kiny
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Our GI doctor has colonic CD. Are you saying it should be categorized as a different disease?To reiterate that AIEC is a feature of ileal disease, and rarely colonic.
The ileum is very different from the colon. The colon lacks M cells (peyer's patches) and paneth cells that are found at the ileum's epithelial barrier.
Ileal and colonoc crohn's are pretty different diseases. They're very different organs.
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It was categorized as a different disease in the past. Ileal crohn's disease was called Chronic Enteritis, enteritis which refers to the small intestine, before we started to call it crohn's. Then it was made even worse by lumping UC with crohn's and using the unfortunate term IBD.Our GI doctor has colonic CD. Are you saying it should be categorized as a different disease?
A friend wants me to ask you this question: her son's Crohn's is in the jejunum and she would like to know if AIEC is also the main trigger and if EEN will be just as effective in his treatment? He is only 6 years old and currently on Humira.To reiterate that AIEC is a feature of ileal disease, and rarely colonic.
The ileum is very different from the colon. The colon lacks M cells (peyer's patches) and paneth cells that are found at the ileum's epithelial barrier.
Ileal and colonoc crohn's are pretty different diseases. They're very different organs.
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Thank you so much! I have a follow up - I remember you mentioned that an early onset Crohn's case is odd to you. This mom's son is 6, would he have enough time to develop enough peyer's patches? What about M cells? Do they come on scene later during adulthood as well?Peyer's patches and the M cells that cover them are an exclusive feature of the epithelial barrier in the small intestine and distal jejenum. The M cells are little indentations, if you search for "electron microscope m cells" on Google you will many images.
Unlike the rest of the epithelial cells, they are not covered by mucosa, they are directly exposed to lumen content.
These M cells are part of the peyer's patches and lymphoid follicles. I once posted a german study of very early crohn's disease, where the first signs of crohn's disease where small inflamed lympoid follicles.
These M cells are the entry point of bacteria and dietary antigen, below them you find a dome, a peyer's patch, it's big enough to see with the naked eye. That peyer's patch is full of T cells, B cells and macrophages, it's a dense aggregation of immune cells.
When someone develops inflammation in the small intestine, it is the peyer's patches that initiate that response, it is a response to antigen crossing the epithelial barrier through M cells.
I was actually going to be in that trial, but I am in DC and couldn't make all the required trips to NY.Dr. Hirten said that the trial at Mt. Sinai is doing well and still recruiting. He is hoping to have test results next year. This is all the update I can get.
Here is the trial info: https://clinicaltrials.gov/ct2/show/NCT03808103
That would have been very cool if you participated. How are you doing otherwise?I was actually going to be in that trial, but I am in DC and couldn't make all the required trips to NY.
One thing about Crohn's that I think is pretty clear but not well understood is the idea of downstream effects. I'm pretty sure that somehow areas of inflammation in the small intestine often cause inflammation in the large intestine, because one thing that's been observed is that small intestinal resection can result in healing of ulcers in the large intestine. I don't know if this is due to pathogens being pushed downstream or what.How do we explain the involvement of the colon? So many get ulcers in the colon too and while the biologics allow the small bowel to heal, it takes care of the colon too.
Only if we had another kiny who understands the colon, then this forum would be complete.Not sure. In UC the colonic inflammation possibly involves autoreactive cells and loss of tolerance, people with UC have inflammation all over the intestine. It's possible UC has nothing to do with pathogens.
This is not the case for crohn's disease involving the colon, there's patchy and deep transmural inflammation and there's granuloma, which indicates bacteria have entered tissue. I don't understand the colon nearly as well as the small intestine, there's always a possibility that they have a common explanation, but because the colon lacks peyer's patches, it's hard to compare them.