European Crohn’s and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn’s Disease

Rieder, Florian; Latella, Giovanni; Magro, Fernando; Yüksel, Elif Sarıtaş; Higgins, Peter; Sabatino, Antonio Di; Bruyn, Jessica R. de; Rimola, Jordi; Brito, Jorge; Bettenworth, Dominik; Assche, Gert Van; Bemelman, Willem A.; D’Hoore, André; Pellino, Gianluca; Dignaß, Axel

doi:10.1093/ecco-jcc/jjw055

Cited by 216 publications

(259 citation statements)

References 198 publications

(253 reference statements)

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“…Innovative imaging approaches such as dynamic contrastenhanced MR [63] or magnetization transfer MR [64] as well as ultrasound elastography [65] may lead to the improvement of imaging-based characterization of stricturing CD. However, currently no imaging modality is able to determine the clinical significance of fibrotic strictures or to predict the risk of patients undergoing surgery [66] .…”

Section: Discussionmentioning

confidence: 99%

Pathogenesis of Intestinal Fibrosis in Inflammatory Bowel Disease and Perspectives for Therapeutic Implication

Bettenworth

Rieder²

2017

Dig Dis

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Background: Intestinal fibrosis with stricture formation is a common feature of inflammatory bowel disease (IBD) and leads to a significantly impaired quality of life in affected patients, intestinal obstruction as well as to the need for surgical intervention. This constitutes a major treatment challenge. Key Messages: Fibrosis results from the response of gut tissue to the insult inflicted by chronic inflammation. Similarly to what occurs in other organs, the underlying fibrogenic mechanisms are complex and dynamic, involving multiple cell types, interrelated cellular events, and a large number of soluble factors. Owing to a breakdown of the epithelial barrier in IBD, luminal bacterial products leak into the interstitium and induce an innate immune response mediated by the activation of both immune and non-immune cells. Other environmental factors as well as chronic inflammation will certainly impact the quality and quantity of intestinal fibrosis. Finally, the composition of the intestinal extracellular matrix is dramatically altered in chronic gut inflammation and actively promotes fibrosis through its mechanical properties. The conventional view that intestinal fibrosis is an inevitable and irreversible process is gradually changing in light of an improved understanding of the cellular and molecular mechanisms that underline its pathogenesis. In addition, clinical observations in patients who undergo strictureplasty have shown that stricture formation is reversible. Conclusions: Identification of the unique mechanisms of intestinal fibrogenesis should create a practical framework to target and block specific fibrogenic pathways, estimate the risk of fibrotic complications, permit the detection of early fibrotic changes and, eventually, allow the development of treatment methods customized to each patient's type and degree of intestinal fibrosis.

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Section: Discussionmentioning

confidence: 99%

Pathogenesis of Intestinal Fibrosis in Inflammatory Bowel Disease and Perspectives for Therapeutic Implication

Bettenworth

Rieder²

2017

Dig Dis

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“…Con respecto al tratamiento, en los casos de estenosis cortas, no complicadas, o de anastomosis ileocolónicas o colóni-cas se puede realizar una dilatación con balón por medio de endoscopia si se seleccionan adecuadamente los pacientes; sin embargo, se debe tener en cuenta el riesgo de perforación durante el procedimiento (5). Deben evitarse resecciones intestinales extensas debido a las posibles complicaciones…”

Section: Figuraunclassified

“…Las estenosis intestinales son una complicación frecuente en la EC, se ha descrito su presencia hasta en un 40% de los pacientes con enfermedad localizada en íleon (4) y aproximadamente 30% a 50% de los pacientes presentan estenosis o lesiones penetrantes al momento del diagnóstico (5). La relevancia clínica de estas estenosis se debe a que hasta en un 60% de los casos se requiere de cirugía dentro de los primeros 20 años posteriores al diagnóstico (6).…”

Section: Introductionunclassified

“…Dado que la EC es una enfermedad transmural, esta afecta todas las capas del intestino favoreciendo los depó-sitos de proteínas en la matriz extracelular que alteran la arquitectura de los segmentos comprometidos (5). Las estenosis son el resultado de la inflamación crónica que lleva a una remodelación tisular, hipertrofia de las células mesenquimales, hiperplasia y fibrosis de los segmentos afectados por la enfermedad inflamatoria intestinal; como consecuencia de un proceso alterado de cicatrización posterior a la lesión inicial y a la respuesta inflamatoria que se presenta en el paciente susceptible genéticamente (1, 7).…”

Section: Introductionunclassified

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Enfermedad de Crohn fibroestenótica en íleon medio como manifestación inicial de la enfermedad – Reporte de un caso

Rubiano

Medina

Arango

et al. 2017

Rev. Colomb. Gastroenterol.

