Role of biologics and other therapies in stricturing Crohn's disease: what have we learnt so far?

Background: Therapy of strictures, one of the most common complications of Crohn’s disease (CD), remains a challenging task in gastroenterology. While infliximab is widely recognized as being very effective in active CD, it has been reported to cause strictures in some patients. As a consequence, essentially by inference, many clinicians have chosen not to use it in the presence of strictures. Aims: To find evidence in the available data that infliximab does not cause strictures and that there is no rational basis to avoid its a priori use when a stricture is already present. In addition, to review what is currently known on the general management of strictures in CD. Methods: Discussion of the data that led to the hypothesis of a causal association between infliximab and strictures. Review of the mechanisms and the risk factors for stricture development in CD; of the different types of CDrelated strictures; of the available means to distinguish them, and of the literature related to the efficacy and safety of infliximab as well as other biologics and other therapies in different stricturing scenarios. Results and Conclusions: Although larger controlled studies are due in the near future, current evidence indicates that infliximab does not cause strictures in CD. The drug appears safe and effective in the presence of an inflammatory stenosis while being predictably ineffective, but not harmful, in the presence of fibrosis. Different stricturing scenarios in CD must be clearly distinguished for proper management of this complication.