Nat Rev Gastroenterol Hepatol. 2024 Aug;21(8):572-584.doi: 10.1038/s41575-024-00935-y. Epub 2024 Jun 3.

Dominik Bettenworth ^1 2, Mark E Baker ³, Joel G Fletcher ⁴, Vipul Jairath ^5 6 7, Cathy Lu ⁸, Willem Bemelman ⁹, Geert d'Haens ¹⁰, Andre d'Hoore ¹¹, Axel Dignass ¹², Iris Dotan ^13 14, Roger Feakins ¹⁵, Phillip Fleshner ¹⁶, Christina Ha ¹⁷, Gaylyn Henderson ¹⁸, Ruishen Lyu ¹⁹, Julian Panes ²⁰, Gerhard Rogler ²¹, Ren Mao ²², Jordi Rimola ²³, William J Sandborn ²⁴, Siew C Ng ²⁵, Britta Siegmund ²⁶, Mark Silverberg ²⁷, Stuart A Taylor ²⁸, Bram Verstockt ^29 30, Ilyssa O Gordon ³¹, David H Bruining ³², Brian G Feagan ^5 6 7, Florian Rieder ^33 34 35; Stenosis Therapy Anti-Fibrotic Research (STAR) Consortium

Author information

¹CED Schwerpunktpraxis, Münster, Germany. ced@innere-medizin.de.

²Medical Faculty, University of Münster, Münster, Germany. ced@innere-medizin.de.

³Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.

⁴Department of Radiology, Mayo Clinic, Rochester, MN, USA.

⁵Alimentiv Inc, London, Ontario, Canada.

⁶Department of Medicine, Western University, London, Ontario, Canada.

⁷Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada.

⁸Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

⁹Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands.

¹⁰Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, Netherlands.

¹¹Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.

¹²Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt am Main, Germany.

¹³Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel.

¹⁴Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

¹⁵Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK.

¹⁶Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

¹⁷Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA.

¹⁸Gutless and Glamorous, Atlanta, GA, USA.

¹⁹Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.

²⁰Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.

²¹Department of Gastroenterology and Hepatology, University Hospital, Zurich, University of Zurich, Zurich, Switzerland.

²²Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

²³Inflammatory bowel disease unit, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, IDIBAPS, Barcelona, Spain.

²⁴Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, CA, USA.

²⁵Division of Gastroenterology and Hepatology, State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, China.

²⁶Division of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

²⁷Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada.

²⁸Centre for Medical Imaging, University College London, London, UK.

²⁹Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.

³⁰Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.

³¹Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

³²Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.

³³Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

³⁴Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

³⁵Center for Global Translational Inflammatory Bowel Disease Research, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Fibrostenosis of the small bowel is common in patients with Crohn's disease. No consensus recommendations on definition, diagnosis and management in clinical practice are currently available. In this Consensus Statement, we present a clinical practice RAND/UCLA appropriateness study on the definition, diagnosis and clinical management of fibrostenosing Crohn's disease. It was conducted by a panel of 28 global experts and one patient representative. Following a systematic literature review, 526 candidate items grouped into 136 questions were generated and subsequently evaluated for appropriateness. Strictures are best defined as wall thickening, luminal narrowing and prestenotic dilation. Cross-sectional imaging is required for accurate diagnosis of fibrostenosing Crohn's disease, and it is recommended before making treatment decisions. It should also assess the degree of inflammation in the bowel wall. Multiple options for medical anti-inflammatory, endoscopic and surgical therapies were suggested, including follow-up strategies following therapy. This Consensus Statement supports clinical practice through providing guidance on definitions, diagnosis and therapeutic management of patients with fibrostenosing small bowel Crohn's disease.