Crohn's disease complicated by strictures: a systematic review

Rieder, Florian; Zimmermann, Ellen M.; Remzi, Feza H.; Sandborn, William J.

doi:10.1136/gutjnl-2012-304353

Cited by 410 publications

(366 citation statements)

References 163 publications

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“…Colonoscopy lesions, n (%) 26 (18) Cecal lesions, n (%) 21 (15) Ascending colonic lesions, n (%) 19 (13) Transverse colonic lesions, n (%) 15 (10) Descendent colonic lesions, n (%) 17 (12) Sigmoid colonic lesions, n (%) 17 (12) Left-sided colonic lesions, n (%) 19 (13) Rectal lesions, n (%) 11 (8) Left-sided + rectal lesions, n (%) 22 (15) Ileal stricture, n (%) 13 (9) Perianal involvement, n (%) 45 (30) 5-aminosalicylic acid (5-ASA), n (%) 86 (57) Steroids, n (%) 17 (11) Thiopurines, n (%) 57 (38)…”

Section: ±mentioning

confidence: 99%

Predictive factors of small bowel patency in Crohn's disease patients

Albuquerque¹,

Cardoso²,

Marques³

et al. 2015

Rev Esp Enferm Dig

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Section: ±mentioning

confidence: 99%

Predictive factors of small bowel patency in Crohn's disease patients

Albuquerque¹,

Cardoso²,

Marques³

et al. 2015

Rev Esp Enferm Dig

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“…Despite a great progress in modern anti-inflammatory therapies including immunosuppressants and biologics, intestinal fibrosis is a frequent complication in the natural history of IBD, as up to onethird of CD patients and about 5% of UC patients develop Review Article on Endoscopic Therapy strictures in the clinical course of the disease (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In CD, chronic inflammation induces transmural damage which causes accumulation of extracellular matrix (ECM) and expansion of mesenchymal cells, finally leading to intestinal strictures.…”

Section: Introductionmentioning

confidence: 99%

“…This implies that control of intestinal inflammation alone does not necessarily affect the associated fibrotic process. There are no standard anti-fibrotic medical treatments for IBD, and dilation of intestinal strictures with endoscopy or surgical treatment plays an important role in managing the strictures of IBD (3)(4)(5)(6)(7)(8)(9)(10). Therefore, treatment goals of IBD include not only symptom control alone but prevention of intestinal fibrosis with structural bowel damage, that is, bowel tissue remodeling (11,12).…”

Section: Introductionmentioning

confidence: 99%

New endoscopic approach of anti-fibrotic therapy for inflammatory bowel disease

Suzuki

Yoneyama

2017

Ann. Transl. Med.

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Fibrosis continues to be paid a great attention in not only basic research but also clinical practice, especially for the development of novel therapeutics in various fibrotic diseases. However, there remain several obstacles to translation in developing anti-fibrosis therapy. The present review documents our translational practice from target discovery to first-in-patient studies in the development of anti-fibrosis therapy for inflammatory bowel disease (IBD). First topic is a target selection. We have focused on the target that has an ability to regulate multifactorial cascades of fibrosis. Carbohydrate sulfotransferase 15 (CHST15) synthesizes matrix proteoglycan that regulates various pathogenic mediators and contributes to tissue remodeling during injury. Small interfering RNA (siRNA) targeting CHST15 inhibited activation of fibroblasts in vitro and reduced fibrosis in vivo. Second topic is a clinically feasible application. We established a safe and novel pancolonic delivery of siRNA, which is achieved by direct injection to extracellular matrix (ECM) through endoscope. Third topic is an endpoint for both nonclinical and clinical studies. We have focused on tissue-specific findings for co-existence of fibrosis in ulcerative lesions in IBD and investigated whether the balance of mucosal healing (MH) and fibrosis, which is evaluated by endoscopy and histology respectively, can be used for study endpoints. Phase 1 clinical trial of STNM01, a synthesized CHST15 siRNA, by a single dose endoscopic submucosal injection for non-healer patients with Crohn's disease showed high rates of MH. Analyses of biopsy specimens revealed that STNM01 reduced CHST15 expression at local lesions, repressed pre-existing fibrosis and repaired the damaged crypts. Thus, blockade of multifactorial modulator CHST15 in ECM showed a potential to treat tissue remodeling and skew fibrosis toward mucosal repair. Our practice suggests that target-and tissue-specific findings-based strategy would be a key to translation in developing anti-fibrosis therapy.

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“…Over time, inflammation and fibrosis together cause progressive bowel wall thickening, stricture development, and obstructing and penetrating complications. 1 An argument could be made that intestinal fibrosis is most responsible for a complicated and disabling CD course, considering that despite the introduction of anti-tumor necrosis factor alpha (TNF) therapies to control inflammation, surgical rates have not changed in nearly 20 years in the USA. 2 The complexity of CD management decisions are often related to our inability to determine the relative contribution of inflammation and fibrosis in a damaged bowel segment.…”

Section: Introductionmentioning

confidence: 99%

Imaging of intestinal fibrosis: current challenges and future methods

Stidham

Higgins

2016

United European Gastroenterology Journal

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Crohn's disease (CD) activity assessments are dominated by inflammatory changes without discrete measurement of the coexisting fibrotic contribution to total bowel damage. Intestinal fibrosis impacts the development of severe structural complications and the overall natural history of CD. Measuring intestinal fibrosis is challenging and existing methods of disease assessment are unable to reliably distinguish fibrosis from inflammation. Both the immediate clinical need to measure fibrosis for therapeutic decision-making and the near-future need for tools to assess pipeline anti-fibrotic medications highlight the demand for biomarkers of fibrosis in CD. Developing non-invasive technologies exploit changes in intestinal perfusion, mechanical properties, and macromolecular content to provide quantitative markers of fibrosis. In this review of existing and experimental technologies for imaging intestinal fibrosis, we discuss the expanding capabilities of quantitative MR and ultrasound imaging, encouraging developments in non-invasive elastography, and emerging novel methods including photoacoustic imaging.

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Crohn's disease complicated by strictures: a systematic review

Cited by 410 publications

References 163 publications

Predictive factors of small bowel patency in Crohn's disease patients

Predictive factors of small bowel patency in Crohn's disease patients

New endoscopic approach of anti-fibrotic therapy for inflammatory bowel disease

Imaging of intestinal fibrosis: current challenges and future methods

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