How to Evaluate Fibrosis in IBD?

Abstract

In this review, we will describe the importance of fibrosis in inflammatory bowel disease (IBD) by discussing its distinct impact on Crohn’s disease (CD) and ulcerative colitis (UC) through their translation to histopathology. We will address the existing knowledge on the correlation between inflammation and fibrosis and the still not fully explained inflammation-independent fibrogenesis. Finally, we will compile and discuss the recent advances in the noninvasive assessment of intestinal fibrosis, including imaging and biomarkers. Based on the available data, none of the available cross-sectional imaging (CSI) techniques has proved to be capable of measuring CD fibrosis accurately, with MRE showing the most promising performance along with elastography. Very recent research with radiomics showed encouraging results, but further validation with reliable radiomic biomarkers is warranted. Despite the interesting results with micro-RNAs, further advances on the topic of fibrosis biomarkers depend on the development of robust clinical trials based on solid and validated endpoints. We conclude that it seems very likely that radiomics and AI will participate in the future non-invasive fibrosis assessment by CSI techniques in IBD. However, as of today, surgical pathology remains the gold standard for the diagnosis and quantification of intestinal fibrosis in IBD.

Intestinal strictures in Crohn's disease: An update from 2023

“…Complications requiring surgery may occur in up to 70% of patients within 10 years of diagnosis, with half of them attributed to the development of strictures 2 . The stricture may progress to form a vicious circle, as associated complications such as abscess or fistula formation can be treated with surgery, which may lead to re‐stricturing 3,4 . Intestinal stricture is an unsolved health‐threatening problem.…”

“… 2 The stricture may progress to form a vicious circle, as associated complications such as abscess or fistula formation can be treated with surgery, which may lead to re‐stricturing. 3 , 4 Intestinal stricture is an unsolved health‐threatening problem. Although the therapeutic management of CD has improved with the advent of novel therapeutic agents, an effective approach to deal with CD‐related stricture has not yet been discovered.…”