Two sides of the same coin: protective versus pathogenic mesentery in inflammatory bowel diseases - a comprehensive review

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

The mesentery, a membranous structure containing blood vessels, nerves, and lymphatics and attaching the intestines to the posterior abdominal wall, plays a crucial role in the pathogenesis of inflammatory bowel disease (IBD). In this review, we describe the signature features of the mesentery in IBD, including mesenteric hypervascularity (the comb sign) and edema, creeping fat generation, mesenteric fibrofatty proliferation, mesenteric lymphadenopathy, stenosis/sacculation, and hyperplasia of neurological components. These traits trigger a surge in the production of chemokines and proinflammatory cytokines within the mesentery and cause a significant buildup of inflammatory immune cells, exacerbating intestinal inflammation. Contradictorily, the intact lymphatic mesentery, in conjunction with the intestinal mucosa, immune cells, and commensal bacteria, constitutes a mechanical barrier that restricts bacterial penetration, thus preventing the initiation of abnormal immune responses. The mesentery also contributes to the processes of fibrosis and stenosis by secreting adiponectin and anti-inflammatory cytokines and suppresses intestinal perforation and the translocation of bacteria to the peritoneum, leading to the containment and remission of intestinal inflammation. Moreover, we also propose novel diagnostic strategies and therapeutic interventions that target the mesentery in

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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