Strictureplasty | Crohn’s & Colitis Foundation

Chronic inflammation in the intestines can cause the walls of your digestive tract to thicken or form scar tissue. This can narrow a section of intestine, called a stricture, which may lead to an intestinal blockage. A strictureplasty is a surgical procedure to repair a stricture by widening the narrowed area without removing any portion of your intestine.

It is important to repair strictures because the narrowing of your intestine could lead to a blockage that prevents stool from passing through the body. When strictures are caused by disease inflammation, initial treatment may typically include medication to help improve the narrowing of the intestines. Surgery may also be a necessary option. Strictureplasty and small bowel resection are two surgical procedures to repair a stricture.

Symptoms of a stricture

• Nausea

• Vomiting

• Severe cramping

• Constipation

What You Should Know About Strictureplasty

Any surgery is concerning, but learning about the procedure can lessen your concerns and give you information to discuss with your healthcare team.

• Strictureplasty is a generally safe procedure. It is most effective in the lower sections of the small intestine, called the ileum and the jejunum.

• Strictureplasty is less effective in the upper section of the small intestine, called the duodenum.

• Strictureplasty avoids the need to remove a section of your small intestine. It is preferred when possible, because removing portions of your small intestine cause sometimes cause other complications, including a condition called short bowel syndrome (SBS) which occurs when large sections of the small intestine are removed due to surgery (or various surgeries) and the body is unable to absorb adequate amounts of nutrients and water.

During the procedure

• Your surgeon will make cuts lengthwise along the narrowed areas of your intestine, then sew up the intestine crosswise.

• This type of incision and repair shortens and widens the affected part of your bowel, allowing food to pass through.

• Your surgeon may repair several strictures during the same surgery.

Ask Your Doctor

• How is the stricture diagnosed?

• What preparations will I need to make before my strictureplasty?

• What are the potential complications from surgery?

• What kind of restrictions will I have after my surgery?

• How long will it take me to recover from my strictureplasty?

• How will the surgery affect my diet and bowel movements?

3 Medical Therapies to Treat Strictures in Crohn’s Disease – Crohn’s Disease Center

Anyone who has Crohn’s disease knows that the symptoms of the disease are no picnic. Abdominal cramps, diarrhea, constipation, and other symptoms can make life unpleasant to say the least. Worrying about more serious complications of Crohn’s disease, such as strictures, is yet another challenge that patients may face.

A stricture is a narrowing of a section of the intestine that causes problems by slowing or blocking the movement of food through the area. Strictures, which are caused by recurrent inflammation, can lead to hospitalization and also to surgery to correct them.

Symptoms of strictures include abdominal pain, cramping, and bloating. In serious cases, strictures can progress to the point of causing a complete intestinal obstruction, which may result in nausea, vomiting, abdominal distention, and severe abdominal pain.

It is possible for strictures to occur anywhere along the gastrointestinal tract, but they are most often found in the last part of the small intestine and in the colon. “Between 70 and 90 percent of people with Crohn’s disease will require surgery after 5 to 10 years,” says Anita K. Gregory, MD, director of the colorectal program at St. Joseph Hospital in Orange, California, and a member of the medical advisory committee for the Orange County chapter of the Crohn’s & Colitis Foundation of America. “Of those requiring surgery, 50 percent are due to strictures.”

Ways to Treat Strictures

The treatment of strictures can be difficult, and the risk for recurrence after treatment is relatively high. New lesions may be seen as soon as one year after surgery, with 20 to 44 percent of patients who have undergone surgery needing a second surgical procedure.

There are three different options available to treat strictures, says Bo Shen, MD, a gastroenterologist in the Cleveland Clinic’s Digestive Disease Institute in Ohio. These are:

• Medical therapy with steroids and an anti-inflammatory agent
• Endoscopic surgery (balloon dilation or needle knife therapy to open up the stricture)
• Bowel resection and anastomosis or strictureplasty

Though surgery is the most effective treatment, followed by endoscopy and then medical therapy, the degree of invasiveness and complications also follow in that order, according to Dr. Shen.

“Strictureplasty evolved as a surgical procedure designed to preserve intestinal length,” says Dr. Gregory. “It is appropriate for diffuse multiple strictures, patients with previous resections of more than 100 centimeters of small intestine, and those with short bowel syndrome.”

Endoscopic balloon dilation is technically successful in 75 to 90 percent of cases, according to Gregory. And she says there is a risk for significant complications such as major bleeding or perforation in three percent of patients. An article published in January 2016 in the United European Gastroenterology Journal found that the procedure is safe and effective as a first line of treatment for people with Crohn’s. Of the 46 patients with Crohn’s who received balloon dilation, the research reports that 83 percent were satisfied with the outcome.

While living with Crohn’s complications can be very difficult, it is likely that periods of disease flares when symptoms are worse will be followed by times of remission when these symptoms are less noticeable or maybe even nonexistent. And while perhaps not permanent or perfect, treatment options that can make life a little bit easier certainly do exist.

Colon Strictures: What to Know

Your body is like a network of highways, carrying food, fluids, and waste around and out. When certain sections of those roadways narrow because of disease or other reasons, it’s called a stricture.

When this roadblock happens in your large intestine, it’s called a colon stricture. Your large intestine, or bowel, is where your body converts digested food into poop. A colon stricture slows or stops that waste from passing through.

Types and Causes

Strictures can happen in different parts of your body. They include the tube that carries food to your stomach (esophagus) and your urethra, which channels pee out of your body.

No matter the location, strictures come in two types. You could have one or the other, or both.

Inflammatory strictures result from swelling in your digestive tract. Doctors can treat them with medication or surgery.

Fibrotic strictures happen when scar tissue builds up in the bowel from chronic inflammation. They require surgery.

One main cause of colon strictures is inflammatory bowel diseases (IBDs) like Crohn’s disease and ulcerative colitis. A cycle of inflammation and healing leads to scar tissue that narrows the intestine. Other possible causes include:

One in two adults with Crohn’s disease may get intestine problems like fistulas (sores) or strictures within 20 years of their diagnosis.

