Controversy and consensus of the anti-tumor necrosis factor alpha in the treatment of Crohn′s disease with intestinal stricture

Abstract

The emergence of the anti-tumor necrosis factor alpha (anti-TNF-α) therapies has brought lots of benefits to patients with inflammatory bowel disease (IBD). However, controversies exist over whether anti-TNF-α could be used for Crohn′s disease (CD) patients with intestinal stricture. Some articles found stricturing CD patients under anti-TNF therapy had a high risk of intestinal obstruction or even perforation while others found that there was no association between anti-TNF-α and intestinal obstruction. The fundamental cause lies in that anti-TNF-α only target at inflammation, but cannot be resistant to intestinal fibrosis or change long term outcome. To avoid and prevent intestinal obstruction or perforation, authors should evaluate the component and type of intestinal stricture cautiously before starting anti-TNF-α therapy. Exploring new specific anti-fibrotic therapy will be a promising way for all stricturing CD patients. Key words: Crohn′s disease; Anti-tumor necrosis factor alpha; Infliximab; Intestinal stricture