Probable Stricturing in Small Bowel Crohn Disease: In Support of SAR Consensus Recommendations

Area of Science:

• Gastroenterology
• Radiology
• Immunology

Background:

• Crohn disease is a chronic immune-mediated gastrointestinal disorder impacting millions, with frequent stricture complications despite advances.
• Current classification systems may not fully capture the intermediate stage of bowel wall thickening with luminal narrowing, termed "probable strictures."

Purpose of the Study:

• To highlight "probable strictures" as a distinct radiologic and clinical entity in Crohn disease.
• To advocate for the integration of "probable strictures" into clinical classifications, radiology reports, and treatment pathways.

Main Methods:

• Review of evidence supporting "probable strictures" as a distinct entity.
• Analysis of current classification systems (e.g., Montreal, Paris) and their limitations.
• Examination of radiologic, biomarker, microbial, gene expression, and prognostic data associated with this intermediate stage.

Main Results:

• "Probable strictures" exhibit unique biomarker profiles, microbial signatures, gene expression patterns, and imaging features.
• This intermediate stage is radiologically defined by bowel wall thickening and fixed luminal narrowing without upstream dilation.
• Existing classifications may misclassify "probable strictures" as purely inflammatory rather than indicative of early stricturing.

Conclusions:

• Recognizing "probable strictures" as a distinct entity can improve individualized care for Crohn disease patients.
• Integrating "probable strictures" into reporting and classification systems is crucial for accurate diagnosis and management.
• This approach may lead to more targeted and effective treatment strategies, potentially preventing overt obstruction.