Symptoms

Some signs of strictures can feel vague. Other times, the symptoms may be more obvious. Your colon’s job is to process digested food and liquids and push the waste down to your rectum to be eliminated as stool. A serious stricture can block your bowels and make it hard for you to poop.

Symptoms of a colon stricture may include if you:

If you don’t treat it early, a stricture can turn deadly.

Treatments

Lifestyle changes, medicine, and surgery are the three main ways to treat strictures. Your doctor will recommend a treatment plan tailored to your needs:

Continued

Changes to your diet. A low-fiber or low-residue diet reduces the risk of blocks in your intestine and the number and size of your poops. Studies also show a connection between a gluten-free diet and IBD symptom relief, which could lower your risk of strictures.

Continued

Anti-TNF treatment. This medicine eases inflammation from a protein called tumor necrosis factor (TNF) and prevents new strictures from forming. It only works on strictures related to inflammation, not fibrosis.

Colonoscopy. Doctors widen the colon with a balloon inserted through a flexible tube (endoscope). They may use a stent to keep the narrowed area open.

Your doctor may also suggest surgery. Studies show that most people with Crohn’s disease who also have a stricture will need at least one surgery at some point. There are two kinds:

Strictureplasty widens the narrow part of your intestine without removing it. This surgery is most helpful in the lower part of your small intestine.

Small bowel resection is when the surgeon takes out the damaged part of your intestine, then joins the healthy sections together. You’ll have this surgery if the damage is more severe, or if doctors find that widening the intestine won’t work.

Colon Strictures: What to Know

Your body is like a network of highways, carrying food, fluids, and waste around and out. When certain sections of those roadways narrow because of disease or other reasons, it’s called a stricture.

When this roadblock happens in your large intestine, it’s called a colon stricture. Your large intestine, or bowel, is where your body converts digested food into poop. A colon stricture slows or stops that waste from passing through.

Types and Causes

Strictures can happen in different parts of your body. They include the tube that carries food to your stomach (esophagus) and your urethra, which channels pee out of your body.

No matter the location, strictures come in two types. You could have one or the other, or both.

Inflammatory strictures result from swelling in your digestive tract. Doctors can treat them with medication or surgery.

Fibrotic strictures happen when scar tissue builds up in the bowel from chronic inflammation. They require surgery.

One main cause of colon strictures is inflammatory bowel diseases (IBDs) like Crohn’s disease and ulcerative colitis. A cycle of inflammation and healing leads to scar tissue that narrows the intestine. Other possible causes include:

One in two adults with Crohn’s disease may get intestine problems like fistulas (sores) or strictures within 20 years of their diagnosis.

Symptoms

Some signs of strictures can feel vague. Other times, the symptoms may be more obvious. Your colon’s job is to process digested food and liquids and push the waste down to your rectum to be eliminated as stool. A serious stricture can block your bowels and make it hard for you to poop.

Symptoms of a colon stricture may include if you:

If you don’t treat it early, a stricture can turn deadly.

Treatments

Lifestyle changes, medicine, and surgery are the three main ways to treat strictures. Your doctor will recommend a treatment plan tailored to your needs:

Continued

Changes to your diet. A low-fiber or low-residue diet reduces the risk of blocks in your intestine and the number and size of your poops. Studies also show a connection between a gluten-free diet and IBD symptom relief, which could lower your risk of strictures.

Continued

Anti-TNF treatment. This medicine eases inflammation from a protein called tumor necrosis factor (TNF) and prevents new strictures from forming. It only works on strictures related to inflammation, not fibrosis.

Colonoscopy. Doctors widen the colon with a balloon inserted through a flexible tube (endoscope). They may use a stent to keep the narrowed area open.

Your doctor may also suggest surgery. Studies show that most people with Crohn’s disease who also have a stricture will need at least one surgery at some point. There are two kinds:

Strictureplasty widens the narrow part of your intestine without removing it. This surgery is most helpful in the lower part of your small intestine.

Small bowel resection is when the surgeon takes out the damaged part of your intestine, then joins the healthy sections together. You’ll have this surgery if the damage is more severe, or if doctors find that widening the intestine won’t work.

Crohn’s disease and intestinal strictures: Causes and treatment

Crohn’s disease is a chronic inflammatory condition that can develop in any part of the gastrointestinal tract, which begins at the mouth and ends at the anus. People with Crohn’s disease can usually manage their symptoms, but this condition may lead to additional health complications, such as intestinal strictures.

In most cases, Crohn’s disease affects the small intestine and the first section of the large intestine. It causes inflammation, which can lead the walls of the intestines to swell, making it harder for food to pass through. This narrowing of the intestines is called a stricture, and it is a common complication of Crohn’s disease.

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

Keep reading to learn more about intestinal strictures, including how they form, their symptoms, and the treatment options.

Nearly 40% of people will develop an intestinal stricture within the first 10 years of receiving a diagnosis of Crohn’s disease.

Crohn’s disease causes chronic inflammation in the gastrointestinal (GI) tract, specifically within the small and large intestines.

Researchers have identified two main types of intestinal stricture:

• Inflammatory strictures: These develop when inflammation due to Crohn’s disease flare-ups causes swelling or edema in the cells that line the intestines.
• Fibrotic strictures: These occur when scar tissue builds up in the intestines after prolonged inflammation. The accumulation of scar tissue narrows the intestines, which restricts the normal passage of food or stool.

People can have mixed-type strictures that result from both inflammation and fibrosis. Although inflammation plays a role in the development of both types 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 accumulation of these materials causes the intestinal walls to thicken, which decreases the space inside the intestines.

People can experience a variety of symptoms depending on the severity of the intestinal stricture.

Mild-to-moderate strictures may cause:

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

Symptoms of severe intestinal strictures include:

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

Most strictures occur in the small intestines where doctors cannot observe them with traditional endoscopy. Instead, they use a minimally invasive procedure called endoscopic balloon dilation, which allows them to view the inside of the small intestines.

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 can inflate the balloon, which will open up that area of the intestine.

