Chronic inflammation and other changes are significant components of clinically fibrotic strictures in Crohn's disease: a histological study of resected strictures clinically characterized as noninflamed.

Shivaji, Uday N, Evans, Matthew, Critchlow, Tamsin, Gui, Xianyong, Smith, Samuel C L, Pinkney, Thomas, Iacucci, Marietta, Cooney, Rachel, Ghosh, Subrata and Skordilis, Kassiani (2020) Chronic inflammation and other changes are significant components of clinically fibrotic strictures in Crohn's disease: a histological study of resected strictures clinically characterized as noninflamed. European journal of gastroenterology & hepatology, 32 (11). pp. 1432-1439. ISSN 1473-5687.

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Official URL: http://www.eurojgh.com/

Abstract

BACKGROUND

Strictures related to Crohn's disease due to fibrosis are a result of an exaggerated tissue remodelling response to inflammation, characterized by accumulation of collagen-rich extracellular matrix produced by mesenchymal cells.

OBJECTIVES

The objective of this study was to characterize histological changes seen in resected 'fibrotic' strictures to better understand individual components of intestinal stenosis.

METHODS

We identified patients undergoing surgery for ileal Crohn's disease secondary to symptomatic stricturing disease (Montreal B2) using the histopathology database at Queen Elizabeth Hospital in Birmingham, UK, between 2012 and 2017. Phenotypic data were recorded and resection specimens reviewed. Two independent pathologists applied the semiquantitative scoring system previously developed by us to the microscopic images. Data were analyzed using the possible maximum total score (%PMTS).

RESULTS

Forty-eight patients (M = 25) were included. with median disease duration of 7 years (range 0.25-39 years); nearly two-thirds had ileocolonic distribution (L3). In this cohort, despite presurgery diagnosis of noninflamed fibrosis, chronic inflammation was noted to be a prominent component of all strictures. The histological scoring showed presence of several other prominent findings such as muscular hyperplasia and volume expansion.There was statistically significant positive correlation between chronic inflammation and fibrosis and muscular hyperplasia.

CONCLUSION

The histological features of Crohn's disease-related strictures show multiple changes in multiple layers and not simply fibrosis. In our cohort, despite the observation prior to surgery that strictures were clinically considered fibrotic, the finding of chronic inflammation as a dominant component at a histological level in the resection is important. The findings might suggest that one of the main drivers of progressive fibrosis is the inflammatory component, which probably is never fully resolved.

Item Type: Article
Subjects: QW Microbiology. Immunology
QY Clinical pathology
WI Digestive system. Gastroenterology
WO Surgery
Divisions: Planned IP Care > Gastroentrology
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Depositing User: Jamie Edgar
Date Deposited: 03 Aug 2021 11:24
Last Modified: 03 Aug 2021 11:24
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4526

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