Constrictive and Hypertrophic Strictures in Ileal Crohn’s Disease

Fibromuscular Expansion in Crohn’s Disease Ileal Strictures: An Open Issue

“…Absence of inflammation was found only at the proximal ileal surgical margin (10%), and inflammation limited to the mucosa in only 8% of most affected areas. We did not perform morphometric analyses, so we cannot confirm if the 29 B2 specimens comprised any constrictive stricture as defined by Liu et al 1 Still, the low rates of isolated mucosal inflammation may indicate that if any, they were rare in our series. 8 The likely predominance of hypertrophic strictures is consistent with the median disease duration of 10 years (interquartile range, 7-12) of B2 patients, because Liu et al's 1 patients with hypertrophic strictures had longer disease duration than those with severely constrictive ones (mean AE SD: 13.7 AE 5.0 years vs 6.3 AE 6.2 years).…”

“…We read with great interest the study by Liu et al 1 published in June's issue of Clinical Gastroenterology and Hepatology. Recent pathologic consensus defined small bowel strictures in Crohn's disease (CD) as a combination of decreased luminal diameter and increased thickness of all layers of the intestinal wall, including expansion of the muscularis mucosae (MM) and inner muscularis propria (MP), muscularization of the submucosa, and fibrosis of the submucosa and intestinal wall.…”

Intestinal strictures in Crohn’s disease: a 2021 update

“… 46 , 47 However, a recent study has identified a novel histopathological phenotype in a subset of CD patients with ileal strictures, in which part of strictures were due to mural constriction rather than due to fibromuscular hypertrophy. 48 CD patients who presented with constrictive ileal strictures are featured by earlier onset, frequent multiplicity, and little fibromuscular mural expansion, which are pathologically and clinically distinct from those with hypertrophic strictures. 48 In addition, patients with constrictive strictures manifest as multiple strictures, and have significantly shorter surgery-free intervals than those with hypertrophic strictures.…”

“… 48 CD patients who presented with constrictive ileal strictures are featured by earlier onset, frequent multiplicity, and little fibromuscular mural expansion, which are pathologically and clinically distinct from those with hypertrophic strictures. 48 In addition, patients with constrictive strictures manifest as multiple strictures, and have significantly shorter surgery-free intervals than those with hypertrophic strictures. 48 This study provides evidence that intestinal strictures are truly heterogeneous entities.…”

“… 48 In addition, patients with constrictive strictures manifest as multiple strictures, and have significantly shorter surgery-free intervals than those with hypertrophic strictures. 48 This study provides evidence that intestinal strictures are truly heterogeneous entities. Thus, establishing a detailed diagnosis and treatment criteria for intestinal fibrosis is an urgent requirement.…”