Doctors can use endoscopic balloon dilation both to identify intestinal strictures and to treat intestinal blockages and mild strictures in the short term.

Doctors may also use other imaging techniques, such as CT and MRI scans, to help diagnose an intestinal stricture.

Treatment varies depending on the cause of the stricture.

Inflammatory strictures

A compound called tumor necrosis factor alpha (TNF alpha) can cause inflammation in the body.

Anti-TNF alpha medications help manage this inflammation, preventing new strictures from forming.

Fibrotic strictures

Fibrotic strictures do not respond to anti-inflammatory treatments.

Doctors can treat existing fibrotic strictures with endoscopic balloon dilation. This procedure offers promising short term results. However, approximately 50% of people will require additional dilations or surgery after the initial procedure.

Severe strictures and those in areas that an endoscope cannot reach may require surgery.

Doctors often reserve surgery for people who continue experiencing symptoms of bowel obstruction despite receiving less invasive forms of treatment.

People who develop severe complications of bowel obstruction, such as restricted blood flow to the tissues, infection, or bowel perforation, may also require surgery.

Several factors can increase a person’s risk of developing an intestinal stricture. These factors include:

• having multiple surgeries on the abdominal or pelvic area
• having Crohn’s disease or other inflammatory bowel diseases
• 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 of receiving a diagnosis of Crohn’s disease
• smoking or having a history of smoking

Diet also plays a role in the progression of Crohn’s disease. Gluten, a protein that occurs in wheat, barley, and rye, can trigger inflammation in the GI tract. Continual exposure to gluten can result in chronic inflammation that can eventually lead to strictures.

People who have Crohn’s disease can manage their symptoms and reduce inflammation by adopting a gluten-free diet or avoiding difficult-to-digest foods, such as meat and dairy.

People who have one or more intestinal strictures may benefit from the following dietary changes:

• eating smaller meals more frequently
• eating cooked vegetables and fruits without skin
• avoiding foods that may upset the digestive system, such as meat, dairy, nuts, and beans

Learn more about some dietary factors that could help people with Crohn’s disease.

The inflammation that Crohn’s disease can cause is one of several conditions and factors that can lead to swelling or scarring in the intestinal walls. This damage can result in intestinal strictures.

An intestinal stricture refers to the narrowing of the intestines. Strictures can restrict the passage of food and waste material through the intestines, which can cause unpleasant GI symptoms.

A combination of medical treatment and dietary changes can help reduce the symptoms of intestinal blockages and lower the risk of new strictures forming. In some cases, people will require surgery.

Causes, Symptoms, Diagnosis & Treatment

Overview

The small intestine (duodenum, jejunum and ileum)

What is the small bowel?

The small bowel, also called the small intestine, ranges from 20 to 30 feet long and is about 1 inch in diameter. It has many folds that allow it to fit into the abdominal cavity. One end of the small bowel is connected to the stomach and the other to the large intestine.

The small intestine consists of 3 parts: the duodenum, the jejunum and the ileum. Partly digested food passes from the stomach to the small intestine, where the final digestive processes occur. Nutrients, vitamins, minerals and water are absorbed by its lining.

What is small bowel obstruction?

Small bowel obstruction is a partial or complete blockage of the small intestine. If the small bowel is functioning normally, digested products will continue to flow onward to the large intestine. An obstruction in the small bowel can partly or completely block contents from passing through. This causes waste matter and gases to build up in the portion above the blockage. It could also interfere with the absorption of nutrients and fluids.

Symptoms and Causes

What causes small bowel obstruction?

Small bowel obstruction can occur in people of all ages. There are many common causes and risk factors, including:

• Adhesions: These are bands of scar tissue that may form after abdominal or pelvic surgery. An earlier abdominal surgery is the leading risk factor for small bowel obstruction in the United States.
• Hernias: Segments of the intestine may break through a weakened section of the abdominal wall. This creates a bulge where the bowel can become obstructed if it is trapped or tightly pinched in the place where it pokes through the abdominal wall. Hernias are the second most common cause of small bowel obstruction in the United States.
• Inflammatory disease: Inflammatory bowel disorders such as Crohn’s disease or diverticulitis can damage parts of the small intestine. Complications may include narrowing of the bowel (strictures) or abnormal tunnel-like openings (fistulas).
• Malignant (cancerous) tumors: Cancer accounts for a small percentage of all small bowel obstructions. In most cases, the tumor does not begin in the small intestine, but spreads to the small bowel from the colon, female reproductive organs, breasts, lungs or skin.

What are the symptoms of small bowel obstruction?

Symptoms of small bowel obstruction may include the following:

Diagnosis and Tests

How is small bowel obstruction diagnosed?

• Medical history: The doctor will ask the patient about any previous abdominal or pelvic surgeries or relevant procedures that have been done.
• Physical examination: The doctor will examine the abdominal area for signs of swelling, pain, masses, bulges or hernias, surgical scars, or tenderness.
• Blood tests: A complete blood count and electrolyte analysis will be done.

In cases where patients have fever, low blood pressure, or rapid heartbeat, other lab tests may be needed, including:

• Abdominal X-rays: Basic X-rays can sometimes show whether the small bowel is obstructed.
• Computed tomography (CT scan): A CT scan may be done to confirm a diagnosis and give more accurate information about the cause and the site of obstruction.

Management and Treatment

How is small bowel obstruction treated?

• Hospitalization: Patients with an intestinal obstruction are hospitalized. Treatment includes intravenous (in the vein) fluids, bowel rest with nothing to eat (NPO), and, sometimes, bowel decompression through a nasogastric tube (a tube that is inserted into the nose and goes directly to the stomach).
• Anti-emetics: Medications may be required to relieve nausea and vomiting.
• Surgery: If the small intestine is completely blocked or strangulated, surgery may be needed. The goals of surgery are to identify and treat the causes of bowel obstruction. At times, segments of the bowel may need surgery. The diseased segment may need to be re-sectioned and removed.

