What are intestinal strictures in Crohn’s disease. How do strictures form in the intestines. What are the main symptoms of intestinal strictures. How are intestinal strictures diagnosed and treated. Can intestinal strictures be prevented in Crohn’s disease patients. What are the surgical options for severe intestinal strictures. How do intestinal strictures impact quality of life for Crohn’s disease patients.

Understanding Intestinal Strictures in Crohn’s Disease

Intestinal strictures are a common complication of Crohn’s disease, characterized by narrowing of the intestinal lumen due to inflammation and fibrosis. These strictures can significantly impact a patient’s quality of life and often require medical or surgical intervention.

Crohn’s disease is a type of inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract. It is characterized by chronic inflammation, which can lead to various complications, including strictures.

What causes intestinal strictures in Crohn’s disease?

Intestinal strictures in Crohn’s disease are primarily caused by:

• Chronic inflammation of the intestinal wall
• Repetitive cycles of tissue damage and repair
• Excessive deposition of extracellular matrix proteins
• Activation and proliferation of fibroblasts
• Genetic factors that may predispose certain individuals to stricture formation

Prevalence and Epidemiology of Intestinal Strictures

The prevalence of intestinal strictures varies among Crohn’s disease patients and different populations. Studies have shown that:

• Up to 50% of Crohn’s disease patients may develop strictures over time
• The incidence of strictures increases with disease duration
• Certain genetic factors may increase susceptibility to stricture formation

Are there regional differences in the prevalence of intestinal strictures?

Yes, research has shown regional variations in the prevalence of intestinal strictures:

• In Western countries, strictures are reported in 20-30% of Crohn’s disease patients
• Asian countries have shown varying rates, with some studies reporting lower prevalence
• Japan has reported stricture rates of 30-40% among Crohn’s disease patients
• Korea and Taiwan have shown similar trends to Western countries

Symptoms and Clinical Presentation of Intestinal Strictures

Intestinal strictures can cause a range of symptoms, which may vary in severity depending on the location and extent of the narrowing. Common symptoms include:

• Abdominal pain and cramping
• Nausea and vomiting
• Bloating and distension
• Changes in bowel habits
• Weight loss
• Malnutrition

How do intestinal strictures impact a patient’s quality of life?

Intestinal strictures can significantly affect a patient’s quality of life by:

• Causing chronic pain and discomfort
• Limiting dietary choices and nutritional intake
• Interfering with daily activities and work productivity
• Increasing the risk of hospitalization and surgery
• Contributing to psychological distress and anxiety

Diagnosis and Evaluation of Intestinal Strictures

Accurate diagnosis of intestinal strictures is crucial for appropriate management. Diagnostic methods include:

• Endoscopy (colonoscopy and upper endoscopy)
• Cross-sectional imaging (CT enterography and MR enterography)
• Small bowel follow-through
• Capsule endoscopy (in selected cases)
• Biomarkers and genetic testing

What are the advantages of MR enterography in diagnosing intestinal strictures?

MR enterography offers several advantages in the diagnosis of intestinal strictures:

• Provides detailed images of the small bowel without radiation exposure
• Can distinguish between inflammatory and fibrotic strictures
• Allows assessment of extraluminal complications
• Helps in treatment planning and monitoring disease progression
• Can be repeated safely for long-term follow-up

Medical Management of Intestinal Strictures

The medical management of intestinal strictures in Crohn’s disease aims to reduce inflammation and prevent further fibrosis. Treatment options include:

• Anti-inflammatory medications (corticosteroids, aminosalicylates)
• Immunomodulators (azathioprine, methotrexate)
• Biologic therapies (anti-TNF agents, anti-integrin agents)
• Nutritional support and dietary modifications
• Antifibrotic agents (currently under investigation)

Can biologic therapies prevent or reverse intestinal strictures?

The role of biologic therapies in preventing or reversing intestinal strictures is complex:

• Biologic agents can effectively reduce inflammation and may prevent stricture formation in some cases
• Early initiation of biologics may reduce the risk of stricture development
• Reversal of established fibrotic strictures with biologics alone is limited
• Combination therapy with immunomodulators may improve outcomes
• Ongoing research is exploring new targets for antifibrotic therapies

Endoscopic Interventions for Intestinal Strictures

Endoscopic techniques have emerged as minimally invasive options for managing certain types of intestinal strictures. These include:

• Endoscopic balloon dilation
• Endoscopic stricturotomy
• Stent placement (in selected cases)
• Intralesional steroid injection
• Combination approaches

What factors determine the success of endoscopic balloon dilation?

