New York, NY.
8. Sura R, Colombel JF, Van Kruiningen HJ. Lymphatics, tertiary lymphoid organs and the granulomas of Crohn's disease: an immunohistochemical study. Aliment Pharmacol Ther. Apr 2011;33(8):930-9. doi:10.1111/j.1365-2036.2011.04605.x
9. Crohn BB, Ginzberg L, Oppenheimer G. Regional ileitis: a pathologic and clinical entity. J Am Med Assoc. 1932;99:1323-29.
10. Hadfield G. The Primary Histological Lesion of Regional Ileitis. The Lancet. October 7, 1939;2:773-775.
11. Blackburn G, Hadfield G, Hunt AH. Regional ileitis. St Bartholomew's Hospital Report. 1939;72:181-224.
12. Mooney EE, Walker J, Hourihane DO. Relation of granulomas to lymphatic vessels in Crohn's disease. J Clin Pathol. Apr 1995;48(4):335-8.
13. Tonelli P. Il Linfedema dell'Intestino (malattia di crohn). Global Press S.R.L., Roma; 2001:407.
14. Warren S, Sommers SC. Pathology of Regional Ileitis and Ulcerative Colitis. Journal of American Medical Association. 1954;154(3):189-193.
15. Van Kruiningen HJ, Hayes AW, Colombel JF. Granulomas obstruct lymphatics in all layers of the intestine in Crohn's disease. Nov 2014;122(11):1125-9.
16. Van Kruiningen HJ. Missing the Target to Treat in Crohn's Disease. OBM Hepatology and Gastroenterology 2019;3(3), page 7, doi: 10.21926/obm.hg 1903036
17. Cominelli F, Arseneau KO, Rodriguez-Palacios A, Pizarro TT. Uncovering Pathogenic Mechanisms of Inflammatory Bowel Disease Using Mouse Models of Crohn's Disease-Like Ileitis: What is the Right Model? Review. Cellular and molecular gastroenterology and hepatology. Jul 2017; 4(1):19-32.
18. Van Kruiningen HJ. An Infectious Pig Model of Crohn's Disease. Sep 2016; 22(9):2106-11. doi:10.1097/MIB.0000000000000831