Intestinal Stricture in Crohn’s Disease

What is an Intestinal Stricture in Crohn’s Disease?

Crohn’s disease is a type of inflammatory bowel disease that affects your digestive system. People who are affected by Crohn’s experience many types of complications from the disease and one of the most common complications is the narrowing of a section in the intestine that makes it difficult for any food to pass through. This condition is known as an intestinal stricture and in some cases, an intestinal stricture can further lead to an intestinal blockage as well. Nearly one-third of all patients who have Crohn’s will end up developing an intestinal stricture within ten years of receiving their diagnosis.(1)

What is an Intestinal Stricture in Crohn's Disease?

What are the Causes of an Intestinal Stricture in Crohn’s?

Medical experts have classified intestinal strictures under two major categories. These include:

  1. Inflammatory
  2. Fibrotic

Inflammatory intestinal strictures are caused by the inflammation of swelling that occurs in the digestive tract due to Crohn’s, especially during a flare-up of the disease. Fibrotic intestinal strictures, meanwhile, are more severe, predominantly fibrotic, and require more invasive types of treatment.(2)

What are the Symptoms of an Intestinal Stricture?

The symptoms of an intestinal stricture in Crohn’s disease varies from person to person and also depends on the severity of the blockage caused by the condition. In people who have mild to moderate strictures, some of the commonly observed symptoms include:

In more severe cases of intestinal stricture, the commonly observed symptoms may include:

If you have Crohn’s disease and are experiencing any of the severe symptoms of intestinal stricture, then you should contact your doctor immediately or seek medical help at the earliest.

Are There Any Risk Factors For Intestinal Strictures?

There are actually several risk factors that increase your chances of developing an intestinal stricture due to Crohn’s disease. These may include:

  • If you have got a diagnosis of Crohn’s disease before the age of 40
  • If you have undergone an appendectomy before your diagnosis of Crohn’s
  • If you have a perianal disease at the time of Crohn’s diagnosis
  • If you require steroidal treatment during your first flare-up of Crohn’s

It is also believed that there are certain genetic factors that make you more likely to develop intestinal strictures. You should always check with your doctor about whether the medical history of your family puts you at a higher risk for developing Crohn’s related intestinal stricture.

Smoking is also known to be a risk factor. So if you are a smoker, you should consult your doctor and seek help on how to quit smoking as soon as possible.

What is the Treatment for Intestinal Stricture in Chrohn’s?

The treatment for intestinal stricture in people who have Crohn’s disease varies from person to person. The treatment depends on the location of the stricture, the type of structure, as well as the length of the stricture. Strictures that are primarily related to inflammation caused by Crohn’s can be treated with prescription drugs, such as immunomodulators, steroids, and anti-TNF agents. Anti-TNF drugs are medications that are commonly prescribed to help stop inflammation in the body. However, most of the times though, the majority of Crohn’s related intestinal strictures happen due to a mix of fibrotic and inflammation, and due to this, none of these treatments prove to be effective on their own. They have to be prescribed in combination for the treatment to show effect.(3)

In cases where the intestinal stricture does not respond to any medication, then endoscopic therapy can help prevent or delay surgery. In this procedure, known as endoscopic balloon dilation (EBD), a balloon is used to expand the narrow part of the bowel that is affected. It is effective in the treatment of sing and short intestinal strictures are easily accessible by the endoscope and in conditions where the doctors know there is a rare chance of complications. Unfortunately, the recurrence rate of these intestinal strictures remain fairly high and there is a high chance that you will need to undergo another EBD in the next five years or so.(4)

In cases where the intestinal strictures are not responding to any medication or are not reachable by endoscopy as well, these are generally treated with surgery. For simple and short strictures, the surgical option used is a bowel-preserving procedure known as strictureplasty. In a strictureplasty, the damaged portion of the bowel is cut open during the surgery and the bowel is reshaped. With structures that are more complicated and longer in length, resection surgery is performed, which involves the complete removal of the damaged part of the bowel.

Can Dietary Changes Help With Intestinal Strictures?

If you have intestinal stricture caused by Crohn’s disease, then you should modify your diet for some time in order to avoid the blockage of the part of the bowel that has become narrow. You should opt for eating smaller and more frequent meals, making sure to chew your food thoroughly before swallowing. You should also avoid having foods that are difficult to digest as this would put a lot of strain on your bowel. These include nuts, seeds, vegetable skins, beans, and gristly meats.

However, always consult with your doctor before you go ahead and make any major alterations to your diet as you should not be cutting those foods out that are beneficial for you as it could also lead to a vitamin and mineral deficiency that might very well make your symptoms worse.

Conclusion

Intestinal strictures are a very common occurrence in people who have Crohn’s disease. If left untreated, though, intestinal strictures can prove to be life-threatening. If you have Crohn’s disease and suspect that you might be having a stricture, you should contact your doctor immediately to have the problem checked.

References:  

  1. Bessissow, T., Reinglas, J., Aruljothy, A., Lakatos, P.L. and Van Assche, G., 2018. Endoscopic management of Crohn’s strictures. World journal of gastroenterology, 24(17), p.1859.
  2. Chang, C.W., Wong, J.M., Tung, C.C., Shih, I.L., Wang, H.Y. and Wei, S.C., 2015. Intestinal stricture in Crohn’s disease. Intestinal research, 13(1), p.19.
  3. Rieder, F., Zimmermann, E.M., Remzi, F.H. and Sandborn, W.J., 2013. Crohn’s disease complicated by strictures: a systematic review. Gut, 62(7), pp.1072-1084.
  4. Bessissow, T., Reinglas, J., Aruljothy, A., Lakatos, P.L. and Van Assche, G., 2018. Endoscopic management of Crohn’s strictures. World journal of gastroenterology, 24(17), p.1859.

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