Crohn’s disease is a chronic inflammatory condition that can develop in any part of the gastrointestinal (GI) tract. The symptoms are usually manageable, but this condition can cause complications, such as intestinal strictures.

In most cases, Crohn’s disease affects the small intestine and the first section of the large intestine. It causes inflammation, which can lead to swelling of the intestinal walls, making it harder for food to pass through. This narrowing is called a stricture, and it is a common complication of Crohn’s disease.

However, Crohn’s disease is just one of several health conditions and factors that can lead to intestinal strictures.

Keep reading to learn more about how strictures form, which symptoms they cause, and the treatment options.

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Crohn’s disease causes chronic inflammation in the GI tract, which begins at the mouth and ends at the anus. The inflammation often develops in the small intestine and first part of the large intestine.

Within the first 10 years of receiving a Crohn’s disease diagnosis, nearly 40% of people develop an intestinal stricture.

Researchers have identified two main types of intestinal stricture: inflammatory and fibrotic. Inflammatory strictures develop when inflammation from Crohn’s disease causes swelling, or edema, in the cells that line the intestines.

Fibrotic strictures develop when scar tissue builds up in the intestines after prolonged inflammation. The accumulation of scar tissue narrows the intestines, which restricts the passage of stool. Also, some people have mixed-type strictures that result from both current inflammation and fibrosis.

Although inflammation plays a role in each type of stricture, inflammatory and fibrotic strictures respond to different treatments.

Prolonged exposure to inflammation can change the structure of the intestinal lining, resulting in the accumulation of scar tissue, collagen, and other fibrous material.

The buildup of these materials causes the intestinal walls to thicken, which reduces the space inside the intestines, making it harder for stool to pass.

A variety of symptoms can result from an intestinal stricture. What a person experiences depends on the severity of the issue.

Mild or moderate strictures can cause:

  • discomfort or pain in the abdomen
  • excess gas or bloating
  • decreased appetite
  • low energy

A severe intestinal stricture can cause:

  • intense abdominal pain
  • bloating or swelling of the abdomen
  • constipation
  • vomiting

Most strictures occur in the small intestine, an area that a doctor cannot view with traditional endoscopy.

Instead, doctors perform a minimally invasive procedure called endoscopic balloon dilation, which allows them to see the inside of the small intestine, identify strictures, and treat blockages and mild strictures in the short term.

During the procedure, a doctor guides a catheter with a small, inflatable balloon on the end through the intestines. Once the catheter reaches an intestinal stricture, the doctor inflates the balloon, opening up that area of the intestine.

Doctors can also use other imaging techniques, such as CT and MRI scans, to help diagnose an intestinal stricture. Another option is an X-ray examination of the small intestine, which is called a “small bowel series.”

The best approach to treating a stricture depends on its cause.

Inflammatory strictures

A healthcare professional may use corticosteroids to reduce inflammation in the area. This may be a temporary measure before they prescribe a biologic drug. These drugs affect the immune system in a way that aims to achieve and maintain remission of the issue.

A compound called tumor necrosis factor-alpha (TNF-alpha) can cause inflammation in the body. Biologic medications that target TNF-alpha can help manage the inflammation, preventing new strictures from forming.

A doctor may recommend one of the following biologic drugs. The first three target TNF-alpha.

It is important to discuss all the treatment options and their possible side effects with the doctor.

Fibrotic strictures

Fibrotic strictures do not respond to anti-inflammatory treatments.

Doctors can treat existing fibrotic strictures with endoscopic balloon dilation. This has short-term results, but approximately 50% of people need to have the procedure again or surgery in the future.

Anyone who has a severe stricture or one in an area that an endoscope cannot reach may need surgery. Doctors often reserve this for people who continue to have symptoms of bowel obstruction after undergoing less invasive treatments.

People who develop severe complications of bowel obstruction, such as restricted blood flow, infection, or bowel perforation, may also need surgery.

The following can increase the risk of experiencing intestinal strictures:

  • undergoing multiple surgeries in the abdominal or pelvic area
  • having Crohn’s disease or another type of inflammatory bowel disease
  • receiving steroid treatment during the first Crohn’s disease flare-up
  • having a perianal illness — one that affects the anus or the area around it — at the time when Crohn’s disease is diagnosed
  • smoking or formerly smoking

Inflammation from Crohn’s disease is one of several factors that can lead to swelling or scarring in the intestinal walls. This damage can result in intestinal strictures.

A stricture is a narrowing of the intestines, which can restrict the passage of food and waste through the area, causing uncomfortable symptoms.

A combination of treatments can help alleviate the symptoms and reduce the risk of new strictures forming. When strictures are severe and other approaches are ineffective, a doctor may recommend surgery.