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Stricture

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About Intestinal Strictures

An intestinal stricture, also known as a stenosis, is a narrowing of a tubular part of the body. In the case of Inflammatory Bowel Disease, is a stricturing of the intestines or any other region of the Gastrointestinal Tract.

Strictures are much more common in patients with Crohn's Disease than Ulcerative Colitis and may be Asymptomatic or lead to a variety of complications. If a stricture is severe, it may block a significant portion of an area of the intestines. Strictures are fibrotic (scarring), due to active inflammation and spasms, or a combination thereof. Long term Inflammation can lead to the scarring.

Crohn's patients with Strictures of the Rectum are more likely to also suffer from, Abscess, Colonic Disease, or Perianal Fistulae.[5]

Symptoms

If the stricture isn't causing a significant obstruction of the bowel, it is possible for it not to cause any symptoms. Otherwise, it can cause abdominal pain, cramping, bloating, nausea, constipation, and vomiting. Due to decreased intestinal motility, strictures can lead to other complications such as Small Intestine Bacterial Overgrowth. Under some circumstances, a stricture can lead to a Perforation of the Bowel, Fistulas, and Abscesses.

Diagnosis

Strictures can range in size from 2cm to as much as 30cm.

For suspected strictures of the large intestine, a Barium Enemawith x-ray is commonly utilized.

One of the best forms of diagnosis is via Magnetic Resonance Enterography (an MRI with oral administration of polyethylene glycol solution) because it can determine, with great accuracy, if the stricture is due to scarring (fibrosis) or active inflammation.[1]

Another great and common means of diagnosis is the Computed Tomography Enterography (CTE).

A Small Bowel Follow Through is also commonly utilized to test for the presence of strictures. Other tests include enteroscopy, CT Scan, ultrasonography and endoscopy.

Stricturing can be caused by spasms from inflammation or be due to scarring. It is important for the difference to be determined as it alters treatment course. In strictures caused by spams, there is very little or no proximal dilation of the bowel. Conversely in strictures caused by scarring, there is often bowel dilation.[4]

Treatment

A variety of treatments for strictures are available.
  • If the stricture is due, at least in part to inflammation, then medications to reduce that inflammation can be beneficial.
  • If the stricture is due to scarring, it can be "stretched" open during an endoscopy using procedures such as a balloon dilation.
  • If the stricture is severe and due to scarring, surgery may be necessary to remove the strictured segment of intestine.
  • A newer surgery called a strictureplasty is sometimes utilized that enlarges the width of the strictured intestine.

Biologics and Strictures

It has been shown that Remicade (Infliximab) can promote stricture formation or make them worse because it promotes scar formation during healing.[3] Some doctors suggest before utilizing Remicade (Infliximab), Cimzia (Certolizumab) or Humira (Adalimumab), a patient should be tested to see if there is an inflammatory component to the stricture and if not, have surgery instead.[2]

Videos

Ileocecal valve stenosis:


Video of a balloon dilation of a colonic stricture:

References

[pos]1a[/pos][1] http://www.ncbi.nlm.nih.gov/pmc/arti...0/?tool=pubmed
[pos]2a[/pos][2] http://www.medscape.com/viewarticle/726396
[pos]3a[/pos][3] http://www.medscape.com/viewarticle/729747
[pos]4a[/pos][4] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780209/
[pos]5a[/pos][5] Fields S, Rosainz L, Korelitz BI, et al. Rectal strictures in Crohn's disease and coexisting perirectal complications. Inflammatory Bowel Diseases. 2008; 14(1): 29-31. http://onlinelibrary.wiley.com/doi/1.../ibd.20264/pdf
http://www.medscape.com/viewarticle/746145_11

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