Small intestinal strictures as a complication of mesenteric vessel thrombosis: two case reports | Journal of Medical Case Reports

Patient 1

A 67-year-old Caucasian man presented acutely with a 5-day history of recurrent bouts of epigastric pain, nausea and vomiting. His previous surgical history included coronary artery bypass surgery, appendicectomy and open cholecystectomy with subsequent surgery for recurrent incisional hernia. No personal or family history of thrombosis-related conditions was given. On examination, he had low grade pyrexia but was cardiovascularly stable. Abdominal examination revealed mild distension with tenderness in the epigastrium and right hypochondrium.

Initial investigations revealed leucocytosis and a raised C-reactive protein level. He underwent medical review to rule out a cardiac aetiology (normal electrocardiogram (ECG), negative troponin test). An abdominal ultrasound showed no abnormality. He was discharged with out-patient follow-up but continued to experience intermittent abdominal pains. A subsequent computed tomography (CT) scan revealed a small hiatus hernia, and thickening of the distal (third part) duodenum. On endoscopic visualisation, no abnormality was demonstrated. Eventually, a small bowel follow-through was performed (Figure 1): this demonstrated a short smooth stricture in the upper part of the small bowel with mild proximal dilatation. Radiological findings were suggestive of a possible Crohn’s stricture or an underlying malignancy. At laparotomy, a stenosing segment of the mid-jejunum and a chronically thickened, dilated proximal gut were found. The stenosing segment was resected and a primary side-to-side anastomosis was fashioned using a GIA-75^® stapling device.

Figure 1

Small bowel follow-through showing a smooth stricture with proximal small bowel dilatation.

Macroscopic examination of the resected specimen showed an area of ulceration and haemorrhage measuring 50 mm in length. Histology tests confirmed a deep chronic ulcer, granulation tissue and marked fibrosis disrupting the muscularis propria; mesenteric sections revealed organised thrombosis of medium and small vessels with mild to moderate recanalisation. A thrombophilia screen was found to be unremarkable. On the advice of the haematologist, the patient was commenced on warfarin and made an uneventful postoperative recovery; to date, he has experienced no relapse of his symptoms.

Patient 2

A 78-year-old Caucasian woman presented with sudden onset abdominal pain with associated nausea and vomiting. She had a past medical history of a myocardial infarction, chronic obstructive pulmonary disease (COPD), transitional cell carcinoma of the bladder and an appendicectomy as a child.

On examination, she was tachycardic with evidence of marked lower abdominal peritonism. Blood tests showed neutrophilia and mild acidosis; plain film radiology was diagnostically unhelpful. An ECG was obtained which showed ventricular ectopics and changes suggestive of lateral ischaemia: on cardiological review, these changes were consistent with an old infarct and troponin T levels at 12 hours were negative. A CT scan revealed a probable left ventricular aneurysm and evidence of a thickened loop of terminal ileum containing intra-mural gas, suggestive of ischaemia (Figure 2). A pre-operative echocardiogram confirmed a moderately sized apical ventricular aneurysm containing a small mobile thrombus.

Figure 2

Computed axial tomography scan showing thickening of the terminal ileum with intramural gas. Of note, no definite stricturing can be seen on this slice.

At laparotomy, a 25 cm segment of strictured ischaemic terminal ileum was found with a 5 cm area of necrotic bowel contained within it. This segment was resected and primary side-to-side anastomosis was undertaken using a TLC-75 stapler. The patient returned to the high dependency unit (HDU) and made an uneventful recovery. Results of a thrombophilia screen were negative and histological examination revealed intermittent full thickness necrosis with an atrophic and chronically inflamed mucosa consistent with the effects of chronic ischaemia. No venous thrombosis was seen. The patient made an uneventful recovery and was discharged 5 days later.

STRICTUROPLASTY AS A ORGAN-PRESERVING METHOD IN PATIENTS WITH DISEASE OF THE SMALL INTESTINAL CROWN (clinical case) | Vardanyan

1. Khalif I.L., Vardanyan A.V., Shapina M.V. et al. Anti-relapse therapy for Crohn’s disease in the postoperative period. Literature review. Coloproctology. 2017; No. 3 (61), p. 63-70.

2.Shelygin Yu.A., Kashnikov V.N., Bolikhov K.V., Vardanyan A.V. Predictors of the effectiveness of ileostomy in complicated forms of Crohn’s disease of the colon. Annals of Surgery. 2012; No. 3, p. 37-42.

3. Shelygin Yu.A. Clinical guidelines. Coloproctology. 2019; No. 1, p. 7-38.

4. Vardanyan A.V., Kashnikov V.N., Bolikhov K.V. et al. Laparoscopic ileostomy for Crohn’s disease.Coloproctology. 2011; No. 3, p. 20-23.

5. Shelygin Yu.A., Kashnikov V.N., Bolikhov K.V., Vardanyan A.V. Ileostomy and its effectiveness in complicated forms of Crohn’s disease of the colon. Bulletin of the North-Western State Medical University named after I.I. Mechnikov. 2012; vol. 4, no. 3, p. 19-23.

6. Shelygin Yu.A., Achkasov S.I., Kashnikov V.N. et al. Unified laparoscopic approach for multistage surgical treatment of a patient with ulcerative colitis. Coloproctology. 2013; No. 3 (45), p. 30-31.

7. Shelygin Yu.A., Kashnikov V.N., Bolikhov K.V. et al. The effectiveness of ileostomy in Crohn’s disease of the colon with perianal lesions. Russian journal of gastroenterology, hepatology, coloproctology. 2011; t. 21, no. 6, p. 64-68.

