Smooth Muscle Hyperplasia/Hypertrophy is the Most Prominent Histological Change in Crohn's Fibrostenosing Bowel Strictures: A Semiquantitative Analysis by Using a Novel Histological Grading Scheme
Smooth Muscle Hyperplasia/Hypertrophy is the Most Prominent Histological Change in Crohn's Fibrostenosing Bowel Strictures: A Semiquantitative Analysis by Using a Novel Histological Grading Scheme
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DOI：
10.1093/ecco-jcc/jjw126
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发表时间：
2017-01-01
影响因子：
8
通讯作者：
Gui, Xianyong
中科院分区：
文献类型：
--
作者：
Chen, Wenqian;Lu, Cathy;Gui, Xianyong
背景：肠纤维狭窄是严重克罗恩病的一个特征，也是药物治疗失败的主要原因。针对这种情况的非侵入性成像评估和新的药物治疗正在研究中，这特别需要更好地了解潜在的组织学基础。方法：我们分析了48例需要手术切除的狭窄克罗恩回肠炎或/和结肠炎患者。对纤维狭窄区、非狭窄区和非狭窄区最具代表性的切片进行组织学分析。对肠壁的每一层(包括粘膜肌层[MU]、粘膜下层[SM]、固有肌层[MP]、浆膜下外膜[SS])的组织学异常分别进行评估，包括活动性和慢性炎症、纤维化、平滑肌增生或肥大、神经元肥大和脂肪细胞增殖。结果：狭窄肠段最显著的组织病理学特征是SM的平滑肌增生、MP肥大和慢性炎症。各蛋鸡均以肌肉改变为主。肌肉的总体增生/肥大与慢性炎症呈正相关，与纤维化呈负相关，而SM肌的增生与MU活动性炎症也呈正相关。结论：在CD相关的“纤维狭窄”中，平滑肌增生/肥大是导致狭窄表型的最主要因素，而纤维化的程度较小。炎症-平滑肌增生轴在克罗恩狭窄的发病机制中可能是最重要的。
Background: The simplistically and ambiguously termed 'fibrostenosis' of bowel is a hallmark of severe Crohn's disease [CD] and a major contributor to medical treatment failure. Non-invasive imaging assessment and novel medical therapy targeting this condition are under investigation, which particularly requires a better understanding of the underlying histological basis.Methods: We analysed 48 patients with stricturing Crohn's ileitis or/and colitis that required surgical resection. The most representative sections of the fibrostenotic, non-stenotic and uninvolved regions were reviewed for histological analysis. For each layer of bowel wall (mucosa including muscularis mucosae [MU], submucosa [SM], muscularis propria [MP], subserosal adventitia [SS]), histological abnormalities were evaluated individually, including active and chronic inflammation, fibrosis, smooth muscle hyperplasia or hypertrophy, neuronal hypertrophy and adipocyte proliferation. A novel semiquantitative histological grading scheme was created.Results: The most significant histopathological features characterizing the stricturing intestines were smooth muscle hyperplasia of SM, hypertrophy of MP and chronic inflammation. The muscular alteration was predominant in all layers. The overall muscular hyperplasia/hypertrophy was positively correlated with chronic inflammation and negatively correlated with fibrosis, whereas SM muscular hyperplasia was also associated with MU active inflammation. Similar changes, to a lesser extent, occurred in the adjacent non-stenotic inflamed bowel as well.Conclusions: In CD-associated 'fibrostenosis', it is the smooth muscle hyperplasia/hypertrophy that contributes most to the stricturing phenotype, whereas fibrosis is less significant. The 'inflammation-smooth muscle hyperplasia axis' may be the most important in the pathogenesis of Crohn's strictures.