ASGE Interventional IBD: Management of Complications | March 2022-Biological Therapy for Crohn's Disease Stricture: Friend or Foe?

Video Transcription

Video Summary

Dr. Charles Bernstein, professor of medicine and chief gastroenterologist at the University of Manitoba Medical Center, gives a talk on the role of medical therapy in managing Crohn's strictures. He discusses the debate that arose in the early 2000s regarding whether biologic therapy, such as infliximab, could worsen strictures. Dr. Bernstein explains that current evidence suggests that biologic therapy does not worsen strictures and can actually improve disease outcomes. He defines strictures as a combination of luminal narrowing, increased bowel wall thickness, and pre-stricture dilation. He emphasizes the challenge of determining the presence of active inflammation in strictures and the limited options for reversing fibrosis. Dr. Bernstein discusses several studies that demonstrate the impact of biologic therapy, particularly anti-TNF agents, on stricturing Crohn's disease. He also mentions the potential benefits of endoscopic balloon dilation and the use of anti-TNF therapy in adjunct with it. In conclusion, Dr. Bernstein highlights the need for surgery in cases of anti-TNF therapy failure and recurrent obstructions, and mentions the possibility of using TL1A, a compound currently under study, to reverse fibrosis in Crohn's disease.

Asset Subtitle

Charles Bernstein, MD

Keywords

Dr. Charles Bernstein

medical therapy

Crohn's strictures

biologic therapy

inflammation in strictures