A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease

Bamba, Shigeki; Sakemi, Ryosuke; Fujii, Toshimitsu; Takeda, Teruyuki; Fujioka, Shin; Takenaka, Katsuto; Kitamoto, Hiroki; Umezawa, Shotaro; Sakuraba, Hirotake; Inokuchi, Toshihiro; Fukata, Norimasa; Mizuno, Shinta; Yamashita, M.; Shinzaki, Shinichiro; Tanaka, Hiroki; Takedatsu, Hidetoshi; Ozaki, Ryo; Moriya, Kyoji; Ishii, Manabu; Kinjo, Tetsu; Ozeki, Keiji; Ooi, Makoto; Hayashi, Ryohei; Kakimoto, Kazuki; Shimodate, Yuichi; Kitamura, Kazuya; Yamada, Akihiro; Sonoda, Akira; Yu, Ning; Yoshioka, K.; Ashizuka, Shinya; Takahashi, Fumiaki; Shimokawa, Toshio; Andoh, Akira; Hibi, Toshifumi

doi:10.1007/s00535-020-01670-2

Cited by 20 publications

(38 citation statements)

References 29 publications

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“…Moreover, the study suggested that anti-TNF-α therapy is effective for inflammatory strictures but not for fibrotic strictures, a distinction that can be difficult to establish in clinical practice. Results from a multicenter retrospective study by Bamba et al suggested that anti-TNF-α therapy should be considered in patients with a short stricture length to help avoid intestinal resection [8]. However, it is important to note that it is difficult to compare results between previous studies because of varying study designs and non-uniform classification of strictures and symptoms; therefore, these findings should be analyzed with care.…”

Section: Discussionmentioning

confidence: 99%

“…However, the use of anti-TNF-α therapy as a treatment for CD patients with already established strictures is controversial. Some studies have suggested that it does not lead to better outcomes [6,7], while other studies have indicated a favorable therapeutic effect in this context [8][9][10][11][12]. Recent data from a CREOLE study has shown that the majority of CD patients with symptomatic bowel strictures responded successfully to ADL treatment [13].…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy of Anti-Tumor Necrosis Factor Alpha for Symptomatic Stricturing Small Bowel Crohn’s Disease

Alourfi

Mosli

Saadah

2020

Cureus

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Introduction Crohn's disease (CD) is a chronic inflammatory disease. Current treatment aims to prevent complications and the need for surgical intervention. In patients with symptomatic complications, such as strictures, the possible benefits of anti-tumor necrosis factor-alpha (anti-TNF-α) therapy are currently the subject of considerable debate. This study aims to determine whether anti-TNF-α therapy could decrease the need for or delay the time until surgery in patients with CD presenting with symptomatic strictures of the small bowel in the King Abdulaziz University Hospital (KAUH), Saudi Arabia. Methods We conducted a retrospective, single-center study that assessed the need for surgical treatment in adult patients with symptomatic stricturing CD who were treated conventionally or with TNF-α inhibitors. Simple logistic regression was used to examine the association between surgical resection and biologics therapy and stepwise elimination logistic regression analysis was used to identify predictors of surgical resection. Results In total, 75 patients fulfilled the study criteria with 50 in the anti-TNF-α arm and 25 in the conventional arm. Surgical resection was required for six patients (12.2%) in the anti-TNF-α treatment arm and one patient (4%) in the conventional treatment arm (P=0.26). Endoscopic balloon dilatation was performed in two patients (4%) in the anti-TNF-α arm and one patient (4%) in the conventional arm (P=0.69). No statistically significant association was observed between surgical resection and treatment with biologic therapy (odds ratio [OR]=0.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Efficacy of Anti-Tumor Necrosis Factor Alpha for Symptomatic Stricturing Small Bowel Crohn’s Disease

