摘要
纤维化狭窄是克罗恩病(CD)的最严重并发症之一。它们在诊断的五年中约有50%的患者中发生,在诊断的十年中约有70%的患者中发生。有症状的纤维化狭窄的唯一可用治疗方法是手术切除和内镜下扩张。这两种策略均与高复发率和多次手术切除有关,这对手术发病率和短肠综合征构成了威胁。因此,至关重要的是及早发现患者更容易发生肠纤维化,以加强随访,改用更积极的治疗方法,并建议改变生活方式。关于生物标志物和遗传决定因素的可用数据稀少,无法预测哪个患者会发生肠纤维化。生物或临床标志物可用于确定CD患者的这一亚组,并预测肠道纤维化的发作以及理想情况下的严重程度。此外,环境风险因素的识别可能表明生活方式的改变旨在改变自然过程,从而降低了复杂CD的风险。在这篇综述中,我们将对与复杂的CD病程相关的临床,环境,遗传和血清学因素进行严格的修订,特别关注纤维化表型及其作为肠道纤维化的预测因素的潜在意义。
关键词: 纤维化,克罗恩病(CD),内窥镜检查,手术发病率,肠综合征,肠纤维化。
图形摘要
Current Drug Targets
Title:Fibrotic Strictures in Crohn’s Disease: Mechanisms and Predictive Factors
Volume: 22 Issue: 2
关键词: 纤维化,克罗恩病(CD),内窥镜检查,手术发病率,肠综合征,肠纤维化。
摘要: Fibrotic strictures are one of the most severe complications of Crohn’s Disease (CD). They occur in about 50% of patients at five years and in 70% at ten years of the diagnosis. The only treatment available for symptomatic fibrotic strictures is surgical resection and endoscopic dilation. Both strategies are associated with a high rate of recurrence, and with multiple surgical resections, which pose the threat of surgical morbidity and short bowel syndrome. Therefore, it is crucial to identify, early, the patients more prone to develop intestinal fibrosis to intensify follow-ups, switch to more aggressive treatments, and suggest lifestyle modifications. Scarce data are available concerning biomarkers and genetic determinants to predict which patient will develop intestinal fibrosis. Biologic or clinical markers would be useful to determine this subgroup of CD patients and to predict the onset of intestinal fibrosis and, ideally, its severity. Furthermore, the identification of environmental risk factors may suggest lifestyle changes aimed at modifying the natural course, thus decreasing the risk of complicated CD. In this review, we will critically revise clinical, environmental, genetic, and serologic factors that have been associated with a complicated CD course with a particular focus on the fibrostenosing phenotype and their possible implications as predictive factors of intestinal fibrosis.
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Cite this article as:
Fibrotic Strictures in Crohn’s Disease: Mechanisms and Predictive Factors, Current Drug Targets 2021; 22 (2) . https://dx.doi.org/10.2174/1389450121666201020160803
DOI https://dx.doi.org/10.2174/1389450121666201020160803 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
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