Fibrostenosis occurs in both
Crohn's disease (CD) and
ulcerative colitis (UC). Up to 21% of patients with CD present with
strictures at diagnosis, while the rate of
stenosis varies from 1% to 11% in UC. Despite the increasing use of
immunomodulators and biologics in treatment, there has been no decrease in the rate of progression from inflammatory to complicated disease phenotypes (either stricturing or penetrating). The presence of
stenosis is an independent risk factor for surgery in patients with CD, who are at a risk of postoperative recurrence at a rate of up to 55% at 10 years after surgery. Patients with
inflammatory bowel disease (IBD)
strictures are at risk of malignant transformation. Thus, surveillance colonoscopy should be offered to this group of patients. Several risk factors for the development of
stricture have been identified. In CD, patients aged less than 40-years old, with perianal disease at diagnosis, who need
steroids at the first flare up or have
ileal disease are at the risk of developing
strictures; while in UC, patients with extensive
colitis and long-standing disease are at risk. Recently, microbiota signatures have also been identified as markers for
stricture development. The presence of Ruminococcus spp. is associated with the development of
stricture in pediatric patients with CD. In this review, we highlight the epidemiology, risk factors and natural history of fibrostenosing IBD.