• CROHN'S DISEASE

Over 30 years ago, Rutgeerts et al published a seminal paper detailing the endoscopic recurrence of Crohn’s disease in the neoterminal ileum following ileocecal resection.1 The eponymous Rutgeerts scoring scale in that paper has been widely adopted and remains in wide clinical use today. The ability to directly visualise recurrent lesions prior to any symptoms or radiologic abnormalities has changed practice. Ileocolonoscopy within the first year after ileocecal or ileocolonic resection to assess recurrence and the Rutgeerts score is now standard of care (table 1). Crohn’s disease recurrence is frequent but not universal and progresses over months to years, enough time to intervene, assuming an effective therapy. Indeed monoclonal anti-TNF therapy has shown some ability to halt or prevent recurrence. However, even in this era of biological therapy, recurrence of Crohn’s disease remains high, afflicting half or more patients after surgery. A better understanding of the sequence of events and pathogenesis of ileal tissue lesions is needed to better target therapies to prevent recurrence.

For decades the progression of Crohn’s disease in the neoterminal ileum has been considered an excellent opportunity to study the pathogenesis of Crohn’s disease, as it seems to recapitulate the disease in a single accessible tissue, with aphthous lesions leading sequentially to small ulcers, larger ulcers and stenosis. Because manpower and available patients are constraints at any one medical …