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Publication
Understanding progression of strictures in ileal Crohn's disease—The importance of setting methodological standards
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Advisor(s)
Abstract(s)
Crohn's disease (CD) is a chronic inflammatory bowel disease most frequently involving the terminal ileum and right colon. Given its transmural nature, CD can lead to progressive bowel damage and complications (e.g., strictures, fistulas and abscesses).1 Over 10% of patients present strictures at diagnosis,2 with 15% to over 20% of the remainders developing them through the next 10 and 20 years, respectively.3 Importantly, strictures coexist in over 85% of penetrating CD.4 Population‐based studies showed a 10‐year cumulative risk of surgery (due to stricturing and/or penetrating complications) between 40% and 71%.5 After intestinal resection, anastomotic recurrence is the rule, leading to re‐stricturing and need of intervention, either through endoscopic balloon dilation (EBD) or surgery.6 Despite the high rates of stricturing disease, a gap remains in the understanding of the risk factors and progression rate for stricture development, which are crucial for patient risk stratification and selection of those benefiting the most from intervention. Noteworthy, prior studies on stricturing CD presented significant methodological caveats: (1) lack of a standard definition of stricture, (2)
mixed populations (stricturing disease with and without associated fistulae, ileal and colonic strictures, anastomotic and primary strictures), (3) variable, non‐validated outcomes (subjective obstructive symptoms, different success criteria for therapeutic interventions), and (4) different imaging modalities and protocols, overall contributing for heterogeneous results.