The success of endoscopic balloon dilation depends on several factors:

• Length and complexity of the stricture
• Presence of active inflammation
• Number of dilations performed
• Patient’s overall disease status
• Operator experience and technique

Surgical Management of Intestinal Strictures

Surgery remains an important treatment option for intestinal strictures, particularly in cases where medical and endoscopic approaches are unsuccessful. Surgical interventions include:

• Strictureplasty
• Resection and anastomosis
• Bypass procedures
• Minimally invasive techniques (laparoscopic and robotic surgery)
• Combined endoscopic and surgical approaches

How does strictureplasty compare to resection for intestinal strictures?

Strictureplasty and resection offer different advantages in managing intestinal strictures:

• Strictureplasty preserves bowel length and may reduce the risk of short bowel syndrome
• Resection removes diseased tissue but may lead to more extensive bowel loss
• Strictureplasty is preferred for multiple short strictures
• Resection may be necessary for long or complex strictures
• The choice between techniques depends on individual patient factors and surgeon expertise

Prevention and Long-term Management of Intestinal Strictures

Preventing the formation of intestinal strictures and managing existing ones requires a comprehensive approach:

• Early diagnosis and treatment of Crohn’s disease
• Optimization of medical therapy to control inflammation
• Regular monitoring and surveillance
• Nutritional support and lifestyle modifications
• Patient education and self-management strategies

Can dietary modifications help prevent or manage intestinal strictures?

Dietary modifications can play a role in managing intestinal strictures:

• Low-residue diets may help reduce obstructive symptoms
• Liquid or soft diets can be beneficial during acute flares
• Adequate hydration is important to prevent obstruction
• Avoiding trigger foods may help reduce inflammation
• Nutritional counseling can help optimize overall nutritional status

Intestinal strictures remain a significant challenge in the management of Crohn’s disease. While advances in medical, endoscopic, and surgical techniques have improved outcomes, further research is needed to develop more effective prevention and treatment strategies. A multidisciplinary approach, involving gastroenterologists, surgeons, radiologists, and nutritionists, is essential for optimal patient care. As our understanding of the pathogenesis of strictures grows, new therapeutic targets and personalized treatment approaches may emerge, offering hope for improved outcomes and quality of life for patients with Crohn’s disease.

Intestinal Stricture in Crohn’s Disease

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Crohn’s disease and intestinal strictures: Causes and treatment

Crohn’s disease can cause swelling of the intestinal walls that makes it difficult for food to pass through. This narrowing is called an intestinal stricture.

Crohn’s disease is a chronic inflammatory condition that can develop in any part of the gastrointestinal (GI) tract.

In most cases, Crohn’s disease affects the small intestine and the first section of the large intestine.

Crohn’s disease is just one of several health conditions and factors that can lead to intestinal strictures.

Keep reading to learn more about how strictures form, which symptoms they cause, and the treatment options.

Crohn’s disease causes chronic inflammation in the GI tract, which begins at the mouth and ends at the anus. The inflammation often develops in the small intestine and first part of the large intestine.

Within the first 10 years of receiving a Crohn’s disease diagnosis, nearly 40% of people develop an intestinal stricture.

Researchers have identified two main types of intestinal stricture: inflammatory and fibrotic. Inflammatory strictures develop when inflammation from Crohn’s disease causes swelling, or edema, in the cells that line the intestines.

Fibrotic strictures develop when scar tissue builds up in the intestines after prolonged inflammation. The accumulation of scar tissue narrows the intestines, which restricts the passage of stool. Also, some people have mixed-type strictures that result from both current inflammation and fibrosis.

Although inflammation plays a role in each type of stricture, inflammatory and fibrotic strictures respond to different treatments.

Prolonged exposure to inflammation can change the structure of the intestinal lining, resulting in the accumulation of scar tissue, collagen, and other fibrous material.

The buildup of these materials causes the intestinal walls to thicken, which reduces the space inside the intestines, making it harder for stool to pass.

A variety of symptoms can result from an intestinal stricture. What a person experiences depends on the severity of the issue.

Mild or moderate strictures can cause:

• discomfort or pain in the abdomen
• excess gas or bloating
• decreased appetite
• low energy

A severe intestinal stricture can cause:

• intense abdominal pain
• bloating or swelling of the abdomen
• constipation
• vomiting

Most strictures occur in the small intestine, an area that a doctor cannot view with traditional endoscopy.

Instead, doctors perform a minimally invasive procedure called endoscopic balloon dilation, which allows them to see the inside of the small intestine, identify strictures, and treat blockages and mild strictures in the short term.

During the procedure, a doctor guides a catheter with a small, inflatable balloon on the end through the intestines. Once the catheter reaches an intestinal stricture, the doctor inflates the balloon, opening up that area of the intestine.

Doctors can also use other imaging techniques, such as CT and MRI scans, to help diagnose an intestinal stricture. Another option is an X-ray examination of the small intestine, which is called a “small bowel series.”

