Abstract Background Recent studies have emphasized the role of mesenteric changes, including creeping fat, alongside intestinal alterations in the progression of Crohn's disease (CD). This study aims to investigate intestinal fibrosis and mesenteric changes using tissues obtained from CD patients who underwent surgery for complications such as strictures and perforations. Methods From September 2023 to September 2024, intestinal (CD-Inflamed-Bowel/CD-Uninflamed-Bowel) and mesenteric tissues (CD-Inflamed-Mes/CD-Uninflamed-Mes/ CD-Uninvolved-Mes) were collected from nine CD patients who underwent surgery. Additionally, intestinal (Normal-Bowel) and mesenteric tissues (Normal-Mes) were obtained from one patient who underwent anterior resection for adenoma. Specimens were obtained from the small intestine (4 patients) and the colon (5 patients). Samples were analyzed for morphological changes (H&E staining), collagen deposition (Masson’s trichrome), and fibrosis marker expression (qPCR). Results Preoperative CT or MR enterography revealed the presence of creeping fat in all nine CD patients, with five showing strictures accompanied by upstream bowel dilatation. In intestinal tissues, increased collagen fiber deposition was observed in CD-Inflamed-Bowel compared to CD-Uninflamed-Bowel, whereas mesenteric tissues showed no significant differences in collagen deposition among Uninvolved, Uninflamed, and Inflamed groups. qPCR analysis of intestinal tissues revealed significantly higher expression of the fibrosis marker COL1A1 in CD-Inflamed-Bowel compared to Normal-Bowel and CD-Uninflamed-Bowel (119.9 ± 260 vs. 1.0 ± 0.0 vs. 1.0 ± 0.7, P = 0.041). In mesenteric tissues, COL1A1 expression was significantly elevated in CD patients compared to controls (28.0 ± 7.7 vs. 1.0 ± 0.0, P = 0.002), though no significant differences in COL1A1 expression were found among Uninvolved, Uninflamed, and Inflamed mesenteric tissues within the same patient (17.7 ± 3.7, 25.1 ± 9.2, 41.0 ± 21.2, P = 0.9372). Other fibrosis markers (Vimentin, TGF-β, MMP-1, CHI3L1, CXCL1, and PDPN) showed similar trends. Conclusion This study highlights inflammatory and fibrotic changes in the intestine and mesentery during CD progression. Notably, mesenteric fibrosis was evident even in uninvolved intestinal segments without active inflammation, suggesting mesenteric inflammation and fibrosis may precede intestinal involvement. These findings support the mesentery as a novel potential target for early treatment for disease progression of CD.
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