Fang HM. Intricacy of Crohn’s disease: Incongruity between diagnostic modalities and histopathologic assessment. World J Gastrointest Endosc 2025; 17(4): 103979 [DOI: 10.4253/wjge.v17.i4.103979]
Corresponding Author of This Article
Hai-Ming Fang, MD, PhD, Associate Professor, Chief Physician, Department of Gastroenterology, Pingshan Hospital of Southern Medical University, Pingshan District People’s Hospital of Shenzhen, No. 19 Renmin Street, Pingshan District, Shenzhen 518118, Guangdong Province, China. haimingfang@ahmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Apr 16, 2025; 17(4): 103979 Published online Apr 16, 2025. doi: 10.4253/wjge.v17.i4.103979
Intricacy of Crohn’s disease: Incongruity between diagnostic modalities and histopathologic assessment
Hai-Ming Fang
Hai-Ming Fang, Department of Gastroenterology, Pingshan Hospital of Southern Medical University, Pingshan District People’s Hospital of Shenzhen, Shenzhen 518118, Guangdong Province, China
Author contributions: Fang HM conceived and designed the study, initially drafted and critically revised the manuscript for important intellectual content, and ultimately approved it.
Supported by the Anhui Provincial Natural Science Foundation, No. 2308085MH242; the Basic and Clinical Cooperative Research Promotion Program of Anhui Medical University, No. 021xkjT023; and Anhui Medical University Foundation Project, No. 2022xkj175.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Ming Fang, MD, PhD, Associate Professor, Chief Physician, Department of Gastroenterology, Pingshan Hospital of Southern Medical University, Pingshan District People’s Hospital of Shenzhen, No. 19 Renmin Street, Pingshan District, Shenzhen 518118, Guangdong Province, China. haimingfang@ahmu.edu.cn
Received: December 13, 2024 Revised: February 14, 2025 Accepted: March 6, 2025 Published online: April 16, 2025 Processing time: 122 Days and 14.1 Hours
Abstract
Crohn’s disease (CD) is a chronic and recurrent inflammatory condition. Histologic healing is associated with better outcomes in CD, while less is known regarding the assessment of histological condition. Recently, a study has examined the discordance between endoscopic and histopathologic assessment in ileal CD, revealing a poor correlation between endoscopic and histologic evaluations in assessing mucosal inflammation and disease activity. However, the involvement of CD can span the entire gastrointestinal tract, as well as numerous clinical manifestations and extraintestinal complications, and the patchy nature of transmural inflammation is a well-established characteristic of this disease. The diagnosis of CD relies on a comprehensive evaluation that includes clinical, biochemical, stool, endoscopic, cross-sectional imaging, and histological investigations due to the incomplete understanding of its etiology and pathogenesis. Upon diagnosis, complimentary investigations should focus on markers of disease activity. Since transmural inflammation can only be assessed in resections, therefore, we primarily focused on the evaluation value of clinical aspects, histological scoring systems, particular in vivo imaging evaluation such as computed tomography enterography, magnetic resonance elastography, scintigraphy, sonographically measurement, endoscopic ultrasonography, and advanced endoscopic imaging techniques.
Core Tip: Histologic healing is associated with better outcomes in Crohn’s disease, while less is known regarding the assessment of histological condition. This article evaluated value of clinical aspects, endoscopy, histological scoring systems, particular in vivo imaging evaluation in the assessment of Crohn’s disease. A comprehensive evaluation encompassing clinical examinations, biochemical assessments, stool analyses, endoscopic examinations, cross-sectional imaging, and histological investigations is required for the diagnosis of this disease. Complete assessment involves laboratory abnormalities, including micronutrient deficiencies, cross sectional imaging to identify transmural disease extent, severity and complications, and a psychosocial assessment.
