J Pathol Transl Med.  2023 Jan;57(1):60-66. 10.4132/jptm.2022.11.02.

Inflammatory bowel disease–associated intestinal fibrosis

• Park JM
• Kim J
• Lee YJ
• Bae SU
• Lee HW

• KMID: 2539037
• DOI: http://doi.org/10.4132/jptm.2022.11.02

Abstract

Fibrosis is characterized by a proliferation of fibroblasts and excessive extracellular matrix following chronic inflammation, and this replacement of organ tissue with fibrotic tissue causes a loss of function. Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract, and intestinal fibrosis is common in IBD patients, resulting in several complications that require surgery, such as a stricture or penetration. This review describes the pathogenesis and various factors involved in intestinal fibrosis in IBD, including cytokines, growth factors, epithelial-mesenchymal and endothelial-mesenchymal transitions, and gut microbiota. Furthermore, histopathologic findings and scoring systems used for stenosis in IBD are discussed, and differences in the fibrosis patterns of ulcerative colitis and Crohn’s disease are compared. Biomarkers and therapeutic agents targeting intestinal fibrosis are briefly mentioned at the end.

Keyword

Fibrosis; Inflammatory bowel disease; Crohn disease; Colitis; ulcerative

Figure

• 

  Fig. 1 Gross finding of resected large intestine specimen of 30-year-old patient with Crohn’s disease. Creeping fat covers more than 50% of the intestinal circumference surface with mesenteric proliferation. Cobblestone mucosa and proper muscle hyperplasia that result in intestinal stricture are also noted.

• 

  Fig. 2 Histologic findings of Crohn’s disease. (A) Hypertrophy and hyperplasia of the submucosa and muscularis propria are present. (B) Chronic inflammation with lymphoid aggregates and lymphoid follicles is dominant. (C) Although chronic inflammation is predominant, active inflammation that consists of extensive neutrophilic infiltrates is also noted. (D) Fibromuscular hyperplasia of damaged submucosal vessels causes slow blood flow. (E) Neural hypertrophy is also noted. (F) Trichrome stain reveals that dissection between the hyperplastic smooth muscle bundles is interspersed with fibrosis.

Reference

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