8.Strong SA, Koltun WA, Hyman NH et al. Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the surgical management of Crohn’s disease. Dis. Colon Rectum. 2007; 50: 1735-1746. https://doi.org/10.1007/s10350-007-9012-7

9. Frolkis AD, Dykeman J, Negron ME, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies.Gastroenterology 2013; 145 (5): 996-1006. https://doi.org/10.1053/j. gastro.2013.07.041

10. Kariyawasam VC, Selinger CP, Katelaris PH, et al. Early use of thiopurines or methotrexate reduces major abdominal and perianal surgery in Crohn’s disease. Inflamm Bowel Dis. 2014; 20: 1382-1390. https://doi.org/10.1097/MIB.0000000000000119

11.Toh JWT, Wang N., Young CJ et al. Major Abdominal and Perianal Surgery in Crohn’s Disease: Long-term Follow-up of Australian Patients With Crohn’s Disease. Dis Colon Rectum. 2018; 61 (1): 67-76. https://doi.org/10.1097/DCR.0000000000000975

12. Frolkis AD, Lipton DS, Fiest KM, et al. Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-analysis of population-based studies.Am J Gastroenterol. 2014; 109 (11): 1739-48. https://doi.org/10.1038/ajg.2014.297

13. Roy P, Kumar D. Strictureplasty. Br J Surg. 2004; 91: 1428-1437. https://doi.org/10.1002/bjs.4804

14. Lee EC, Papaioannou N, Ann R. Minimal surgery for chronic obstruction in patients with extensive or universal Crohn’s disease. Coll Surg Engl. 1982; 64: 229-233

15.Alexander-Williams J. The technique of intestinal strictureplasty. Colorectal Dis. 1986; 1 (54): 7.

16. Tonelli F, Alemanno G, Di Martino C, et al. Results of surgical treatment for jejunal Crohn’s disease: choice between resection, strictureplasty, and combined treatment. Langenbecks Arch Surg. 2017; 402 (7): 1071-1078. https://doi.org/10.1007/s00423-016-1497-x

17.Yamamoto T, Fazio VW, Tekkis PP. Safety and efficacy of strictureplasty for Crohn’s disease: a systematic review and meta-analysis. Dis Colon Rectum. 2007; 50: 1968-1986. https: // doi. org / 10.1007 / s10350-007-0279-5

18. Rottoli M, Vallicelli C et al. Predictors of early recurrence after strictureplasty for Crohn’s disease of the small bowel during the years of biologics. Dig Liver Dis. 2018 Dec 8.pii: S1590-8658 (18) 31266-0.https://doi.org/10.1016/j.dld.2018.11.027

19. Mege D, Panis Y. Unmet Therapeutic Needs: Focus on Intestinal Fibrosis Surgical Approach: Resection, Strictureplasty and Others. Dig Dis. 2017; 35 (1-2): 38-44. https://doi.org/10.1159/000449081

20. Maguire LH, Alavi K et al. Surgical Considerations in the Treatment of Small Bowel Crohn’s Disease.J Gastrointest Surg. 2017 Feb; 21 (2): 398-411. https://doi.org/10.1007/s11605-016-3330-9

90,000 Crohn’s disease

Crohn’s disease is a chronic inflammatory bowel disease of an autoimmune nature, characterized by stenosis of the intestinal segments with the involvement of all layers of the intestinal wall in the pathological process, the formation of fistulas and extraintestinal lesions.

The common name for this disease is “Crohn’s disease”, but to date, other terms are used to denote it: “granulomatous colitis”, “granulomatous enteritis”, “regional colitis”, “transmural colitis”, etc. p.

The term “Crohn’s disease” seems to be the most apt, as it includes all the many forms of the disease.

Etiology

The etiological factor of the disease has not been established. The role of viruses and bacteria is assumed. The role of genetic factors in the onset of the disease has been more or less proven.

Pathogenesis

Autoimmune mechanisms play a certain role in the pathogenesis of the disease. Patients have antibodies to the colon tissue, lymphocytes specifically sensitized to the antigens of the colon mucosa.Immune complexes also have a damaging effect. Signs of impaired cellular immunity are determined, in particular, a decrease in the content of T-cells in the peripheral blood. All this leads to severe inflammatory changes in the intestines. Macroscopically, inflammatory changes can be single or multiple, with the altered areas alternating with unchanged ones. Changes in the ileum and cecum are more characteristic; the rectum is not always affected. The process captures all layers of the wall, looks like slit-shaped ulcers or cracks.Bowel strictures and pseudopolyposis are common.

Clinical picture and possible complications

Clinic of Crohn’s disease is largely due to the predominant localization of the pathological process. With the defeat of the large intestine, mainly its right sections, the patient has a clinic of the syndrome of the defeat of the colon – abdominal pain, rumbling, bloating, diarrhea with the discharge of semi-liquid stools with a small admixture of blood and mucus, weight loss, joint pain. Crohn’s disease is a long-term chronic course.With the defeat of the end part of the small intestine (terminal ileitis), pain appears in the right ileal region, vomiting, fever, which often leads to surgery due to suspected acute appendicitis. Narrowing of the lumen of the small intestine may be accompanied by its obstruction.

The pain is cramping and more pronounced than in ulcerative colitis, the stool is less frequent, there may be no blood in the feces, there are no tenesmus and false desires. If the distal ileum is simultaneously affected, a tumor-like conglomerate is palpated in the right ileum, caused by productive inflammation of all layers of the intestine, mesenteric lymph nodes.Often in the area of ​​the ileocecal angle, intestinal strictures develop, they can also be in other parts of both the small and large intestines. In this case, a rather typical picture of the syndrome of partial and sometimes complete intestinal obstruction develops. An isolated lesion of the small intestine, its attachment to the pathological process in the large intestine leads to the development of a typical picture of the syndrome of enteric insufficiency. The patient loses weight, he has the phenomenon of polyhypovitaminosis, metabolic disorders of varying severity.The development of fistulas is characteristic, especially in the perianal region. In case of damage to the esophagus and duodenum, the clinic may resemble a peptic ulcer, stenosis of the outlet section of the stomach and the initial sections of the duodenum often develops with the corresponding clinic of cicatricial stenosis of the intestine. In addition to local complications – fistulas, intestinal obstruction – extraintestinal manifestations are characteristic of Crohn’s disease – fever, joint damage, skin rashes, eye and liver damage.Of the possible complications, it should be noted perforation of the intestine at the site of ulceration, followed by the formation of an abscess in the abdominal cavity, fistulas, less often with the development of peritonitis.

