Department of Gastroenterology, General Hospital-ASL 1 Imperiese, Sanremo, IM, Italy.
SC Gastroenterologia ed Endoscopia Digestiva, Ospedale San Paolo ASL 2 Savonese, Savona, SV, Italy.
Dig Dis Sci. 2020 Jul;65(7):1904-1916. doi: 10.1007/s10620-020-06227-0. Epub 2020 Apr 11.
Despite recent advances aimed to treat transmural inflammation in Crohn's disease (CD) patients, the progression to a structuring behavior still represents an issue for clinicians. As inflammation becomes chronic and severe, the attempt to repair damaged tissue can result in an excessive production of extracellular matrix components and deposition of connective tissue, thus favoring the formation of strictures. No specific and accurate clinical predictors or diagnostic tools for intestinal fibrosis exist, and to date, no genetic or serological marker is in routine clinical use. Therefore, intestinal fibrosis is usually diagnosed when it becomes clinically evident and strictures have already occurred. Anti-fibrotic agents such as tranilast, peroxisome proliferator-activated receptor gamma agonists, rho kinase inhibitors, and especially mesenchymal stem cell therapy have provided interesting results, but most of the evidence has been derived from studies performed in vitro. Therefore, current therapy of fibrotic strictures relies mainly on endoscopic and surgical procedures. Although its long-term outcomes may be debated, endoscopic balloon dilation appears to be the safest and most effective approach to treat appropriately selected strictures. The use of endoscopic stricturotomy is currently limited by the expertise needed to perform it and by the few data available in the literature. Some good results have been achieved by the positioning of self-expandable metal stents (SEMS). However, there is no concordance regarding the type of stent to use and for how long it should be left in place. The development of new specific SEMS may lead to better outcomes and to an increased use of this alternative in CD-related strictures.
尽管最近有针对克罗恩病（CD）患者的透壁性炎症的治疗进展，但向结构性行为的进展仍然是临床医生关注的问题。随着炎症变为慢性和严重，修复受损组织的尝试可能导致细胞外基质成分的过度产生和结缔组织的沉积，从而有利于形成狭窄。目前还没有用于肠纤维化的特定、准确的临床预测因子或诊断工具，迄今为止，也没有遗传或血清学标志物用于常规临床。因此，肠纤维化通常在临床上出现明显狭窄时才被诊断。抗纤维化药物，如曲尼司特、过氧化物酶体增殖物激活受体γ激动剂、rho 激酶抑制剂，尤其是间充质干细胞治疗，已经取得了有趣的结果，但大多数证据来自体外研究。因此，目前纤维化狭窄的治疗主要依赖于内镜和手术程序。尽管其长期结果可能存在争议，但内镜球囊扩张似乎是治疗适当选择的狭窄最安全、最有效的方法。内镜狭窄切开术的应用目前受到执行该手术所需的专业知识和文献中可用数据有限的限制。自扩张金属支架（SEMS）的应用取得了一些良好的效果。然而，关于使用哪种类型的支架以及应该放置多长时间，目前还没有共识。新型特异性 SEMS 的发展可能会带来更好的结果，并增加在 CD 相关狭窄中的应用。