The following can increase the risk of experiencing intestinal strictures:

• undergoing multiple surgeries in the abdominal or pelvic area
• having Crohn’s disease or another type of inflammatory bowel disease
• receiving steroid treatment during the first Crohn’s disease flare-up
• having a perianal illness — one that affects the anus or the area around it — at the time when Crohn’s disease is diagnosed
• smoking or formerly smoking

Inflammation from Crohn’s disease is one of several factors that can lead to swelling or scarring in the intestinal walls. This damage can result in intestinal strictures.

A stricture is a narrowing of the intestines, which can restrict the passage of food and waste through the area, causing uncomfortable symptoms.

A combination of treatments can help alleviate the symptoms and reduce the risk of new strictures forming. When strictures are severe and other approaches are ineffective, a doctor may recommend surgery.

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Crohn’s disease – symptoms, diagnosis and treatment in the gastro-hepatocenter EXPERT

“Crohn’s disease” is a chronic disease of unknown etiology, which is characterized by an inflammatory process in the gastrointestinal tract, in which ulcers, erosions, fistulas, scars and strictures are formed (mainly in the small and large intestine).

This disease can develop in any segment of the digestive tube from the mouth to the rectum. In most cases, there is a lesion of the final segment of the small intestine (locally or with the involvement of the large intestine).

The cause of the disease is currently unknown, but the generally accepted theory is that the following factors play a role in the development of Crohn’s disease:

1. hereditary predisposition (not realized in all patients) . d.)
2. Violation of the intestinal microflora

At the moment the disease is considered as a chronic incurable , and therefore the vast majority of patients require lifelong treatment and observation by a doctor . The disease is characterized by an increased risk of surgical intervention and can lead to the development of complications:

• strictures (narrowing of the lumen of the digestive tube)
• fistulas (the presence of passages between parts of the intestine or between the intestine and internal organs or skin)
• abscesses
• infiltrates, etc. d.

There are three main forms (phenotypes) of Crohn’s disease:

1. inflammatory – the mucous membrane of the gastrointestinal tract is inflamed, covered with erosions and / or ulcers, may bleed , enterocutaneous or enteroorgan fistulous passages, abscesses or infiltrates.

As mentioned above, the disease can affect various parts of the gastric tract, and therefore the following localizations of Crohn’s disease are distinguished separately:

1. colitis – only the large intestine is affected
2. terminal ileitis – the terminal ileum is affected
3. ileocolitis – the large intestine is affected in combination with the terminal ileum
4. lesions of the upper gastrointestinal of the intestinal tract – involvement in the inflammatory process of the ileum above the terminal section, jejunum, duodenum 12, stomach, esophagus and oral cavity

Separately, Crohn’s disease with perianal lesions is distinguished, in which anal fissures, paraproctitis, perianal fistulas and abscesses are detected. Perianal Crohn’s disease can be combined with any of the localizations described above.

A feature of Crohn’s disease is often the segmental nature of the lesion, i.e. inflamed (altered) parts of the digestive tube alternate with unchanged (healthy). In this regard, the disease can be localized in different departments (for example, Crohn’s disease with simultaneous involvement of the colon and stomach), but this is not always observed. A significant part of patients can have inflammation in only one zone all their lives. This zone can be extended (for example, a total lesion of the colon) or limited.

Crohn’s disease often affects the entire thickness (all layers) of the intestinal wall, but in some cases the inflammation is superficial, shallow.

Video interview with a gastroenterologist: definition, risk groups, symptoms of Crohn’s disease

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The degree of severity is determined by the attending physician on the basis of examination data, complaints, results of laboratory and instrumental studies.

Crohn’s disease occurs with periods of exacerbation (active disease) and remission, which alternate and can persist for a long time. Remission of the disease can be spontaneous (most symptoms disappear without therapy, but erosions and ulcers in the intestine usually do not heal) and drug-induced (occurs during therapy).

An exacerbation of the disease is almost impossible to predict, but it is more likely if the patient does not receive therapy or forgets to take the recommended treatment.

In summary, Crohn’s disease is diverse and presents differently in different patients. It can be a mild disease involving a small segment of the intestine, mild inflammation without complications, or a severe disease requiring powerful drugs or surgery.

