Strictures in Inflammatory Bowel Disease

What is a stricture?

A stricture is a narrowing of a portion of the bowel caused by periods of inflammation and healing, leading to formation of scar tissue. This then causes a slowing of, or an obstruction to the intestinal flow.

Where do they occur?

They tend to be more common in people with Crohn's disease, but can occur in around 6 - 11% of patients with ulcerative colitis.

The most common site for a stricture to occur is the terminal ileum. Other sites may include the rectum and the transverse colon.

What are the symptoms?

These may be variable depending on the site of the stricture, but most often include:

• abdominal cramps
• pain after eating
• nausea and vomiting
• constipation

The presence of a stricture can be confirmed by x-rays or endoscopy.

Can it be cancerous?

Strictures are not usually cancerous but some may not easily be distinguished from cancer. Therefore it may be necessary to perform x-rays and endoscopy with biopsies.

Patients with long strictures of which adequate examination cannot be made, may be advised to undergo surgery.

How are they treated?

They may be treated either medically or surgically.

a) Medical management

If the stricture is not too narrow, a modified diet, (i.e. no coarse fibre and small, regular meals), and drug therapy may continue.

b) Surgical management

Most strictures eventually require surgical removal. This involves either cutting out the affected part and joining the two ends together or alternatively, the stricture may be improved by passing a balloon catheter through a colonoscope and dilating the narrow portion. This form of treatment depends on the site of the stricture and the absence of abnormal histology. It may have to be repeated several times on different occasions to be effective.