Intestinal strictures and Crohn's disease

What is an intestinal stricture?

Intestinal strictures are essentially narrowings in the intestine which can make it difficult for food matter to pass through.

Strictures can be mild or severe and in the most severe cases can lead to a complete blockage, meaning no food or fluid can pass through that part of your intestine. If this happens emergency surgery is needed to allow free passage for food and drink again.

How do you get a stricture?

Strictures tend to happen more commonly in Crohn’s disease, although strictures can occasionally occur in people who have ulcerative colitis.

Strictures happen when scar tissue builds in the wall of the large or small intestine. This scar tissue occurs as a result of long periods of inflammation caused by Crohn’s disease. The inflammation can cause damage which when it then repairs leads to scar tissue. The building up of scar tissue in the same place can then cause strictures. If there is also swollen (inflamed) tissue in the area it can contribute to the narrowing.

What are the symptoms of a stricture?

If you have a mild stricture you may not experience any symptoms if it is not slowing down or stopping the passage of food.

If a stricture does slow down food you may experience:

  • Abdominal pain
  • Abdominal cramps
  • Bloating

If the stricture causes a full or near blockage then food and liquid may not be able to pass through at all. In these cases you may experience:

  • Severe abdominal pain
  • Abdominal bloating or distending
  • Nausea
  • Vomiting
  • Inability to pass stools

If you are experiencing these symptoms then you should go to hospital immediately.

How are strictures diagnosed?

If a stricture is suspected then the following tests may be used to diagnose it:

  • X-ray - you may be asked to swallow barium, or have it inserted into your colon in the form of an enema. This coats the lining of the intestine and shows up on an x-ray, showing any strictures
  • Endoscopy - if a stricture is suspected in your small intestine you may be given an upper gastrointestinal endoscopy (gastroscopy) or if it is suspected in your large intestine you may be given a colonoscopy. In an endoscopy the inside of your digestive system is examined using a tool called an endoscope - a long, thin, flexible tube with a camera at the end which is inserted into your digestive system either through your mouth or anus

How are strictures treated?

The treatment for intestinal strictures depends on the severity of the narrowing and what the cause is thought to be.

If the stricture is mild and swollen tissue is a contributing factor then the treatment may be to try to reduce inflammation through medication, while making changes to diet by avoiding high fibre foods which may be harder to pass through. Chewing food well before swallowing and blending food may also be suggested.

For moderate strictures which can be viewed using an endoscope the treatment may be to stretch the intestine during an endoscopy. During the treatment a balloon is used at the end of the endoscope to stretch the section of intestine. This is known as endoscopic balloon dilation. If this procedure doesn’t work, or doesn’t last long after being done, then surgery may be required.

Where surgery is required a strictureplasty or resection may be carried out.

  • Stricutreplasty - The damaged section/s of bowel are cut open and reshaped. How this is done will depend on the size of the stricture but generally the damaged section of the intestine is cut crossways and then reshaped by sewing it up in the opposite direction
  • Resection - the damaged section/s of the bowel are completely removed and the healthy ends are sewn back together

Strictureplasty procedures and resections are the two most common types of surgery carried out on people with Crohn’s disease.

Is there anything else I should know about strictures?

  • Strictures can lead to perforation of the bowel. When the bowel is moving food through the digestive system it contracts. If it has to work harder (stronger contractions) to push food through a narrowing then an increase in pressure may happen. This pressure can cause the bowel wall to weaken which may lead to it rupturing (perforation)

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