ways to handle restrictions
Treatment of strictures can be difficult, and the risk of recurrence after treatment is relatively high. According to a review published in February 2022 in the journal Gastrointestinal diseases on the front lineAnd The treatment your health care team chooses depends on several factors, including the type of stricture — inflammatory, caused by inflammation, or fibrotic, when chronic inflammation causes scar tissue to build up in the intestine — what the size, location, and severity of the obstruction is.
Three options are available to treat the limitations, says Bo Shen, MD, director of the IBD Center at Columbia University Irving Medical Center in New York City:
- Medical treatment with steroids, immunosuppressive agents, or anti-inflammatory agents
- Endoscopic treatment with an endoscope inserted into the body (balloon dilatation, endoscopic needle knife, or isolated tip knife therapy to open the stricture)
- Bowel resection and anastomosis, or strictureplasty
According to the Crohn’s & Colitis Foundation, when the strictures are caused by an inflammatory disease, medication may be prescribed as a first-line treatment to relieve bowel distress.
Dr. Gregory says that laparoscopic balloon dilatation is technically successful in 75 to 90 percent of cases. If laparoscopic balloon dilatation is not successful, some patients may be eligible for another endoscopic treatment called a fully enclosed self-expandable metallic stent (FCSEMS), which is a metal tube that expands into the intestine and holds the strictures open. But a small study published in April 2022 in Lancet It was found that it may have a lower success rate than endoscopic balloon dilation. The randomized study included 80 people who required strict treatment for Crohn’s disease. Half underwent endoscopic balloon dilatation and the other half underwent FCSEMS. After one year, 80 percent of patients who underwent endoscopic balloon dilatation did not require another treatment for the strictures, compared to about 50 percent of those who underwent FCSEMS. However, it may be an option for those who do not respond to endoscopic balloon dilatation. According to the Crohn’s & Colitis Foundation, medications can calm inflammation, which can be enough to relieve restrictions in some people.
Two types of surgery to treat strictures are small bowel resection and strictureplasty. Small bowel resection removes diseased parts of the intestine in order to preserve healthy parts of the organ. This option may not be good for people with multiple individual strictures, or a history of resection, as it can lead to complications such as short bowel syndrome.
With strictureplasty, the surgeon widens the narrowed part of the intestine without removing any of it. Instead, the surgeon makes tiny incisions to shorten and widen the narrowed areas.
“Stenosis has evolved as a surgical procedure designed to preserve bowel length,” says Gregory. “It is suitable for deploying multiple strictures, patients who have had a previous resection of more than 100 cm of the small intestine, and those with short bowel syndrome.”
While living with complications of Crohn’s can be very difficult, it is likely that periods of flare-ups, when symptoms are worse, will be followed by times of remission, when these symptoms are less noticeable or perhaps even absent. And while treatment options that might make life a little easier may not be permanent or perfect, they certainly exist.
Additional reporting by Kaitlyn Sullivan.