Diagnostics

Laboratory blood tests reveal anemia as a result of blood loss or the development of malabsorption syndrome; various manifestations of intoxication and inflammation: leukocytosis with stab shift, increased ESR, increased activity of acute phase blood proteins. Like anemia, hypoalbuminemia and electrolyte disturbances are associated with the progression of secondary malabsorption syndrome.During irrigoscopy and passage of barium through the small intestine, segmental lesions of the small and large intestine are revealed, the alternation of affected and unaffected segments. The contours of the intestine are uneven, there are longitudinal ulcers, a thickening of the relief, which creates a picture of “cobblestone pavement”. Segmental narrowing of the affected areas is characteristic (“cord symptom”). As a rule, the decisive word in the diagnosis of Crohn’s disease remains with endoscopic research methods – fibrocolonoscopy, sigmoidoscopy with multiple mucosal biopsies.The need to take the deeper layers of the intestine during biopsy is emphasized. Endoscopic findings depend on the duration and phase of the disease. In the initial period, a dull mucous membrane is determined, erosion is visible on it, surrounded by whitish granulations (like aft). As the duration of the disease in the exacerbation phase increases, the picture changes. The mucous membrane thickens unevenly, deep longitudinal ulcers-cracks are found, the intestinal lumen is narrowed. It is often possible to identify the formed fistulas. With a decrease in the activity of the process, scars are formed at the site of the ulcers and areas of stenosis are formed.Histological examination reveals a picture of nonspecific inflammation, but with a number of features. The entire thickness of the mucous membrane is infiltrated, especially the submucosa. Sarcoid-like granulomas can be identified. Unfortunately, this pathognomonic sign of Crohn’s disease is rarely detected during biopsy examination. Ultrasound examination of the abdominal cavity, computed tomography provide valuable information in the diagnosis of abscesses, which are often found in Crohn’s disease. In the presence of external fistulas, fistulography is indicated.

Differential Diagnostics

Most often Crohn’s disease has to be differentiated from ulcerative colitis, tuberculous intestinal lesions, ischemic colitis, yersiniosis, acute appendicitis. Ulcerative colitis, occurring with concomitant paraproctitis or retrograde ileitis, can cause a diagnostic error. In addition, even with the use of modern endoscopic and radiological research methods, histological examination of biopsies in about a tenth of cases, it is not possible to distinguish between these two diseases (“undifferentiated colitis”). The development of cicatricial changes, intestinal fistulas is characteristic not only of Crohn’s disease, but also of intestinal tuberculosis. Abdominal pain, intestinal bleeding – symptoms of ischemic colitis – can also be adequately assessed only after a proper clinical and instrumental examination.

City Clinical Hospital # 31 – IBD: Ulcerative colitis. What does the patient need to know? (page 6)

Page 6 of 10

Complications of ulcerative colitis

Being a serious disease, in case of an unfavorable course in the absence of proper therapy, UC has serious complications for the life of patients .Surgery is often necessary in such cases.

These include:

• Toxic colon dilatation (toxic megacolon). This complication consists in excessive expansion of the lumen of the colon (up to 6 cm in diameter or more), accompanied by a sharp deterioration in the patient’s well-being, fever, bloating, and decreased stool frequency.
• Intestinal massive bleeding .Such bleeding develops when large vessels supplying the intestinal wall are affected. The volume of blood loss exceeds 300 – 500 ml per day.
• Perforation of the colon wall. Occurs with overstretching and thinning of the intestinal wall. In this case, the entire contents of the lumen of the colon enters the abdominal cavity and causes a formidable inflammatory process in it – peritonitis.
• Colon stricture. Narrowing of the colon lumen occurs in 5-10% of UC cases.At the same time, in some patients, the passage of feces through the colon is disrupted and intestinal obstruction occurs. Each case of detection of stricture in UC requires careful examination of the patient to exclude Crohn’s disease and colon cancer.
• Colon cancer (colorectal cancer) . The oncological process develops, as a rule, with a prolonged course of UC, more often with a total lesion of the large intestine. So, in the first 10 years of UC, the development of colorectal cancer is noted in 2% of patients, in the first 20 years – in 8%, with a duration of more than 30 years – in 18%.

90,000 MRI of the small intestine (MR enterography, hydro MRI)

Magnetic resonance imaging (MRI) is a modern diagnostic method that allows you to identify pathologies of internal organs using volumetric computer reconstruction.

FSBI “Consultative and Diagnostic Center with a Polyclinic” actively uses the MRI method in the diagnosis of various diseases, including disorders in the work of the gastrointestinal tract.

The Department of Functional Diagnostics of the CDC at Krestovsky is equipped with a high-field magnetic resonance tomograph of the latest generation Magnetom Avanto from Siemens, which allows high-quality research, clearly giving a complete clinical picture of the nature of the disease and possible methods of its treatment.

Indications for magnetic resonance imaging of the small intestine are: inflammatory bowel diseases and their complications, congenital anomalies in the development of the intestine, benign and malignant tumors, etc.etc.

The MRI procedure is quick and painless, but there are a number of contraindications for this examination method, for example, if the patient has a pacemaker, dental implants, bridges, prostheses; during pregnancy and lactation.

The MR-enterography procedure is aimed at identifying pathological processes in the small intestine and is carried out with the use of a contrast agent. Before scanning on an MRI scanner, the patient drinks a liter of liquid, during the examination, an intravenous injection of a contrast agent is performed.

The procedure is performed on an empty stomach. The last meal should take place the day before, no later than 6 pm. Colon cleanse should be performed with an enema given the day before the test or with a bowel prep.

After undergoing magnetic resonance imaging, the specialists of the gastroenterology department of the consultative and diagnostic center will give recommendations on further treatment of diseases in the hospital or outpatient.

You can make an appointment with a doctor by calling +7 (812) 325-00-03 or by leaving an online application

Ultrasound diagnostics of inflammatory bowel diseases

The method of ultrasound diagnostics in medicine is one of the youngest – the first studies were carried out 50 years ago. During this period, he has established himself very positively, which allowed him in a number of disciplines – obstetrics and gynecology, cardiology, surgery – to take a leading place in the patient examination program.In coloproctology, for a long time, ultrasound was used only to detect distant metastases. However, with the development of new techniques and the development of ultrasound technology, it became possible to visualize the intestine and diagnose lesions of the large and small intestines.

