Intestinal fibrosis in Crohn's disease: Medical treatment or surgery?

Crohn's disease (CD) is a chronic panenteric disease of unknown aethiology which tends to progress in spite of medical or surgical treatment. Intestinal fibrosis is among the most common complications of CD, resulting in stricture formation in the small intestine and colon. About 75% of CD patients will undergo surgery at least once over the course of their disease and fibrotic strictures represent the main indication for surgery and the first cause of hospitalization and costs for CD patients. Clinical management of intestinal strictures depends on the type of stricture: inflammatory strictures are treated medically and are usually responsive to treatment, while fibrotic strictures require surgery. Clinical decisions regarding the right treatment choice for such conditions require proper knowledge on what to expect from the emerging drug strategies and surgical techniques. To achieve optimal results in patient management an approach combining the expertise of both gastroenterologist and colorectal surgeon is essential. This review aims at providing clinicians with an overview on fibrotic strictures in CD patients. Particular focus will be placed on the principal imaging modalities, and the medical, endoscopic and surgical treatment options with relative indications, according to the most recent evidence available.