Alourfi

Mosli

Saadah

2020

Cureus

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“…However, results of the combination of anti‐TNF therapy and endoscopic treatment or surgery are still conflicting. Several studies have found that anti‐TNF agents applied before or after endoscopic balloon dilatation (EBD) contribute to a lower risk of bowel surgery and intestinal stricture recurrence 75‐77 . In contrast, a comparative pilot study has demonstrated that there is an increased risk of fibrosis in patients who undergo preoperative anti‐TNF‐α treatment 78 .…”

Section: Treatmentmentioning

confidence: 99%

Intestinal stricture in Crohn's disease: A 2020 update

Lin

Qiu

Zhuang

et al. 2021

J of Digest Diseases

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Crohn's disease (CD) is a chronic and relapsing–remitting inflammatory disorder of the gastrointestinal tract. Approximately 70% of patients inevitably develop fibrosis‐associated intestinal stricture after 10 years of CD diagnosis, which seriously affects their quality of life. Current therapies play limited role in preventing or reversing the process of fibrosis and no specific anti‐fibrotic therapy is yet available. Nearly half of patients thus have no alternative but to receive surgery. The potential mechanisms of intestinal fibrosis remain poorly understood; extracellular matrix remodeling, aberrant immune response, intestinal microbiome imbalance and creeping fat might exert fundamental influences on the multiple physiological and pathophysiological processes. Recently, the emerging new diagnostic techniques have markedly promoted an accurate assessment of intestinal stricture by distinguishing fibrosis from inflammation, which is crucial for guiding treatment and predicting prognosis. In this review, we concisely summarized the key studies published in the year 2020 covering pathogenesis, diagnostic modalities, and therapeutic strategy of intestinal stricture. A comprehensive and timely review of the updated researches in intestinal stricture could provide insight to further elucidate its pathogenesis and identify novel drug targets with anti‐fibrotic potentiality.

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“…The optimal DAE insertion route should be guided by SB imaging prior to the procedure. To date, the majority of studies relating to EBD used BAE to apply endotherapy [ 19 , 136 , 137 , 139 - 141 , 144 - 147 ]. Although in a recent study, NMSE facilitated dilation of 3 strictures, along with retrieval of a retained capsule, without any adverse events, additional studies are warranted to further evaluate the safety and effectiveness of this recently introduced modality [ 134 ].…”

Section: Introductionmentioning

confidence: 99%

“…Postprocedural complications were reported in 3 cases, 1 of which was a perforation requiring surgical management (1%). The authors reported a less satisfactory response to EBD when patients were active smokers [ 141 ].…”

Section: Introductionmentioning

confidence: 99%

The role of small-bowel endoscopy in inflammatory bowel disease: an updated review on the state-of-the-art in 2021

Skamnelos

Lazaridis²,

Vlachou³

et al. 2021

aog

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The impact of small-bowel (SB) capsule endoscopy and device-assisted enteroscopy on clinical practice, since their introduction 2 decades ago, has been remarkable. These disruptive technologies have transformed the investigation and management of SB pathology and now have a firmly established place in guidelines and clinical algorithms. Furthermore, recent years have witnessed innovations, driven by the demand of new goals in the management of inflammatory bowel disease (IBD), such as mucosal healing and evolving strategies based on tight monitoring and accelerated escalation of care. These developments in SB endoscopy have also been paralleled by refinement in dedicated radiological SB imaging technologies. This updated review highlights the current state of the art and more recent innovations with a focus on their role in IBD.

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A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease

Cited by 20 publications

References 29 publications

The Efficacy of Anti-Tumor Necrosis Factor Alpha for Symptomatic Stricturing Small Bowel Crohn’s Disease

The Efficacy of Anti-Tumor Necrosis Factor Alpha for Symptomatic Stricturing Small Bowel Crohn’s Disease

Intestinal stricture in Crohn's disease: A 2020 update

The role of small-bowel endoscopy in inflammatory bowel disease: an updated review on the state-of-the-art in 2021

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