Non-invasive Multi-modal Methods to Differentiate Inflamed vs Fibrotic Strictures in Patients With Crohn’s Disease.
Clin Gastroenterol Hepatol. 2019 Apr 14;:
Authors: Allocca M, Fiorino G, Bonifacio C, Peyrin-Biroulet L, Danese S
Fibrotic strictures occur in 30% of patients with Crohn’s disease (CD). However, there are no therapeutic agents that prevent or reverse fibrotic strictures. Strictures are treated by endoscopic dilatation procedures and surgical procedures, but there are high rates of recurrence. Two anti-fibrotic agents (nintedanib and pirfenidone) were recently approved for the treatment of idiopathic pulmonary fibrosis and inhibitors of Rho-associated protein kinases (ROCK1 and ROCK2) reversed fibrosis in mice with chronic intestinal inflammation. Cross-sectional imaging techniques, such as magnetic resonance (MR) enterography, computed tomography enterography, and bowel ultrasound, are used to assess small-bowel and CD-related complications, including strictures. It is important to be able to determine the degree of inflammation and fibrosis in strictures to select the best therapy; this can be a challenge since inflammation and fibrosis coexist to varying degrees in a damaged bowel segment. Delayed gadolinium enhancement, magnetization transfer MR imaging, and ultrasound elastography seem to be promising tools for assessing fibrosis in patients with CD. We review non-invasive techniques for assessment of fibrosis, including analyses of genetic, epigenetic, and protein markers. We discuss the potential of imaging techniques such as diffusion-weighed and magnetization transfer MR imaging, strain elastography, shear-wave imaging, and positron emission tomography to guide therapeutic decisions for patients with stricturing CD.
PMID: 30995529 [PubMed – as supplied by publisher]