Intestinal ultrasound is a relatively inexpensive, non-invasive and radiation-safe imaging technique used to diagnose and monitor the treatment of inflammatory bowel disease.The method is of particular relevance in the presence of strictures, anomalies in the development of the intestine, if it is impossible to conduct an endoscopic examination. In addition, the method is an additional source of information in identifying the symptom of “compression from the outside” of the intestinal wall, identified during colonoscopy. Intestinal examination is carried out using linear or convex probes with a frequency of 3.5 and 5 MHz. For transabdominal examination, as a rule, the cecum, all parts of the colon, and the sigmoid colon are available.

Inflammatory bowel disease is a chronic inflammatory process involving all or part of the gastrointestinal tract. The most common of these are ulcerative colitis and Crohn’s disease.

Crohn’s disease is an inflammatory bowel disease of unexplained etiology, affecting the small and large intestines with a tendency to recur. Differential diagnosis is made with tumors, tuberculosis, ulcerative colitis, diverticulosis.Ultrasound signs of Crohn’s disease are detected already at an early stage of the disease, when they are limited to moderate and asymmetric thickening of the wall of that other segment of the gastrointestinal tract. In the presence of pronounced changes, ultrasound examination reveals a well-defined symptom of a hollow organ lesion (thickening of the intestinal wall), which is more often localized in the right iliac region.

Roughness of the outer contour of the altered segment of the gastrointestinal tract in Crohn’s disease is due to the presence of serositis and extensive adhesions.The values ​​of the main ultrasound indicators change in different phases of the course of Crohn’s disease. In a complicated form with the development of an inflammatory infiltrate and interintestinal abscesses, the contours of the affected segment look indistinct. A conglomerate is determined, fluid zones are revealed around, which may indicate the formation of an abscess. With long-term dynamic observation of a patient with Crohn’s disease, the ultrasound method helps to diagnose, monitor treatment, and track regression or recurrence of pathological changes.

Ulcerative colitis is a chronic disease with a tendency to recurrence, localized in the colon. The pathological process, as a rule, begins with the rectum, is limited to it, or spreads higher. When conducting an ultrasound examination during an exacerbation of the disease, thickening of the walls, a slight narrowing of the cavity, smoothing or absence of haustra are revealed. Ultrasound examination with established NUC is an adequate method for monitoring the state of the intestine.

The limitation of ultrasound examination in inflammatory bowel diseases is associated with a deterioration in information content in the presence of obesity, chronic constipation, increased gas production.

In the department of ultrasound diagnostics of GBUZ “Tambov Regional Clinical Hospital named after V. D. Babenko”, ultrasound examination of the intestine has been performed since March 2016. The doctor of ultrasound diagnostics was trained under the program “Ultrasound diagnostics of intestinal diseases” at the State Scientific Center of Coloproctology named after A.N. Ryzhikh Moscow. An ultrasound of the intestine is prescribed by a gastroenterologist. If you have symptoms related to the gastrointestinal tract, consult a specialist who recommends, if necessary, an ultrasound examination of the intestines.

Rules for preparing patients for bowel ultrasound examination.

Do not eat or drink on the day of the study. It should take 5 – 6 hours from the last meal to the procedure. Before the examination, the patient is recommended to exclude bread, raw vegetables and fruits, sweets and dairy products from the diet.Under no circumstances should the intestines be prepared with enemas and laxatives with osmotic properties (Fortrans, Lavacol, etc.), which is a contraindication for the study.

The absence of contraindications for use, limitation of the frequency of research and special training make ultrasonography the method of choice in the diagnosis of ulcerative colitis, Crohn’s disease and complications of inflammatory bowel diseases.

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* By submitting the completed data in the registration form, I confirm that I am a healthcare worker of the Russian Federation and I give specific, informed and conscious consent to the processing of personal data to the Personal Data Operator of Pfizer Innovations LLC (hereinafter referred to as the “Operator”) registered at the address: …Moscow, Presnenskaya embankment, house 10, 22nd floor.

I grant the Operator the right to carry out the following actions with my personal data, as well as information about my hobbies and interests (including by analyzing my social media profiles): collecting, recording, organizing, accumulating, storing, updating (updating, change), extraction, use, transfer (access, provision), deletion and destruction, by automated and (or) partially automated (mixed) processing of personal data.

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The processing of my personal data is carried out for the purpose of registration on the Operator’s website www.pfizerprofi.ru to provide me with access to information resources of the Pfizer company, as well as to interact with me by providing information through any communication channels, including mail, SMS, e-mail, telephone and other communication channels.

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Balloon dilatation of the esophagus, stomach, intestines

Full article:

Technical aspects

The advantage, at least theoretically, of balloon dilation over bougienage is the uniform effect throughout the stricture and the virtual absence of axial loading on the tissues.

Currently, there are three types of balloons: installed along the guidewire under X-ray control, passed through the endoscope channel under visual control, and a combination of the first and second types (balloons for dilatation of biliary strictures). Balloons for endoscopic dilatation of strictures are shown in Fig. 1.

When using a guidewire, it is passed through the stricture (using an endoscope or X-ray control), a balloon (with X-ray contrast marks) is passed through it, which is installed in such a way that the stricture falls on its central part, then, using a special inflation device, the balloon is filled with water-soluble contrast up to a certain pressure (indicated by the manufacturer for each cylinder of a specific diameter).Initially, the “waist” on the balloon is clearly visualized in the area of ​​constriction, which disappears with a successful dilatation.

The balloons designed for passing through the endoscope can be installed in two ways:

1. If the apparatus for the stricture can be performed, which happens, however, relatively rarely. Then, after overcoming it, the balloon is completely removed from the canal and then the device begins to be removed together with the balloon until it reaches its correct location in the stricture.
2. If the stricture is insuperable, the device attempts to “cannulate” the balloon area of ​​the stenosis.

