| Original Article |
Question: What are the Crohn’s disease (CD) related ileal strictures?
Design/Method: A prospective study was done during a 5-month interval. Twenty-four strictures and internal controls from 17 adults with obstructive CD were analyzed by cross-sectional morphometry
Setting: The United States
Patient/Study community: Adults with obstructive CD
Results: Constrictive ileal strictures and hypertrophic strictures in CD are differ pathologically and clinically
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Differences between hypertrophic and constrictive ileal strictures |
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Hypertrophic |
Constrictive |
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stricture-to-internal control circumference ratio (CR*) ≥1.0 |
CR <1.0 | |
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concentrically thickened walls |
Thin and pliant walls |
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Mean 3-fold increases in cross-sectional area and stainable fibromucular tissue |
Cross-sectional areas, and stainable fibromuscular tissue comparable with control values |
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High transmural inflammation scores |
Low transmural inflammation scores
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Occurred single |
12 of 18 occurred multiply |
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The density of myenteric plexitis was significantly higher |
Exhibited mild inflammation including scattered lymphoid aggregates, no fibrosis, and, at most, slight splaying of the muscularis mucosae (MM) fibers |
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The circumferential extent of mesenteric fat wrapping was increased with decrease in CR |
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Severely constrictive |
Mildly constrictive |
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| 8 mildly constrictive strictures showed mild fibromuscular mural expansion | ||
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showed significant increases in fibrosis and smooth muscle content |
showed no increases in fibrosis or smooth muscle content |
showed small increases in fibrosis or smooth muscle content |
| *CR: stricture-to-internal control circumference ratio, MM: muscularis mucosae | ||
Commentary:
| SerIleal strictures are phenotypically diverse in Crohn’s disease. There is a need for future clinical trials using antifibrotic and anti-inflammatory drugs that take some strictures’ lack of fibromuscular growth into account |
Citation: Qingqing Liu, Xiaofei Zhang, Huaibin Mabel Ko, and et all. Constrictive and Hypertrophic Strictures in Ileal Crohn’s. Clinical Gastroenterology and Hepatology. 2022; 20(6): 1292–1304
DOI: 10.1016/j.cgh.2021.08.012
https://pubmed.ncbi.nlm.nih.gov/34400338/
Topics: Contrictive, Crohn’s Disease, Strictures
