Department of Internal Medicine I, University of Regensburg, Regensburg, Germany; Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA; Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, USA.
J Crohns Colitis. 2008 Dec;2(4):279-90. doi: 10.1016/j.crohns.2008.05.009. Epub 2008 Jul 3.
Intestinal fibrosis is a common complication of IBD that can become seriously symptomatic and may require surgical intervention if stricture formation ensues. This review discusses existing and developing knowledge of intestinal fibrosis and its implications for therapy.
Review of the literature, personal communications, unpublished observations.
Known mechanisms of intestinal fibrosis include fibroblast proliferation and migration, activation of stellate cells, and extraintestinal fibroblast recruitment. However, novel mechanisms are being uncovered, including epithelial-to-mesenchymal transition, endothelial-to-mesenchymal transition, pericyte differentiation, and fibrocyte recruitment. Most of the traditional and novel mechanisms underlying intestinal fibrosis are associated to the presence of chronic inflammation, but is also possible that fibrosis develops independently of persistent immune activation in the gut. At the moment, the development of preventive, non-interventional, and more effective management of intestinal fibrosis is hampered by the lack of a greater knowledge of its basic pathophysiology and predisposing factors.
It is reasonable to expect that therapy of IBD-associated fibrosis will radically improve once the underlying mechanisms are better understood, and therapeutic modalities will emerge that prevent or reverse this complication of IBD.
肠纤维化是 IBD 的常见并发症，如果发生狭窄，可能会出现严重症状，并可能需要手术干预。本文讨论了肠纤维化的现有和发展中的知识及其对治疗的影响。
文献复习、个人交流、未发表的观察结果。
已知的肠纤维化机制包括成纤维细胞增殖和迁移、星状细胞激活以及肠外成纤维细胞募集。然而，新的机制正在被揭示，包括上皮细胞-间充质转化、内皮细胞-间充质转化、周细胞分化和成纤维细胞募集。肠纤维化的大多数传统和新机制都与慢性炎症的存在有关，但纤维化也可能在肠道持续免疫激活之外独立发展。目前，由于对其基本病理生理学和易患因素缺乏更多了解，预防、非干预性和更有效的肠纤维化管理的发展受到阻碍。
一旦更好地了解潜在机制，预计 IBD 相关纤维化的治疗将得到极大改善，并且将出现预防或逆转这种 IBD 并发症的治疗方法。
