Gasparetto Marco, Angriman Imerio, Guariso Graziella
Department of Women and Children's Health, Paediatric Gastroenterology Unit, Padua University Hospital, Padova, Italy.
Department of Surgery, Gastroenterology and Oncology, Padua University, Padova, Italy.
J Multidiscip Healthc. 2015 Mar 31;8:167-79. doi: 10.2147/JMDH.S38729. eCollection 2015.
Stricture formation is a common complication of Crohn's disease (CD), occurring in approximately one-third of all patients with this condition. Our aim was to summarize the available epidemiology data on strictures in patients with CD, to outline the principal evidence on diagnostic imaging, and to provide an overview of the current knowledge on treatment strategies, including surgical and endoscopic options. Overall, the unifying theme of this narrative review is the multidisciplinary approach in the clinical management of patients with stricturing CD.
A Medline search was performed, using "Inflammatory Bowel Disease", "stricture", "Crohn's Disease", "Ulcerative Colitis", "endoscopic balloon dilatation" and "strictureplasty" as keywords. A selection of clinical cohort studies and systematic reviews were reviewed.
Strictures in CD are described as either inflammatory or fibrotic. They can occur de novo, at sites of bowel anastomosis or in the ileal pouch. CD-related strictures generally show a poor response to medical therapies, and surgical bowel resection or surgical strictureplasty are often required. Over the last three decades, the potential role of endoscopic balloon dilatation has grown in importance, and nowadays this technique is a valid option, complementary to surgery.
Patients with stricturing CD require complex clinical management, which benefits from a multidisciplinary approach: gastroenterologists, pediatricians, radiologists, surgeons, specialist nurses, and dieticians are among the health care providers involved in supporting these patients throughout diagnosis, prevention of complications, and treatment.
狭窄形成是克罗恩病（CD）的常见并发症，约三分之一的该病患者会出现这一情况。我们的目的是总结CD患者狭窄的现有流行病学数据，概述诊断成像的主要证据，并概述当前治疗策略的相关知识，包括手术和内镜治疗选择。总体而言，本篇叙述性综述的统一主题是对CD狭窄患者进行临床管理时的多学科方法。
以“炎症性肠病”“狭窄”“克罗恩病”“溃疡性结肠炎”“内镜球囊扩张术”和“狭窄成形术”为关键词进行Medline检索。对一系列临床队列研究和系统评价进行了综述。
CD中的狭窄被描述为炎症性或纤维化性。它们可原发出现，也可出现在肠吻合部位或回肠袋中。与CD相关的狭窄通常对药物治疗反应不佳，常需要进行肠段手术切除或手术狭窄成形术。在过去三十年中，内镜球囊扩张术的潜在作用日益重要，如今该技术是一种有效的选择，可作为手术的补充。
CD狭窄患者需要复杂的临床管理，多学科方法对此有益：胃肠病学家、儿科医生、放射科医生、外科医生、专科护士和营养师等医疗服务提供者参与到这些患者的整个诊断、并发症预防和治疗过程中。
