Gastroenterology. 2022 Jan;162(1):26-31. doi: 10.1053/j.gastro.2019.05.072. Epub 2019 Jun 27.

Geert D'Haens ¹, Florian Rieder ², Brian G Feagan ³, Peter D R Higgins ⁴, Julian Panés ⁵, Christian Maaser ⁶, Gerhard Rogler ⁷, Mark Löwenberg ⁸, Robbert van der Voort ⁹, Massimo Pinzani ¹⁰, Laurent Peyrin-Biroulet ¹¹, Silvio Danese ¹², International Organization for Inflammatory Bowel Disease Fibrosis Working Group

International Organization for Inflammatory Bowel Disease Fibrosis Working Group:

Mariangela Allocca, Gert De Hertogh, Chris Denton, Jörg Distler, Kelly McCarrier, Dermot McGovern, Tim Radstake, Daniel Serrano, Jaap Stoker

Author information

¹Amsterdam University Medical Center, Academic Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands. Electronic address: g.dhaens@amsterdamumc.nl.

²Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

³Western University, Department of Medicine, London, Ontario, Canada.

⁴University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, Michigan.

⁵Hospital Clínic de Barcelona, August Pi i Sunyer Biomedical Research Institute, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Barcelona, Spain.

⁶University Teaching Hospital Lüneburg, Outpatients Department of Gastroenterology, Lüneburg, Germany.

⁷University Hospital Zurich, Department of Gastroenterology and Hepatology, and University of Zurich, Zurich, Switzerland.

⁸Amsterdam University Medical Center, Academic Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands.

⁹Vision Medical Communications, Nijmegen, The Netherlands.

¹⁰University College London, Institute for Liver and Digestive Health, Division of Medicine, Royal Free Hospital, London, UK.

¹¹University Hospital of Nancy, University of Lorraine, Department of Hepato-Gastroenterology and INSERM U954, Vandoeuvre-lès-Nancy, France.

¹²Inflammatory Bowel Disease Center, Humanitas Clinical and Research Hospital, Humanitas University, Milan, Italy.

Abstract

Intestinal fibrosis is a common complication of inflammatory bowel disease (IBD) that is usually the consequence of chronic inflammation. Although the currently available anti-inflammatory therapies have had little impact on intestinal fibrosis in Crohn’s disease (CD), increased understanding of the pathophysiology and the development of therapies targeting fibrogenic pathways hold promise for the future. One of the critical challenges is how reduction or reversal of intestinal fibrosis should be defined and measured in the setting of clinical trials and drug approval.

The International Organization for Inflammatory Bowel Disease (IOIBD) organized a workshop in Amsterdam, The Netherlands, on December 19^th and 20^th, 2018 in an attempt to review the current knowledge of the biological background, diagnosis, treatment of intestinal fibrosis and clinical trial endpoints. Basic and clinical scientists discussed the pathophysiology of intestinal fibrosis, the current status of biomarkers and imaging modalities in stenosing CD, and recent clinical studies in this area. Researchers from outside of the IBD field presented advances in the understanding of fibrotic processes in other organs, such as the skin, liver and lungs. Lastly, the design of clinical trials with antifibrotic therapy for IBD was discussed, with priority on patient populations, patient reported outcomes (PROs) and imaging.

This report summarizes the key findings, discussions and conclusions of the workshop.