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Histopathology of Intestinal Fibrosis

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Fibrostenotic Inflammatory Bowel Disease

Abstract

Fibrostenotic inflammatory bowel disease classically refers to Crohn’s disease, where stricture and submucosal fibrosis are frequent and defining histopathologic features. Descriptions of histologic fibrosis in ulcerative colitis have existed for over half a century, but are not currently part of the clinical diagnostic framework. Histologic scoring systems for fibrosis in inflammatory bowel disease are varied and highlight the need for improved histopathologic correlation, given recent advances in our understanding of the pathophysiology of intestinal fibrosis.

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References

  1. Koukoulis G, Ke Y, Henley JD, Cummings OW. Obliterative muscularization of the small bowel submucosa in Crohn disease: a possible mechanism of small bowel obstruction. Arch Pathol Lab Med. 2001;125(10):1331–4.

    PubMed  CAS  Google Scholar 

  2. Zhang X, Ko H-BM, Cai Z, Zhu H, Polydorides AD, Torres J, et al. Fibromuscular strictures in Ileal Crohn’s disease: a detailed morphometric and Histopathologic analysis. Mod Pathol. 2017;30(S2):209A–10A.

    Google Scholar 

  3. Burke JP, Mulsow JJ, O’Keane C, Docherty NG, Watson RW, O’Connell PR. Fibrogenesis in Crohn’s disease. Am J Gastroenterol. 2007;102(2):439–48.

    Article  CAS  PubMed  Google Scholar 

  4. Rieder F, Brenmoehl J, Leeb S, Scholmerich J, Rogler G. Wound healing and fibrosis in intestinal disease. Gut. 2007;56(1):130–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Rieder F, Fiocchi C. Intestinal fibrosis in IBD—a dynamic, multifactorial process. Nature Rev. 2009;6(4):228–35.

    CAS  Google Scholar 

  6. Scales BS, Huffnagle GB. The microbiome in wound repair and tissue fibrosis. J Pathol. 2013;229(2):323–31.

    Article  CAS  PubMed  Google Scholar 

  7. Burke JP, Cunningham MF, Watson RW, Docherty NG, Coffey JC, O’Connell PR. Bacterial lipopolysaccharide promotes profibrotic activation of intestinal fibroblasts. Br J Surg. 2010;97(7):1126–34.

    Article  CAS  PubMed  Google Scholar 

  8. Gumaste V, Sachar DB, Greenstein AJ. Benign and malignant colorectal strictures in ulcerative colitis. Gut. 1992;33(7):938–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. De Dombal FT, Watts JM, Watkinson G, Goligher JC. Local complications of ulcerative colitis: stricture, pseudopolyposis, and carcinoma of colon and rectum. Br Med J. 1966;1(5501):1442–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hunt RH, Teague RH, Swarbrick ET, Williams CB. Colonoscopy in management of colonic strictures. Br Med J. 1975;3(5979):360–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Goulston SJ, McGovern VJ. The nature of benign strictures in ulcerative colitis. N Engl J Med. 1969;281(6):290–5.

    Article  CAS  PubMed  Google Scholar 

  12. Edwards FC, Truelove SC. The course and prognosis of ulcerative colitis. Gut. 1964;5:1–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Gore RM. Colonic contour changes in chronic ulcerative colitis: reappraisal of some old concepts. AJR Am J Roentgenol. 1992;158(1):59–61.

    Article  CAS  PubMed  Google Scholar 

  14. Gordon IO, Agrawal N, Goldblum JR, Fiocchi C, Rieder F. Fibrosis in ulcerative colitis: mechanisms, features, and consequences of a neglected problem. Inflamm Bowel Dis. 2014;20(11):2198–206.

    Article  PubMed  Google Scholar 

  15. Mitomi H, Okayasu I, Bronner MP, Kanazawa H, Nishiyama Y, Otani Y, et al. Comparative histologic assessment of proctocolectomy specimens from Japanese and American patients with ulcerative colitis with or without dysplasia. Int J Surg Pathol. 2005;13(3):259–65.

    Article  PubMed  Google Scholar 

  16. Warren S, Sommers SC. Pathogenesis of ulcerative colitis. Am J Pathol. 1949;25(4):657–79.

    PubMed  PubMed Central  CAS  Google Scholar 

  17. Lumb G. Pathology of ulcerative colitis. Gastroenterology. 1961;40:290–8.

    PubMed  CAS  Google Scholar 

  18. Lumb G, Protheroe RH. Ulcerative colitis; a pathologic study of 152 surgical specimens. Gastroenterology. 1958;34(3):381–407.

