Letter to the Editor: comment on “Two sides of the same coin: protective versus pathogenic mesentery in inflammatory bowel diseases – a comprehensive review”
Year: 2026
Type: letter
Abstract: Dear Editor, We read with great interest the comprehensive review by Lu et al entitled “Two sides of the same coin: protective versus pathogenic mesentery in inflammatory bowel diseases”[1]. The authors provide a masterful synthesis of the mesentery’s dichotomous role in IBD, integrating anatomical, molecular, and clinical perspectives. This work represents a significant advance that reframes our understanding of IBD pathogenesis and highlights promising therapeutic avenues. To further strengthen this framework for future research and clinical translation, we respectfully offer the following constructive suggestions. First, the review rightly identifies mesenteric features such as creeping fat as key biomarkers. However, their translational application is hindered by heterogeneous definitions across studies [e.g., visual grading versus quantitative indices like the mesenteric creeping fat index (MCFI)][1,2]. We suggest that future research should emphasize the development of consensus-driven, quantitative radiological criteria. Recent work, including pivotal trials assessing surgical outcomes, demonstrates the critical role of standardized endoscopic evaluation in this context[3], which could serve as a model for validating radiological biomarkers in clinical practice. Second, the discussion on mesenteric nerves is insightful. While the dual role of neurotransmitters such as substance P is noted, the contextual triggers (e.g., disease phase, microbial milieu) that determine their pro- or anti-inflammatory switch remain unclear. A clearer elaboration of these condition-dependent mechanisms, potentially aided by a schematic summary, would greatly enhance understanding and guide future experimental design. Systematic analyses of fibrotic pathways in other mesenteric disorders underscore the complexity of such microenvironmental regulation[4], highlighting the need for precise mechanistic mapping in IBD. Third, the analysis of mesenteric resection is balanced. To further refine clinical interpretation, outcomes would benefit from further contextualization based on surgical technique and patient stratification. The international SPICY trial showed no significant difference in endoscopic recurrence (primary endpoint) at 6 months between extended and limited resection[5]. Recent data from the MESCOLIC trial investigators also provide high-level evidence on postoperative endoscopic recurrence following mesenteric-based surgery[3]. Collectively, this evidence suggests that surgical benefit is likely not universal but contingent on specific techniques and patient phenotypes (e.g., stricturing versus fistulizing disease), aligning with evolving precision-surgical principles. Finally, the section on mesenteric microbiota is compelling. While strong associations are presented, establishing causality represents the crucial next step. We propose that future work should advocate for multi-omics integration (e.g., metagenomics with metabolomics) and interventional studies in gnotobiotic models. This approach is exemplified by mechanistic research in related fields that strives to dissect causation in mesenteric pathology[4]. Ethical approval Not applicable. Consent Not applicable.
Source: International Journal of Surgery
Authors: Jie-Min Huang, Yang Li, Rong Shi, Zu-Qing Chen
Institution: Fujian University of Traditional Chinese Medicine
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Genetics
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W7125215452