Our Summary

This research paper talks about the surgical treatment of a condition called stricture, which is a narrowing of the intestines often caused by inflammatory bowel disease (IBD) like Crohn’s disease. The stricture happens when there’s an increase in cells called fibroblasts and a protein called collagen in the bowel wall.

Telling whether a stricture is caused mainly by inflammation or by established fibrosis (thickening and scarring of connective tissue) can be tricky. If it’s mainly due to inflammation, it might respond to medication. But if fibrosis is the main cause, surgery is usually needed.

The paper talks about two surgical approaches: endoluminal (inside the bowel) and extraluminal (outside the bowel). Endoscopic dilatation, which is a procedure to widen the narrowed part of the bowel, works well for strictures in a short section of the small bowel. Other options include surgically dividing the stricture but keeping the length of the intestine, doing a strictureplasty (a type of surgery that widens the narrowed part without removing any of it), or removing the narrowed part altogether.

The paper also mentions that the mesentery, which is the tissue that attaches the intestines to the wall of the abdomen, plays a role in whether the stricture comes back. In diseases like Crohn’s, which can come and go, it’s important to keep as much of the intestine as possible while also reducing the risk of the stricture coming back.

Finally, the paper emphasizes that a team of different health professionals should be involved before and after the surgery to get the best results in these challenging cases.

FAQs

  1. What is the primary cause of strictures in intestinal inflammatory disease?
  2. What are the different approaches to treating predominantly fibrotic strictures?
  3. How is the balance between preserving intestinal length and reducing recurrence risk achieved in diseases like Crohn’s disease?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal resection is to ensure they follow their post-operative care plan carefully. This may include taking prescribed medications, eating a healthy diet, avoiding certain foods that may cause irritation or blockages, and attending follow-up appointments with their healthcare provider. It is important for patients to communicate any concerns or changes in symptoms to their doctor in order to monitor their progress and prevent complications.

Suitable For

Patients with inflammatory bowel disease, such as Crohn’s disease, are typically recommended intestinal resection when they have strictures that are predominantly fibrotic and not responsive to medication. Additionally, patients with short-segment isolated small bowel strictures may benefit from endoscopic dilatation. The decision to perform a strictureplasty or resect the strictured segment will depend on the individual patient’s condition and the extent of the disease. It is important to involve a multidisciplinary team in the pre- and postoperative care of these patients to improve outcomes and reduce the risk of recurrence.

Timeline

Before intestinal resection:

  • Patient presents with symptoms such as abdominal pain, bloating, diarrhea, and weight loss.
  • Diagnostic tests are performed, including imaging studies and endoscopy, to confirm the presence of a stricture in the bowel.
  • Treatment with medications to control inflammation may be attempted, but if the stricture is predominantly fibrotic, surgery may be necessary.
  • The patient undergoes preoperative evaluation and preparation for surgery, including discussions with the surgical team and other healthcare providers.

After intestinal resection:

  • The patient undergoes surgery to remove the strictured segment of the bowel.
  • Postoperative care includes monitoring for complications such as infection, bleeding, and bowel obstruction.
  • The patient may require a temporary or permanent stoma, depending on the extent of the resection.
  • Recovery involves gradual reintroduction of food and monitoring for signs of recurrence or complications.
  • Long-term follow-up with the healthcare team is important to monitor for recurrence of strictures and manage any ongoing symptoms or complications.

What to Ask Your Doctor

  1. What is the cause of my intestinal stricture? Is it predominantly due to inflammation or fibrosis?
  2. What are the non-surgical treatment options for my intestinal stricture?
  3. What are the risks and benefits of surgical intervention for my intestinal stricture?
  4. What type of surgical approach do you recommend for my specific case (endoluminal vs extraluminal)?
  5. What are the potential long-term outcomes and complications of surgical treatment for my intestinal stricture?
  6. How will the length of my intestine be preserved during the surgical procedure?
  7. How will the mesentery be addressed during the surgical treatment of my intestinal stricture?
  8. How can we reduce the risk of stricture recurrence after surgical intervention?
  9. What is the role of the multidisciplinary team in managing my intestinal stricture?
  10. Are there any specific lifestyle changes or dietary modifications I should consider to prevent future strictures?

Reference

Authors: Mohan HM, Coffey JC. Journal: J Dig Dis. 2020 Jun;21(6):355-359. doi: 10.1111/1751-2980.12880. Epub 2020 Jun 18. PMID: 32410340