lymphoid follicles with red ring signs as first manifestation of early Crohn’s disease
- Thread starter kiny
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kiny
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This study is so interesting because it shows the earliest endoscopic signs of crohn's disease are inflamed lymphoid follicles. Early signs of crohn's disease always point to involvement of lymphoid follicles and peyer's patches.
M. Behr and V. Kruiningen have long suggested crohn's might be a so-called "inside-out" model instead of "outside-in". Meaning, the mucosal inflammation is just a secondary event.
Crohn's disease would result from tissue infection, causing regional lymphangitis and lymphatic drainage issues in the intestine. Eventually one also developes mucosal inflammation, penetration of lumen content and bile acid malabsorption, but this is secondary to deeper inflammation. Direct modulation of the microbiome would be pointless, as has been consistently shown not to lead to remission. However manipulating diet through EN, changes fat absorption, impacts bile acid malabsorption and reduces bacterial load, and would all help. Liquid diets in general with rapidly absorbable nutrients would help.
Intestinal TB is similarly an "inside-out" event. TB enters through the lungs, disseminates, and ends up infecting the intestine through the lymphatic system and people develop intestinal TB. Mucosal inflammation and dysbiosis is a secondary event, modulation of the microbiome is pointless.
M. Behr and V. Kruiningen have long suggested crohn's might be a so-called "inside-out" model instead of "outside-in". Meaning, the mucosal inflammation is just a secondary event.
Crohn's disease would result from tissue infection, causing regional lymphangitis and lymphatic drainage issues in the intestine. Eventually one also developes mucosal inflammation, penetration of lumen content and bile acid malabsorption, but this is secondary to deeper inflammation. Direct modulation of the microbiome would be pointless, as has been consistently shown not to lead to remission. However manipulating diet through EN, changes fat absorption, impacts bile acid malabsorption and reduces bacterial load, and would all help. Liquid diets in general with rapidly absorbable nutrients would help.
Intestinal TB is similarly an "inside-out" event. TB enters through the lungs, disseminates, and ends up infecting the intestine through the lymphatic system and people develop intestinal TB. Mucosal inflammation and dysbiosis is a secondary event, modulation of the microbiome is pointless.
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