Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong SAR, China.
J Dig Dis. 2020 Jun;21(6):332-335. doi: 10.1111/1751-2980.12853.
Fibrostenosis occurs in both Crohn's disease (CD) and ulcerative colitis (UC). Up to 21% of patients with CD present with strictures at diagnosis, while the rate of stenosis varies from 1% to 11% in UC. Despite the increasing use of immunomodulators and biologics in treatment, there has been no decrease in the rate of progression from inflammatory to complicated disease phenotypes (either stricturing or penetrating). The presence of stenosis is an independent risk factor for surgery in patients with CD, who are at a risk of postoperative recurrence at a rate of up to 55% at 10 years after surgery. Patients with inflammatory bowel disease (IBD) strictures are at risk of malignant transformation. Thus, surveillance colonoscopy should be offered to this group of patients. Several risk factors for the development of stricture have been identified. In CD, patients aged less than 40-years old, with perianal disease at diagnosis, who need steroids at the first flare up or have ileal disease are at the risk of developing strictures; while in UC, patients with extensive colitis and long-standing disease are at risk. Recently, microbiota signatures have also been identified as markers for stricture development. The presence of Ruminococcus spp. is associated with the development of stricture in pediatric patients with CD. In this review, we highlight the epidemiology, risk factors and natural history of fibrostenosing IBD.
纤维狭窄症发生于克罗恩病（CD）和溃疡性结肠炎（UC）中。高达 21%的 CD 患者在诊断时即出现狭窄，而 UC 的狭窄发生率为 1%至 11%不等。尽管在治疗中越来越多地使用免疫调节剂和生物制剂，但炎症向复杂疾病表型（狭窄或穿透）的进展率并没有降低。狭窄的存在是 CD 患者手术的独立危险因素，这些患者术后复发的风险高达 55%，术后 10 年复发率为 55%。患有炎症性肠病（IBD）狭窄的患者有恶性转化的风险。因此，应向这组患者提供结肠镜监测。已经确定了几种发展为狭窄的危险因素。在 CD 中，年龄小于 40 岁、诊断时伴有肛周疾病、首次发作时需要类固醇治疗或患有回肠疾病的患者有发展为狭窄的风险；而在 UC 中，广泛性结肠炎和疾病持续时间长的患者有风险。最近，微生物组特征也被确定为狭窄发展的标志物。在患有 CD 的儿科患者中，直肠真杆菌的存在与狭窄的发展有关。在这篇综述中，我们重点介绍了纤维狭窄性 IBD 的流行病学、危险因素和自然病史。
