Differentiation of fibrotic and inflammatory component of Crohn’s disease-associated strictures

Abstract

Patients with Crohn’s disease (CD) commonly develop bowel strictures, which may contain various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment approach, fibrotic strictures would require endoscopic balloon dilation or surgery. Cross-sectional imaging surpasses endoscopy for characterization of stenotic segments and potentially may contribute to the optimal clinical management of these patients. This short review aims to discuss the potentialities and limitations of cross-sectional imaging techniques for assessing bowel fibrosis in patients with CD.

Mechanism of fibrosis and stricture formation in Crohn's disease

“…Recent data suggest that anti-inflammatory therapies might be beneficial to avoid surgery for a subgroup of patients in a shorter perspective. 6 However, whether antiinflammatory therapy treats only the inflammatory component 7,8 of the stricture, or if it affects stricture development per se, is not known. Indeed, despite the introduction of biological treatments 20 years ago, a significant number of patients still need stricture-associated surgery.…”

Positionspapier zur Befunderhebung von Darmultraschallbefunden bei chronisch entzündlichen Darmerkrankungen

“…Meistens enthalten Stenosen entzündliche und fibrotische Komponenten. Die Wahl der optimalen Therapie hängt von der Dominanz der einen oder anderen Komponente ab [61]. Eine sichere Differenzierung zwischen inflammatorischer und narbiger Stenose kann mittels der Darmsonografie ebenso wenig wie mittels MRT getroffen werden, da es auch histopathologisch keine "Entweder-oder"-Situation ist [62,63].…”

Crohn’s disease at radiological imaging: focus on techniques and intestinal tract

“…Despite the encouraging results, these techniques have still to be largely and definitely validated. 8,26,[34][35][36][37] Undeniable limitations of US techniques remain the limited field of view (especially in identifying complications), the interposition of abdominal fat and/or presence of meteorism. 27 Nevertheless, US can be useful for evaluation of perianal fistulas and gluteal abscesses, relying on the use of high-frequency probes and on the possibility of 2 different approaches: transperineal and endocavitary (through endoanal and/or endovaginal probes).…”