Successful dilatation is judged by the ability to move the balloon forward and backward through the stricture in an inflated state.

In our work we use a combination of endoscopic and X-ray control for balloon placement and dilatation. The dilator is guided through the endoscope channel and placed in the center of the constriction under X-ray control. Inflation is performed under X-ray control until the “waist” disappears, but not exceeding the maximum recommended pressure.

Usually we hold the balloon in an inflated state in the area of ​​the stricture for 2-3 minutes. The balloon is then desuflated and removed from the canal. The area of ​​the eliminated stricture and the previously inaccessible areas of the gastrointestinal tract, for example, the stomach and duodenum with esophageal strictures, are examined endoscopically.

A rather difficult question to solve remains – to what diameter should the dilatation be carried out? On the one hand, there is evidence that perforation occurs more often when using a balloon with a diameter of 18 mm, at least when it is used to treat stenoses of the gastric outlet [5] , on the other hand, clinical symptoms are closely related to the narrowing diameter.When using balloons (or bougie) to dilate esophageal strictures, it is recommended to expand the stricture by 6-10 F in one session compared to its initial diameter [19] . This approach seems to us to be reasonably careful; we try not to dilate strictures, regardless of their localization, by more than 10 F during one procedure. For esophageal strictures, some authors recommend dilation to a lumen of 14-15 mm (42-45 F) [13] . As for the strictures of the colon, there is evidence that after dilatation of the strictures of the colon anastomoses to 40 F in 90% of patients, the symptoms of obstruction disappeared [4] .In our work, in the overwhelming majority of cases, we use a balloon with a diameter of no more than 16 mm due to the increased risk of perforation and virtually no difference in symptomatology in patients with strictures enlarged to 16 and 18-20 mm.

It is necessary to adequately prepare the patient for dilation – with pronounced strictures of the esophagus and the outlet of the stomach, the overlying sections may contain a large amount of liquid, the remains of the food eaten the day before. It is necessary to wash the contents through a probe.Adequate preparation is also extremely important for treating colon strictures.

Like other therapeutic endoscopic interventions, dilation should only be performed when the patient is adequately sedated.

Before the procedure, an endoscopic examination of the stricture with biopsy and an X-ray examination with barium are mandatory. A study with a water-soluble contrast is also performed after dilatation to exclude perforation. Recommended and repeated endoscopic examination to exclude complications.Sometimes it is prudent to repeat the biopsy from the narrowed area to rule out a malignant lesion.

Indications for dilatation are only strictures with obvious clinical symptoms and sometimes the need to exclude its malignant nature, such as strictures arising on the background of NUC.

Esophagus

The main indications for dilatation are peptic and caustic strictures. Dilation of tumor constrictions and strictures of anastomoses is also possible.Dilatation is also successfully used for cardia achalasia. In our experience, the most rewarding are short narrowing of the lumen of a peptic nature. With the appointment of adequate antisecretory therapy, such strictures rarely recur.

Dilation with strictures resulting from burns of the esophagus with acid or alkali is the most difficult (due to the frequent high length, tortuosity and tightness of the narrowing). A series of dilatations with balloons of different diameters (from smallest to largest) is often used after 3-7 days.The percentage of recurrence of such strictures is high.

Tumor stenoses are easy, as a rule, amenable to dilatation, but the elimination of dysphagia is rather short-lived. In a series of 39 patients with esophageal cancer, dilation reduced dysphagia in 90% of patients; among complications, there was one perforation [12] . Dilations in tumor strictures can be performed repeatedly, with repeated occurrences of dysphagia. In one study, patients with this condition typically required re-dilation every 4 weeks [10] .After elimination of tumor stenosis, stenting with a self-expanding metal stent should be performed, which, however, is not always possible in Russia for financial reasons. There are reports of successful combination of dilatation with chemotherapy as a palliative treatment for inoperable tumors of the cardia [7] .

In case of dilatation of strictures of esophageal anastomoses, the results are more favorable with short strictures (when their length is more than 12 mm, balloon dilatation is generally ineffective), but the result does not depend on the diameter of the narrowing.Worse results with manual anastomoses and with a history of their failure [6] .

Stomach

Given the emergence of highly effective antiulcer therapy and a significant decrease in the incidence of ulcer recurrence after successful eradication of Hp, balloon dilation can be successfully used in cicatricial narrowing of the pylorus and duodenum as an alternative to surgical intervention. Of course, there is no point in dilating with decompensated stenosis. Possible dilatation and malignant, as palliative treatment, and after burn strictures, strictures of anastomoses.Solt J., et al., Published long-term results of dilatation in patients with benign gastric outlet stenosis (postoperative, peptic, corrosive and postvagotomy strictures) [15] . He performed 117 balloon dilations in 72 patients, and the median follow-up was 98 months. The mean diameter of the stenosis was 6 mm before treatment and 16 mm after it. Reduction and disappearance of symptoms was observed in 80% immediately after the procedure and in 70% after three months.Restenosis was observed in 16 patients 1-18 months after the intervention. Complications included one case of arterial bleeding and two perforations. Boylan J.J., and Gradzka M.I., emphasize that proper antiulcer treatment, in particular Hp eradication and discontinuation of NSAIDs, is necessary to maintain the result of a successfully performed dilation for peptic outlet gastric stricture [2] . Anastomotic and malignant strictures are more prone to rapid relapse [11] .

Small and large intestine

The main indications for dilatation are strictures resulting from Crohn’s disease or NUC and strictures of the anastomoses. Although there are reports of the use of this method in diverticular, tumor and ischemic strictures [8] . A retrospective analysis of balloon dilatation of strictures through a colonoscope in 59 patients with Crohn’s disease (53 with anastomotic strictures and 6 with primary strictures) showed that a long-term positive result was achieved in 41% of patients, and in 17% after one dilatation.However, in 59% of patients during the observation period, there was a need for surgical treatment as a result of recurrent stricture. Complications were two perforations [17] . Brooker J.C., et al., Reports the combination of balloon dilation with the administration of sustained-release steroids for Crohn’s disease strictures [3] .