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Review
. 2017 Feb;152(2):340-350.e6.
doi: 10.1053/j.gastro.2016.09.047. Epub 2016 Oct 5.

Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases

Florian Rieder  1 , Claudio Fiocchi  2 , Gerhard Rogler  3
Affiliations
Review

Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases

Florian Rieder et al. Gastroenterology. 2017 Feb.

Abstract

In the last 10 years, we have learned much about the pathogenesis, diagnosis, and management of intestinal fibrosis in patients with inflammatory bowel diseases. Just a decade ago, intestinal strictures were considered to be an inevitable consequence of long-term inflammation in patients who did not respond to anti-inflammatory therapies. Inflammatory bowel diseases-associated fibrosis was seen as an irreversible process that frequently led to intestinal obstructions requiring surgical intervention. This paradigm has changed rapidly, due to the antifibrotic approaches that may become available. We review the mechanisms and diagnosis of this serious complication of inflammatory bowel diseases, as well as factors that predict its progression and management strategies.

Keywords: Crohn’s Disease; Dilation; Treatment; Ulcerative Colitis.

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Figures

Figure 1
Figure 1
Pathophysiology of intestinal fibrosis: Soluble factors (red) and different origins of mesenchymal cells (blue). CTGF: connective tissue growth factor; EGF, epidermal growth factor; EndoMT: endothelial-to-mesenchymal transition; ET: endothelins; PDGF: platelet-derived growth factor
Figure 2
Figure 2
Model for kinetics of the expression of inflammatory, fibrotic factors, and matrix stiffness in active inflammatory bowel disease before and after treatment.
Figure 3
Figure 3
The true incidence of fibrostenosis is likely underestimated due to the subclinical accumulation of extracellular matrix over time.
Figure 4
Figure 4
Care algorithm for small bowel and ileocecal strictures in patients with CD. In patients with CD or ulcerative colitis, colonic strictures require special care.
See this image and copyright information in PMC

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