Challenges in the Pathophysiology, Diagnosis, and Management of Intestinal Fibrosis in Inflammatory Bowel Disease

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.


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 19th and 20th, 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.

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