Medical Therapies for Stricturing Crohn’s Disease: Efficacy and Cross-Sectional Imaging Predictors of Therapeutic Failure

Campos, Cécile; Perrey, Antoine; Lambert, Céline; Pereira, Bruno; Goutte, Marion; Dubois, Anne; Goutorbe, Félix; Dapoigny, Michel; Bommelaer, Gilles; Hordonneau, Constance; Buisson, Anthony

doi:10.1007/s10620-017-4572-4

Cited by 37 publications

(45 citation statements)

References 33 publications

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“…Despite the best therapy, up to 66% of patients with stricturing CD fail medical therapy and 40% fail endoscopic dilation and thus will require surgery. Preserving bowel length is essential to the treatment of these patients.…”

Section: Management Of Crohn's Disease Associated Stricturesmentioning

confidence: 99%

Crohn's disease associated strictures

Chan

Mourad

Leong

2018

J of Gastro and Hepatol

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Crohn's disease (CD) is a chronic relapsing and remitting disease that can affect any segments of the gastrointestinal tract. More than 50% of patients with CD develop stricturing or penetrating complications within the first 10 years after diagnosis. Strictures can lead to intestinal obstruction, which is a common indication for surgery. Despite significant advances in the understanding of the pathogenesis of intestinal fibrostenosis, imaging and therapeutic armamentarium of CD, the risk of intestinal surgery remained significantly high. Endoscopic balloon dilation is a promising first-line alternative to surgery as it is less invasive and could preserve intestinal length. In this review, we will evaluate the literature on the mechanism of intestinal fibrosis, emerging imaging techniques, and management strategies for CD associated strictures.

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Section: Management Of Crohn's Disease Associated Stricturesmentioning

confidence: 99%

Crohn's disease associated strictures

Chan

Mourad

Leong

2018

J of Gastro and Hepatol

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show abstract

“…In the meanwhile, previous reports also indicated that the presence of intestinal complications was known to be one of lower efficacy of anti-TNF agents 56. The aim of our study was, therefore, to verify the effect of removal of intestinal complication by surgery on recovery of the efficacy of biologics.…”

mentioning

confidence: 86%

Author's Reply

2018

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“…13 In multivariate analysis, small stricture luminal diameter and increased stricture wall thickness were predictors of strictures for which medical therapy typically fails. 14 The patients should be educated about their disease and the operative options because they commonly possess only rudimentary insight. Many surgeons feel that biologic agents should be discontinued several weeks prior to an elective procedure because they might interfere with the normal immune response and increase the likelihood of postoperative complications, although the impact of these agents is controversial and no strictureplasty-specific evidence is currently available.…”

Section: Preoperative Evaluation and Optimizationmentioning

confidence: 99%