Fibrostenotic Crohn’s Disease

Abstract

Crohn’s disease is often complicated by gastrointestinal strictures. Postoperative recurrence at the anastomotic site is common and repeated surgical interventions may be necessary. Medical treatment may relieve active inflammation (see chapter on active luminal disease) but fibrous strictures will not respond to this. Mechanical treatment methods consist of endoscopic balloon dilation, stricturoplasty or surgical resection. Fibrostenotic Crohn’s disease does not respond to medical therapy and requires endoscopic or surgical treatment.

Identification of Epithelial to Mesenchymal Transition as a Novel Source of Fibroblasts in Intestinal Fibrosis

“…Intestinal fibrosis in the form of fibrostenotic strictures is a well described complication of longstanding CD and is thought to occur as a result of chronic inflammation and dysregulated wound healing (2,3). The mechanism by which inflammation leads to fibrosis is only beginning to be understood but likely involves EMT to some degree (13).…”

“…Colon tissue (ϳ1 mm 3 ) was fixed in 4% paraformaldehyde at 4°C for 60 min and then washed three times in phosphate-buffered saline before being incubated at 37°C in 1 mg/ml ␤-gal (Sigma), 5 mM potassium ferrocyanide, 5 mM potassium ferricyanide, 2 mM MgCl 2 , 0.2% Nonidet P-40, and 0.1% sodium deoxycholate in phosphate-buffered saline for 72 h as previously described (34). The tissues were mounted in paraffin and counterstained with eosin.…”

“…Chronic inflammation combined with dysregulated wound healing is thought to result in a number of complications including fistula and fibrostenotic stricture formation (3,4). Over one-third of patients with CD undergo surgery to relieve obstruction related to fibrotic strictures, and many will require repeat interventions because of recurrent disease (3).…”

Intralesional steroid injection after endoscopic balloon dilation in pediatric Crohn's disease with stricture: a prospective, randomized, double-blind, controlled trial

“…12,33 Endoscopic dilation is thought to be the best bowel-conserving option for short and isolated CD-related strictures, mainly if localized at the ileocecal anastomosis. 34 These approaches are recommended in pediatric patients because of a longer life expectancy than that of adults and a concern for malnutrition that is harmful for growth and pubertal development. 35 We wished to evaluate the effectiveness of intrastrictural CS injection in preventing restricturing and surgery.…”

A Comprehensive Review of Strictureplasty Techniques in Crohn’s Disease: Types, Indications, Comparisons, and Safety

“…Overall, the perioperative complication rate reported by most authors spans from 0% to 57% and averages 13%. [26][27][28][29][30][31] Data for procedure-specific recurrence rates are available only for a few strictureplasty techniques. In one study, Michelassi's 32 side-to-side isoperistaltic strictureplasty was shown to have a recurrence rate of 23%.…”