Intensive drug therapy versus standard drug therapy for symptomatic intestinal Crohn's disease strictures (STRIDENT): an open-label, single-centre, randomised controlled trial

Schulberg, Julien; Wright, Emily K; Holt, Bronte A.; Hamilton, Amy L.; Sutherland, Tom; Ross, Alyson L; Vogrin, Sara; Miller, Ashley M.; Connell, William; Lust, Mark; Ding, Nik S.; Moore, Gregory T.; Bell, Sally; Shelton, Edward; Christensen, Britt; Cruz, Peter De; Rong, Yuwei J; Kamm, Michael A.

doi:10.1016/s2468-1253(21)00393-9

Cited by 32 publications

(30 citation statements)

References 31 publications

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“…The results showed that patients receiving intensive high-dose adalimumab with later dose escalation plus thiopurine had slight improvements in obstructive symptom score, morphological stricture changes (such as bowel wall thickness in US), and higher reduction of inflammatory index (such as Crohn’s Disease Activity Index, MRI Index of Activity score, fecal calprotectin, and C-reactive protein), compared with standard adalimumab monotherapy. 78 However, there were no statistically significant differences between the two groups. 78 Thus, well-designed studies are needed to support the utilization of anti-TNF escalation plus immunosuppressives in CD strictures.…”

Section: Search Strategymentioning

confidence: 80%

“… 78 However, there were no statistically significant differences between the two groups. 78 Thus, well-designed studies are needed to support the utilization of anti-TNF escalation plus immunosuppressives in CD strictures.…”

Section: Search Strategymentioning

confidence: 80%

“…Schulberg et al 78 first performed a randomized controlled trial evaluating anti-TNF treatment in 123 CD patients with strictures. The results showed that patients receiving intensive high-dose adalimumab with later dose escalation plus thiopurine had slight improvements in obstructive symptom score, morphological stricture changes (such as bowel wall thickness in US), and higher reduction of inflammatory index (such as Crohn’s Disease Activity Index, MRI Index of Activity score, fecal calprotectin, and C-reactive protein), compared with standard adalimumab monotherapy.…”

Section: Search Strategymentioning

confidence: 99%

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Intestinal strictures in Crohn’s disease: a 2021 update

Lin

Wang

Liu

et al. 2022

Therap Adv Gastroenterol

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Intestinal strictures remain one of the most intractable and common complications of Crohn’s disease (CD). Approximately 70% of CD patients will develop fibrotic strictures after 10 years of CD diagnosis. Since specific antifibrotic therapies are unavailable, endoscopic balloon dilation and surgery remain the mainstay treatments despite a high recurrence rate. Besides, there are no reliable methods for accurately evaluating intestinal fibrosis. This is largely due to the fact that the mechanisms of initiation and propagation of intestinal fibrosis are poorly understood. There is growing evidence implying that the pathogenesis of stricturing CD involves the intricate interplay of factors including aberrant immune and nonimmune responses, host-microbiome dysbiosis, and genetic susceptibility. Currently, the progress on intestinal strictures has been fueled by the advent of novel techniques, such as single-cell sequencing, multi-omics, and artificial intelligence. Here, we perform a timely and comprehensive review of the substantial advances in intestinal strictures in 2021, aiming to provide prompt information regarding fibrosis and set the stage for the improvement of diagnosis, treatment, and prognosis of intestinal strictures.

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Section: Search Strategymentioning

confidence: 80%

Section: Search Strategymentioning

confidence: 80%

Section: Search Strategymentioning

confidence: 99%

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Intestinal strictures in Crohn’s disease: a 2021 update

Lin

Wang

Liu

et al. 2022

Therap Adv Gastroenterol

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“…Previous two trials [ 25 , 30 ] indicated that anti-TNF treatment is effective in alleviating stenosis. In the present study, neither anti-TNF treatment nor combination (anti-TNF + immunomodulator) treatment was associated with surgical risk (Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Mucosal healing of small intestinal stricture is associated with improved prognosis post-dilation in Crohn’s disease

et al. 2022

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Background Small intestinal stricture is a major cause for surgery in Crohn’s disease (CD). Endoscopic balloon dilation (EBD) is performed for small intestinal strictures to avoid surgery, often repeatedly. However, factors that are associated with prognosis after EBD of small intestinal strictures remain poorly investigated. Mucosal healing is the therapeutic target in CD. We aimed to investigate the impact of mucosal healing defined by the presence of ulcers at the small intestinal stricture site on the prognosis of EBD in CD patients. Methods We retrospectively included patients with CD who underwent initial EBD for endoscopically impassable small intestinal strictures from January 2012 to March 2020 at a single center. The association between presence of ulcer at the stricture site and surgery after EBD was examined by Cox proportional hazards model. Results Of the 98 patients included, 63 (64.3%) had ulcer at the stricture site. 20 (31.7%) of these patients underwent surgery for the stricture in due course, whereas 4 (11.4%) of the patients without ulcer of the stricture underwent surgery. In multivariate analysis, patients with ulcer of the stricture had a significantly higher risk for surgery than those without ulcer (hazard ratio 4.84; 95% confidence interval 1.58–14.79). Conclusion Mucosal healing at the stricture site indicated a favorable prognosis after EBD for small intestinal strictures in CD.

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“…While medical therapy plays a key role in the treatment of B1 disease and inflammatory components of B2 or B3 disease, and perianal disease, endoscopic and surgical therapy are the main treatment modalities for structural or neoplastic complications. The inflammatory component of strictures may benefit from medical therapy, particularly biologics [ 7 ]. Patients with stricturing CD or bowel obstruction were excluded in nearly all published randomized–controlled trials of biologics [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn’s disease

Shen

2022

Gastroenterology Report

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Endoscopic therapy for inflammatory bowel diseases (IBD) or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease, bridging medical and surgical treatments. Currently, the main applications of interventional IBD are (i) strictures; (ii) fistulas and abscesses; (iii) bleeding lesions, bezoars, foreign bodies, and polyps; (iv) post-operative complications such as acute and chronic anastomotic leaks; and (v) colitis-associated neoplasia. The endoscopic treatment modalities include balloon dilation, stricturotomy, strictureplasty, fistulotomy, incision and drainage (of fistula and abscess), sinusotomy, septectomy, banding ligation, clipping, polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. The field of interventional IBD is evolving with a better understanding of the underlying disease process, advances in endoscopic technology, and interest and proper training of next-generation IBD interventionalists.

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Intensive drug therapy versus standard drug therapy for symptomatic intestinal Crohn's disease strictures (STRIDENT): an open-label, single-centre, randomised controlled trial

Cited by 32 publications

References 31 publications

Intestinal strictures in Crohn’s disease: a 2021 update

Intestinal strictures in Crohn’s disease: a 2021 update

Mucosal healing of small intestinal stricture is associated with improved prognosis post-dilation in Crohn’s disease

Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn’s disease

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