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Strictures in Crohn's Disease: From Pathophysiology to Treatment
Mattia Crespi1, Pietro Dulbecco2, Antonella De Ceglie1
1Department of Gastroenterology, General Hospital-ASL 1 Imperiese, Sanremo, IM, Italy.
Digestive Diseases and Sciences
|April 13, 2020
Summary
Crohn
Area of Science:
- Gastroenterology and Hepatology
- Inflammatory Bowel Disease Research
- Fibrosis and Tissue Repair Mechanisms
Background:
- Chronic transmural inflammation in Crohn's disease (CD) can lead to intestinal fibrosis and strictures.
- Current diagnostic tools for intestinal fibrosis lack specificity and accuracy.
- Existing anti-fibrotic therapies show promise primarily in preclinical studies.
Purpose of the Study:
- To review current understanding of intestinal fibrosis in Crohn's disease.
- To evaluate existing and emerging therapeutic strategies for fibrotic strictures.
- To discuss the role of endoscopic and surgical interventions.
Main Methods:
- Literature review of studies on Crohn's disease fibrosis.
- Analysis of preclinical and clinical data on anti-fibrotic agents.
- Evaluation of endoscopic and surgical treatment outcomes for strictures.
Main Results:
- Intestinal fibrosis in CD is a significant complication with no reliable early diagnostic markers.
- Preclinical anti-fibrotic agents and stem cell therapies show potential but require further clinical validation.
- Endoscopic balloon dilation is a safe and effective option for selected strictures.
- Self-expandable metal stents (SEMS) offer an alternative, but optimal usage remains debated.
Conclusions:
- Fibrotic strictures in Crohn's disease remain a clinical challenge, often diagnosed late.
- Further research is needed to validate anti-fibrotic therapies and establish diagnostic biomarkers.
- Endoscopic interventions, particularly balloon dilation and SEMS, are key management strategies, with ongoing development expected to improve outcomes.
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