Symptoms of Crohn’s disease

Symptoms of the disease depend on many factors – the location and extent of the affected area, the presence or absence of complications, the severity (activity) of the disease. All signs of Crohn’s disease can be conditionally divided into three groups:

Non-specific symptoms

• increased fatigue and general weakness (sometimes this is the only symptom)
• increased body temperature (constantly or occasionally, including to low values)
• unexplained progressive weight loss
• decreased appetite a

Bowel symptoms

• mushy or loose stools (from 1-2 to 10 or more times a day)
• blood or mucus in the stool
• “false urge” to defecate
• “imperative” (urgent) urge to defecate
• constipation (rare, for example, in the development of complications)
• pain in the abdomen of any nature and localization
• pain in the anus

9001 1 nausea and vomiting (rare, e.g. in the development of complications)

Symptoms from other organs (extraintestinal symptoms)

• joint pain, redness and swelling of the joints (arthritis, spondyloarthritis, sacroiliitis)
• skin rash, formation of pustules and ulcers on the skin (pyoderma gangrenosum, erythema nodosum)
• painful sores in the oral cavity (aphthous stomatitis) )
• liver and bile duct symptoms (jaundice and pruritus)
• other symptoms.

The presence of a fistulous tract on the skin of the abdomen, near the anus with mucous, fecal, purulent discharge, rectal fissure also require the exclusion of Crohn’s disease.

These symptoms do not always indicate Crohn’s disease. Diagnosis will allow the doctor to make an accurate diagnosis and prescribe adequate treatment.

Diagnosis of Crohn’s disease

The gastroenterologist of our clinic diagnoses Crohn’s disease based on the symptoms and the results of instrumental and laboratory tests. For the diagnosis of Crohn’s disease, we use the following methods:

• blood and stool tests, including coprogram, immunological test for inflammation in the intestine, stool test for calprotectin
• Ultrasound of the abdominal cavity
• FGDS
• sigmoidoscopy or colonoscopy
• biopsy (during RMS or colonoscopy) followed by histological examination of the removed fragment
• Colon View test for blood in a stool sample.

In case of perianal lesions (anal fissures, perianal fistulas and paraproctitis), joint management of the patient by a gastroenterologist and a proctologist is very important.

If necessary, endovideocapsule examination of the small intestine, enteroscopy, magnetic resonance imaging (MRI) or computed tomography (CT), rectal endosonography are used as additional diagnostic methods.

The expediency and frequency of a particular diagnostic procedure is determined by the doctor.

Treatment of Crohn’s disease

When Crohn’s disease is diagnosed, treatment can be carried out by the following methods:

• medical
• surgical.

Drug therapy may be prescribed to achieve remission, prolong its period, or to prevent the occurrence of complications of the disease.

Surgical operation is carried out in case of complications that have already arisen: fistulas, abscesses, strictures, intestinal obstruction, perforation of the large intestine and others. The decision on the need for surgical intervention is made by the gastroenterologist together with the surgeon.

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Prognosis of Crohn’s disease

With proper treatment and a stable remission, patients can lead a normal life, as the body eventually adapts to Crohn’s disease. The prognosis in the presence of complications of the disease is usually unfavorable and depends on the method of their treatment.

Prevention and recommendations

For the prevention of Crohn’s disease and its exacerbations, our gastroenterologist recommends:

• give up tobacco smoking forever (including passive)
• follow a balanced diet
• avoid stress

To avoid exacerbations of Crohn’s disease, all patients should regularly visit a gastroenterologist, who, if necessary, will adjust the course of maintenance therapy.

For more information on dietary and lifestyle issues for patients with Crohn’s disease, see our IBD Frequently Asked Questions article.

Patients who suffer from Crohn’s disease for a long period of time are at an increased risk of developing bowel cancer, so they are shown an annual endoscopic examination of the colon to control the disease.

Doctors treating the disease

Andrey Kharitonov

Gastroenterologist

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Sokolova Ksenia Sergeevna

Gastroenterologist, hepatologist, therapist

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Book an appointment for Crohn’s disease

Our administrator will call you back within 15 minutes and arrange a convenient time for an appointment ., 46 years old, applied to the gastro-hepatocenter EXPERT with complaints of discomfort and rumbling in the intestines, minor pain in the right side of the abdomen, loosening of the stool.
Prior to this, M. was examined for 2 months in a polyclinic at the place of residence, where the doctor ruled out acute intestinal infections. M. took probiotics, but without significant effect. Colonoscopy was not performed.

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Suspicion of acute appendicitis

Patient K. was urgently hospitalized twice with aching pains in the abdomen and suspected acute appendicitis. Both times the surgeons found no indications for surgery, and the patient refused hospitalization until the next exacerbation.

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• Aggravations
• Symptoms of Crohn’s disease
• Diagnosis
• Treatment
• Prognosis for Crohn’s disease
• Prevention and advice

Articles

• How to take medicine correctly?
• Frequently asked questions about IBD
• Nutrition for IBD: modern diets
• Nutrition for IBD: deficiency conditions and their correction
• Nutrition for IBD: specific issues of diet therapy
• Mesalazines
• Immunosuppressants (immunosuppressants) in the treatment of IBD
• Nutrition for patients with Crohn’s disease and ulcerative colitis: new recommendations

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