Advertisement

Fibrostenotic Inflammatory Bowel Disease: A Cinderella Story

  • Florian Rieder
Chapter

Abstract

Intestinal fibrosis in inflammatory bowel disease (IBD) leading to stricture formation, intestinal obstruction and need for surgical intervention remains one of the largest unresolved clinical challenges in IBD. Despite the emergence of novel anti-inflammatory drugs the incidence of stricture formation and surgery remained largely unchanged. Challenges in testing anti-fibrotic compounds have so far prevented progress in this area, but recent development put clinical trials for anti-fibrotic compounds into reach.

Keywords

Stricture Crohn’s Surgery Anti-fibrotic Obstruction 

Notes

Financial Support

This work was supported by grants from the National Institutes of Health [T32DK083251, P30DK097948 Pilot Feasibility Study, K08DK110415] and the European Crohn’s and Colitis Foundation to F.R.

Conflicts of Interest

F.R. Consulting: UCB, Celgene, Samsung, Roche, Pliant, Thetis, Boehringer-Ingelheim, Helmsley; AdBoards: AbbVie, UCB, Receptos, RedX, Celgene; Speakers Bureau: AbbVie.

References

  1. 1.
    Rieder F, Fiocchi C, Rogler G. Mechanisms, management, and treatment of fibrosis in patients with inflammatory bowel diseases. Gastroenterology. 2017;152:340–350.e6.CrossRefPubMedGoogle Scholar
  2. 2.
    Oberhuber G, Stangl PC, Vogelsang H, et al. Significant association of strictures and internal fistula formation in Crohn’s disease. Virchows Arch. 2000;437:293–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Farmer RG, Whelan G, Fazio VW. Long-term follow-up of patients with Crohn’s disease. Relationship between the clinical pattern and prognosis. Gastroenterology. 1985;88:1818–25.CrossRefPubMedGoogle Scholar
  4. 4.
    Gordon IO, Agrawal N, Goldblum JR, et al. Fibrosis in ulcerative colitis: mechanisms, features, and consequences of a neglected problem. Inflamm Bowel Dis. 2014;20:2198–206.CrossRefPubMedGoogle Scholar
  5. 5.
    Wynn TA, Ramalingam TR. Mechanisms of fibrosis: therapeutic translation for fibrotic disease. Nat Med. 2012;18:1028–40.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Richeldi L, du Bois RM, Raghu G, et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med. 2014;370:2071–82.CrossRefPubMedGoogle Scholar
  7. 7.
    Hughes G, Toellner H, Morris H, et al. Real world experiences: Pirfenidone and Nintedanib are effective and well tolerated treatments for idiopathic pulmonary fibrosis. J Clin Med. 2016;5.  https://doi.org/10.3390/jcm5090078.
  8. 8.
    Magro F, Rodrigues-Pinto E, Coelho R, et al. Is it possible to change phenotype progression in Crohn’s disease in the era of immunomodulators? Predictive factors of phenotype progression. Am J Gastroenterol. 2014;109:1026–36.CrossRefPubMedGoogle Scholar
  9. 9.
    Chatu S, Subramanian V, Saxena S, et al. The role of thiopurines in reducing the need for surgical resection in Crohn’s disease: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109:23–34. quiz 35.CrossRefPubMedGoogle Scholar
  10. 10.
    Rieder F, Zimmermann EM, Remzi FH, et al. Crohn’s disease complicated by strictures: a systematic review. Gut. 2013;62:1072–84.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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;50:1968–86.CrossRefPubMedGoogle Scholar
  12. 12.
    Maconi G, Sampietro GM, Cristaldi M, et al. Preoperative characteristics and postoperative behavior of bowel wall on risk of recurrence after conservative surgery in Crohn’s disease: a prospective study. Ann Surg. 2001;233:345–52.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    de Buck van Overstraeten A, Vermeire S, Vanbeckevoort D, et al. Modified side-to-side isoperistaltic strictureplasty over the ileocaecal valve: an alternative to ileocaecal resection in extensive terminal ileal Crohn’s disease. J Crohns Colitis. 2016;10:437–42.CrossRefPubMedGoogle Scholar
  14. 14.
    Rieder F. The gut microbiome in intestinal fibrosis: environmental protector or provocateur? Sci Transl Med. 2013;5:190ps10.CrossRefPubMedGoogle Scholar
  15. 15.
    Johnson LA, Luke A, Sauder K, et al. Intestinal fibrosis is reduced by early elimination of inflammation in a mouse model of IBD: impact of a “Top-Down” approach to intestinal fibrosis in mice. Inflamm Bowel Dis. 2012;18:460–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Rieder F, de Bruyn JR, Pham BT, et al. Results of the 4th scientific workshop of the ECCO (Group II): markers of intestinal fibrosis in inflammatory bowel disease. J Crohns Colitis. 2014;8:1166–78.CrossRefPubMedGoogle Scholar
  17. 17.
    Stidham RW, Higgins PD. Imaging of intestinal fibrosis: current challenges and future methods. United European Gastroenterol J. 2016;4(4):515–22.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastroenterology, Hepatology and NutritionDigestive Diseases and Surgery Institute, Cleveland Clinic FoundationClevelandUSA

Personalised recommendations