Department of Life, Health and Environmental Sciences, Gastroenterology Unit, University of L'Aquila, L'Aquila, Italy.
Eur Rev Med Pharmacol Sci. 2013 May;17(10):1283-304.
Intestinal fibrosis is a common complication of in inflammatory bowel disease (IBD) and can occur in both ulcerative colitis (UC) and Crohn's disease (CD), but is much more prevalent in CD. Fibrosis is a consequence of local chronic inflammation and is characterized by abnormal deposition of extracellular matrix (ECM) proteins producted by activated myofibroblasts. Current anti-inflammatory therapies used in IBD do not prevent nor they reverse established fibrosis and strictures. Despite the therapeutic advance in the treatment of IBD in the last two decades, the incidence of intestinal strictures in CD has not significantly changed. This implies that control of intestinal inflammation does not necessarily affect the associated fibrotic process. The conventional view that intestinal fibrosis is an inevitable and irreversible process in patients with IBD is progressively changing in light of improved understanding of the cellular and molecular mechanisms that underline the pathogenesis of fibrosis. Comprehension of the mechanisms of intestinal fibrosis may pave the way for the developments of anti-fibrotic agents and of new possible therapeutic approches in IBD. Nevertheless, there are important clinical issues that need further investigations, in particular the identification of factors relevant for the development of the intestinal fibrosis in IBD and the need of accurate and effective monitoring of the fibrotic progression and of effectiveness of the new proposed treatments.
肠纤维化是炎症性肠病（IBD）的常见并发症，可发生在溃疡性结肠炎（UC）和克罗恩病（CD）中，但在 CD 中更为常见。纤维化是局部慢性炎症的结果，其特征是由活化的肌成纤维细胞产生的细胞外基质（ECM）蛋白的异常沉积。目前用于 IBD 的抗炎治疗既不能预防也不能逆转已建立的纤维化和狭窄。尽管在过去二十年中 IBD 的治疗取得了进展，但 CD 中的肠道狭窄发生率并未显著改变。这意味着控制肠道炎症不一定会影响相关的纤维化过程。传统观点认为，肠纤维化是 IBD 患者不可避免和不可逆转的过程，但随着对纤维化发病机制的细胞和分子机制的理解的提高，这种观点正在逐渐改变。对肠纤维化机制的理解可能为抗纤维化药物的开发和 IBD 中可能的新治疗方法铺平道路。然而，仍有一些重要的临床问题需要进一步研究，特别是确定与 IBD 中肠纤维化发展相关的因素，以及需要对纤维化进展和新提出的治疗方法的有效性进行准确和有效的监测。
