Management of Strictures in Crohn's Disease: Surgery Versus Medical Treatment

Abstract

Introduction: Crohn's disease (CD) is a chronic inflammatory affection of the digestive tract that progresses towards intestinal destruction leading to a stenosing form, and the management of these stenoses is often multidisciplinary, medico-surgical. In the light of the data in the literature, we will study the efficacy of medical treatment and the place of surgery in the management of strictures in crohn's disease. Materials and Methods: This is a retrospective descriptive study over a 5-year period, including all patients with stenotic phenotype Crohn's Disease who are followed in our departement. Results: We included 109 patients with stenotic phenotype crohn's disease. The mean age of our patients was 43 years, there were 70 women and 39 men, with a sex ratio of 1.8. In terms of therapeutic management, 71 patients (65% of the total) received medical treatment as first-line therapy, including 22 patients (20.2%) who received corticosteroids first. Disease-modifying therapy was based on immunosuppressants in 45 patients (41.3%), and 26 patients (23.8%) received anti-TNF in mono or combination therapy. Progression was marked by a good therapeutic response without recourse to surgery in 35 patients (32% of all patients), while 36 patients (33%) did not respond and underwent surgery after failure of medical treatment. 38 patients (35%) underwent surgical treatment in the first instance, post-operative disease-modifying therapy consisted of Anti TNF, in mon or combination therapy, in 16 patients, immunosuppressive therapy in 20, while two patients remained clinically and endoscopically quiescent on no disease-modifying therapy. Discussion: In the absence of symptoms, simple monitoring is required, and consequently no treatment is recommended. But in the case of symptomatic stenosis, the management of small bowel stenosis depends on the intensity of occlusive symptoms, the association with immunosuppressive therapy and morphological criteria assessed ............