    PubMed  CAS  Google Scholar 

  19. Jones MK, Tomikawa M, Mohajer B, Tarnawski AS. Gastrointestinal mucosal regeneration: role of growth factors. Front Biosci. 1999;4:D303–9.

    Article  CAS  PubMed  Google Scholar 

  20. Dammeier J, Brauchle M, Falk W, Grotendorst GR, Werner S. Connective tissue growth factor: a novel regulator of mucosal repair and fibrosis in inflammatory bowel disease? Int J Biochem Cell Biol. 1998;30(8):909–22.

    Article  CAS  PubMed  Google Scholar 

  21. Willis E, Lopez R, Agrawal N, Rieder F, Gordon I. Alterations in lamina propria and muscularis mucosa in ulcerative colitis are associated with prior medication and degree of histologic inflammatory activity. Mod Pathol. 2017;30(S2):206A.

    Google Scholar 

  22. Gordon IO, Agrawal N, Willis E, Goldblum JR, Lopez R, Allende D, Liu X, Patil DY, Yerian L, El-Khider F, Fiocchi C, Rieder F. Fibrosis in ulcerative colitis is directly linked to severity and chronicity of mucosal inflammation. Aliment Pharmacol Ther. 2018;47(7):922–39.

    Article  CAS  PubMed  Google Scholar 

  23. Higgins PD. Measurement of fibrosis in Crohn’s disease strictures with imaging and blood biomarkers to inform clinical decisions. Dig Dis. 2017;35(1–2):32–7.

    Article  PubMed  Google Scholar 

  24. Theiss AL, Fuller CR, Simmons JG, Liu B, Sartor RB, Lund PK. Growth hormone reduces the severity of fibrosis associated with chronic intestinal inflammation. Gastroenterology. 2005;129(1):204–19.

    Article  CAS  PubMed  Google Scholar 

  25. Higgins PD, Johnson LA, Sauder K, Moons D, Blanco L, Taube S, et al. Transient or persistent norovirus infection does not alter the pathology of salmonella typhimurium induced intestinal inflammation and fibrosis in mice. Comp Immunol Microbiol Infect Dis. 2011;34(3):247–57.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Adler J, Punglia DR, Dillman JR, Polydorides AD, Dave M, Al-Hawary MM, et al. Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn’s disease. Inflamm Bowel Dis. 2012;18(5):849–56.

    Article  PubMed  Google Scholar 

  27. Maconi G, Carsana L, Fociani P, Sampietro GM, Ardizzone S, Cristaldi M, et al. Small bowel stenosis in Crohn’s disease: clinical, biochemical and ultrasonographic evaluation of histological features. Aliment Pharmacol Ther. 2003;18(7):749–56.

    Article  CAS  PubMed  Google Scholar 

  28. Chiorean MV, Sandrasegaran K, Saxena R, Maglinte DD, Nakeeb A, Johnson CS. Correlation of CT enteroclysis with surgical pathology in Crohn’s disease. Am J Gastroenterol. 2007;102(11):2541–50.

    Article  PubMed  Google Scholar 

  29. Dillman JR, Stidham RW, Higgins PD, Moons DS, Johnson LA, Keshavarzi NR, et al. Ultrasound shear wave elastography helps discriminate low-grade from high-grade bowel wall fibrosis in ex vivo human intestinal specimens. J Ultrasound Med. 2014;33(12):2115–23.

    Article  PubMed  Google Scholar 

  30. Fazio VW, Marchetti F, Church M, Goldblum JR, Lavery C, Hull TL, et al. Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. A randomized controlled trial. Ann Surg. 1996;224(4):563–71. Discussion 71–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kotanagi H, Kramer K, Fazio VW, Petras RE. Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn’s disease? Retrospective analysis of 100 cases. Dis Colon Rectum. 1991;34(10):909–16.

    Article  CAS  PubMed  Google Scholar 

  32. de Bruyn JR, Meijer SL, Wildenberg ME, Bemelman WA, van den Brink GR, D’Haens GR. Development of fibrosis in acute and longstanding ulcerative colitis. J Crohns Colitis. 2015;9(11):966–72.

    Article  PubMed  Google Scholar 

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Correspondence to Ilyssa O. Gordon .

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Gordon, I.O. (2018). Histopathology of Intestinal Fibrosis. In: Rieder, F. (eds) Fibrostenotic Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-90578-5_11

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  • DOI: https://doi.org/10.1007/978-3-319-90578-5_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90577-8

  • Online ISBN: 978-3-319-90578-5

  • eBook Packages: MedicineMedicine (R0)

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