United European Gastroenterol J. 2022 Dec;10(10):1167-1178.doi: 10.1002/ueg2.12326. Epub 2022 Nov 3.

Joseph Sleiman ¹, Prathyush Chirra ², Namita S Gandhi ³, Mark E Baker ⁴, Cathy Lu ⁵, Ilyssa O Gordon ⁶, Satish E Viswanath ², Florian Rieder ^7 8; Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium

Author information

¹Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

²Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.

³Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.

⁴Imaging Institute, Digestive Diseases and Surgery Institute and Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

⁵Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.

⁶Department of Pathology, Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

⁷Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

⁸Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Abstract

Strictures in Crohn's disease (CD) are a hallmark of long-standing intestinal damage, brought about by inflammatory and non-inflammatory pathways. Understanding the complex pathophysiology related to inflammatory infiltrates, extracellular matrix deposition, as well as muscular hyperplasia is crucial to produce high-quality scoring indices for assessing CD strictures. In addition, cross-sectional imaging modalities are the primary tool for diagnosis and follow-up of strictures, especially with the initiation of anti-fibrotic therapy clinical trials. This in turn requires such modalities to both diagnose strictures with high accuracy, as well as be able to delineate the impact of each histomorphologic component on the individual stricture. We discuss the current knowledge on cross-sectional imaging modalities used for stricturing CD, with an emphasis on histomorphologic correlates, novel imaging parameters which may improve segregation between inflammatory, muscular, and fibrotic stricture components, as well as a future outlook on the role of artificial intelligence in this field of gastroenterology.