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La enfermedad de Crohn (EC) es una enfermedad inflamatoria intestinal que puede afectar todo el tracto gastrointestinal siendo el intestino delgado el segmento afectado en cerca del 50% de los pacientes, en los cuales el íleon terminal es el área más comúnmente comprometida por la enfermedad.Las estenosis intestinales son una complicación frecuente en la EC y aproximadamente 30 a 50% de los pacientes presentan estenosis o lesiones penetrantes al momento del diagnóstico. Las técnicas endoscópicas convencionales no permiten evaluar las lesiones del intestino delgado, es por esto que se desarrollaron técnicas como la enteroscopia y la video-cápsula endoscópica, teniendo cada una de ellas sus ventajas e indicaciones.Se presenta un caso de un paciente con EC con fibroestenosis localizada en el íleon medio. No es una localización frecuente para este tipo de lesiones

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“…In the past several years, the prevalence and incidence rates of the disease have increased rapidly, exhibiting high morbidity and mortality rates and resulting in heavy burden on the health care system [2]. The underlying etiopathogenesis of CD remains unknown, but genetic predisposition and environmental and bacterial factors are suspected to play important roles [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Association between Toll-Like Receptor 4 T399I Gene Polymorphism and the Susceptibility to Crohn’s Disease: A Meta-Analysis of Case-Control Studies

Shen

Lei

et al. 2018

Digestion

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Background/Aims: This article was undertaken to investigate the association of toll-like receptor 4 (TLR4) polymorphism (Thr399Ile) and risk of Crohn’s disease (CD) by performing a meta-analysis. Methods: Articles were chosen based on PubMed, Embase, China National Knowledge Internet, and Chinese Wanfang databases (up to 12th October 2016). Specific inclusion criteria were used to evaluate articles. Meta-analysis was performed by using a random or fixed effect model. Fifteen eligible case-control studies were finally included into this meta-analysis. We estimated the summary OR with its corresponding 95% CI to assess the association. Results: Summary results of this meta-analysis showed a moderate association between the TLR4 T399I polymorphism and the risk of CD (allele model: OR 1.26, 95% CI 1.06–1.50, p = 0.009; heterozygote model: OR 1.36, 95% CI 1.11–1.66, p = 0.003; dominant model: OR 1.35, 95% CI 1.10–1.64, p = 0.004; homozygote model: OR 1.08, 95% CI 0.44–2.64, p = 0.866; recessive model: OR 0.97, 95% CI 0.40–2.35, p = 0.946). Stratified analysis on geographical area, ethnicity, and genotypic methods suggested that the polymorphism was associated with increased risk of CD in Asia and Asians, and “T” allele only moderately increased CD risk within polymerase chain reaction-restricted fragment length polymorphism. Conclusions: Our meta-analysis suggests that TLR4 T399I polymorphism is moderately associated with susceptibility to CD, and more studies are needed to confirm our conclusion.

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European Crohn’s and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn’s Disease

Abstract: This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focused on prediction, diagnosis, and management of fibrostenosing Crohn's disease [CD]. The objective was to achieve evidence-supported, expert consensus that provides guidance for clinical practice.

Cited by 216 publications

References 198 publications

Pathogenesis of Intestinal Fibrosis in Inflammatory Bowel Disease and Perspectives for Therapeutic Implication

Pathogenesis of Intestinal Fibrosis in Inflammatory Bowel Disease and Perspectives for Therapeutic Implication

Enfermedad de Crohn fibroestenótica en íleon medio como manifestación inicial de la enfermedad – Reporte de un caso

Association between Toll-Like Receptor 4 T399I Gene Polymorphism and the Susceptibility to Crohn’s Disease: A Meta-Analysis of Case-Control Studies

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