Abstract
Background Strictures are a common complication in Crohn's disease (CD), found in more than 50% of patients. They are characterized by the excessive deposition of extracellular proteins in the tissue as a result of the chronic inflammatory process. The effect of anti-tumor necrosis factor alpha (TNF-α) therapy on the development of fibrosis is not yet fully understood. Aim To investigate whether the degree of intestinal inflammation and fibrosis is correlated with preoperative anti-TNF-α) therapy on the development of fibrosis is not yet fully understood. Methods This unblinded, prospective, single tertiary center, pilot cohort study included all adult patients with CD who underwent elective, laparoscopic, or open intestinal resection. Preoperative investigations included measurement of blood TNF-α) therapy on the development of fibrosis is not yet fully understood. Results Histopathological specimens from 10 patients with CD who underwent ileocecal or ileocolic resections were retrieved. Four of those patients were on anti-TNF-α) therapy on the development of fibrosis is not yet fully understood. α) therapy on the development of fibrosis is not yet fully understood. α) therapy on the development of fibrosis is not yet fully understood. p=0.01). Anti-TNF-α) therapy on the development of fibrosis is not yet fully understood. α) therapy on the development of fibrosis is not yet fully understood. α) therapy on the development of fibrosis is not yet fully understood. Conclusions Patients who underwent preoperative anti-TNF-α treatment had a higher fibrosis score than controls.α) therapy on the development of fibrosis is not yet fully understood.
Highlights
More than 50% of patients with Crohn’s disease (CD) will develop intestinal fibrosis as a result of chronic inflammation [1].Persistent and recurring tissue injury from inflammation, which is triggered and sustained by proinflammatory cytokines, leads to a continuous cycle of tissue breakdown and repair. is results in the accumulation of fibroblasts and myofibroblasts, which may lead to fibrosis as a result of extracellular matrix production [2].Clinically, strictures may occur as a result of inflammation-mediated swelling of the intestinal wall, fibrotic occlusions, or a combination of both [3]
As chronic inflammation is closely associated with fibrosis and stricture formation, and considering the key role of TNF-α in initiating the inflammatory response [5], we hypothesized that anti-TNF-α therapy may lead to reduced fibrosis
E aim of the present study was to investigate whether the degree of intestinal fibrosis, inflammation, and the number of macrophages are correlated with preoperative anti-TNF-α therapy in patients with CD undergoing bowel resection
Summary
Strictures are a common complication in Crohn’s disease (CD), found in more than 50% of patients. ey are characterized by the excessive deposition of extracellular proteins in the tissue as a result of the chronic inflammatory process. e effect of anti-tumor necrosis factor alpha (TNF-α) therapy on the development of fibrosis is not yet fully understood. Aim. To investigate whether the degree of intestinal inflammation and fibrosis is correlated with preoperative anti-TNF-α therapy in patients with CD who are undergoing bowel resection. Histopathological specimens from 10 patients with CD who underwent ileocecal or ileocolic resections were retrieved. Four of those patients were on anti-TNF-α treatment prior to surgery. Patients on anti-TNF-α treatment had a higher fibrosis score than controls (p 0.01). Ere was no significant relationship between the time from the final preoperative anti-TNF-α dose to surgery and the fibrosis score. No significant association was found between the concentration of major inflammatory cytokines, including TNF-α, and the fibrosis score or degree of inflammation. Patients who underwent preoperative anti-TNF-α treatment had a higher fibrosis score than controls
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