Crohn's disease is a chronic inflammatory condition that can develop in any part of the gastrointestinal tract, which begins at the mouth and ends at the anus. People with Crohn's disease can usually manage their symptoms, but this condition may lead to additional health complications, such as intestinal strictures.
In most cases, Crohn's disease affects the small intestine and the first section of the large intestine. It causes inflammation, which can lead the walls of the intestines to swell, making it harder for food to pass through. This narrowing of the intestines is called a stricture, and it is a common complication of Crohn's disease.
However, Crohn's disease is just one of several conditions and factors that can lead to intestinal strictures.
Keep reading to learn more about intestinal strictures, including how they form, their symptoms, and the treatment options.
Nearly 40% of people will develop an intestinal stricture within the first 10 years of receiving a diagnosis of Crohn's disease.
Crohn's disease causes chronic inflammation in the gastrointestinal (GI) tract, specifically within the small and large intestines.
Researchers have identified two main types of intestinal stricture:
- Inflammatory strictures: These develop when inflammation due to Crohn's disease flare-ups causes swelling or edema in the cells that line the intestines.
- Fibrotic strictures: These occur when scar tissue builds up in the intestines after prolonged inflammation. The accumulation of scar tissue narrows the intestines, which restricts the normal passage of food or stool.
People can have mixed-type strictures that result from both inflammation and fibrosis. Although inflammation plays a role in the development of both types of stricture, inflammatory and fibrotic strictures respond to different treatments.
Prolonged exposure to inflammation can change the structure of the intestinal lining, resulting in the accumulation of scar tissue, collagen, and other fibrous material.
The accumulation of these materials causes the intestinal walls to thicken, which decreases the space inside the intestines.
People can experience a variety of symptoms depending on the severity of the intestinal stricture.
Mild-to-moderate strictures may cause:
- discomfort or pain in the abdomen
- excess gas or bloating
- decreased appetite
- low energy
Symptoms of severe intestinal strictures include:
- intense abdominal pain
- bloating or swelling of the abdomen
Most strictures occur in the small intestines where doctors cannot observe them with traditional endoscopy. Instead, they use a minimally invasive procedure called endoscopic balloon dilation, which allows them to view the inside of the small intestines.
During the procedure, a doctor guides a catheter with a small, inflatable balloon on the end through the intestines.
Once the catheter reaches an intestinal stricture, the doctor can inflate the balloon, which will open up that area of the intestine.
Doctors can use endoscopic balloon dilation both to identify intestinal strictures and to treat intestinal blockages and mild strictures in the short term.
Doctors may also use other imaging techniques, such as CT and MRI scans, to help diagnose an intestinal stricture.
Treatment varies depending on the cause of the stricture.
A compound called tumor necrosis factor alpha (TNF alpha) can cause inflammation in the body.
Anti-TNF alpha medications help manage this inflammation, preventing new strictures from forming.
Fibrotic strictures do not respond to anti-inflammatory treatments.
Doctors can treat existing fibrotic strictures with endoscopic balloon dilation. This procedure offers promising short term results. However, approximately 50% of people will require additional dilations or surgery after the initial procedure.
Severe strictures and those in areas that an endoscope cannot reach may require surgery.
Doctors often reserve surgery for people who continue experiencing symptoms of bowel obstruction despite receiving less invasive forms of treatment.
People who develop severe complications of bowel obstruction, such as restricted blood flow to the tissues, infection, or bowel perforation, may also require surgery.
Several factors can increase a person's risk of developing an intestinal stricture. These factors include:
- having multiple surgeries on the abdominal or pelvic area
- having Crohn's disease or other inflammatory bowel diseases
- receiving steroid treatment during the first Crohn's disease flare-up
- having a perianal illness — one that affects the anus or the area around it — at the time of receiving a diagnosis of Crohn's disease
- smoking or having a history of smoking
Diet also plays a role in the progression of Crohn's disease. Gluten, a protein that occurs in wheat, barley, and rye, can trigger inflammation in the GI tract. Continual exposure to gluten can result in chronic inflammation that can eventually lead to strictures.
People who have Crohn's disease can manage their symptoms and reduce inflammation by adopting a gluten-free diet or avoiding difficult-to-digest foods, such as meat and dairy.
People who have one or more intestinal strictures may benefit from the following dietary changes:
- eating smaller meals more frequently
- eating cooked vegetables and fruits without skin
- avoiding foods that may upset the digestive system, such as meat, dairy, nuts, and beans
The inflammation that Crohn's disease can cause is one of several conditions and factors that can lead to swelling or scarring in the intestinal walls. This damage can result in intestinal strictures.
An intestinal stricture refers to the narrowing of the intestines. Strictures can restrict the passage of food and waste material through the intestines, which can cause unpleasant GI symptoms.
A combination of medical treatment and dietary changes can help reduce the symptoms of intestinal blockages and lower the risk of new strictures forming. In some cases, people will require surgery.