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Review
. 2017 Jul;33(4):239-245.
doi: 10.1097/MOG.0000000000000363.

Intestinal fibrosis: ready to be reversed

Giovanni Latella  1 , Florian Rieder
Affiliations
Review

Intestinal fibrosis: ready to be reversed

Giovanni Latella et al. Curr Opin Gastroenterol. 2017 Jul.

Abstract

Purpose of review: Intestinal fibrosis is a common complication of several enteropathies, with inflammatory bowel disease (IBD) being the major cause. Intestinal fibrosis affects both ulcerative colitis and Crohn's disease, and no specific antifibrotic therapy exists. This review highlights recent developments in this area.

Recent findings: The pathophysiology of intestinal stricture formation includes inflammation-dependent and inflammation-independent mechanisms. A better understanding of the mechanisms of intestinal fibrogenesis and the availability of compounds for other nonintestinal fibrotic diseases bring clincial trials in stricturing Crohn's disease within reach.

Summary: Improved understanding of its mechanisms and ongoing development of clinical trial endpoints for intestinal fibrosis will allow the testing of novel antifibrotic compounds in IBD.

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Conflict of interest statement

CONFLICTS OF INTEREST

F.R. is on the Advisory Board for AbbVie and UCB, consultant to Samsung, Celgene, UCB and Roche and on the speakers bureau of AbbVie. G.L. has no competing interests.

Figures

Fig 1
Fig 1. Mechanisms of intestinal fibrosis in inflammatory bowel disease
Fibrogenesis is dynamic and multifactorial process, which is accompanied by an imbalance between matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases. Abbreviations: ECM-extracellular matrix; MMP-matrix metalloproteinase; TIMP- tissue inhibitors of matrix metalloproteinases.
Fig 2
Fig 2. Extracellular matrix stiffness and progression of fibrosis
Myofibroblasts can be activated by immune cells to increase the deposition of extracellular matrix. They respond to the stiffness of their matrix environment, which keeps them in a persistent activated phase, but also allows the release of TGF-β1 from the latency associated peptide through integrin mediated mechanisms. Abbreviations: ECM-extracellular matrix; TGF- transforming growth factor; LAP-latency associated peptide.
Fig 3
Fig 3. Schematic representation of potential therapeutic targets in intestinal fibrosis
Abbreviations: ECM-extracellular matrix; MMP-matrix metalloproteinase; TIMP- tissue inhibitors of matrix metalloproteinases.
See this image and copyright information in PMC

References

    1. Latella G, Rogler G, Bamias G, Breynaert C, Florholmen J, Pellino G, et al. Results of the 4th scientific workshop of the ECCO (I): pathophysiology of intestinal fibrosis in IBD. Journal of Crohn's & colitis. 2014;8(10):1147–65. - PubMed
    1. Rieder F, Fiocchi C, Rogler G. Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases. Gastroenterology. 2017;152(2):340–50 e6. - PMC - PubMed
    1. Bettenworth D, Gustavsson A, Atreja A, Lopez R, Tysk C, van Assche G, et al. A Pooled Analysis of Efficacy, Safety, and Long-term Outcome of Endoscopic Balloon Dilation Therapy for Patients with Stricturing Crohn's Disease. Inflamm Bowel Dis. 2017;23(1):133–42. The largest study to date evaluating safety and efficacy of endoscopic balloon dilation in Crohn's disease associated strictures. - PubMed
    1. Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn's disease complicated by strictures: a systematic review. Gut. 2013;62(7):1072–84. - PMC - PubMed
    1. Rieder F, Latella G, Magro F, Yuksel ES, Higgins PD, Di Sabatino A, et al. European Crohn's and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn's Disease. Journal of Crohn's & colitis. 2016 - PubMed

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