Dilatation of Gastrointestinal Strictures – With a Focus on Crohn’s Disease

Written by A/Prof Viraj Kariyawasam, Gastroenterologist

1. What Are Gastrointestinal Strictures?

A gastrointestinal stricture is a narrowing of the digestive tract that restricts the passage of food, fluid, or stool. Strictures develop when inflammation, scarring (fibrosis), or tissue damage causes the bowel wall to thicken and lose flexibility.

Strictures can occur anywhere along the gastrointestinal tract, including the oesophagus, stomach outlet, small bowel, and colon. The impact on symptoms depends on the location and severity of the narrowing.

2. Why Do Strictures Occur in Crohn’s Disease?

Crohn’s disease is a chronic inflammatory condition that can affect the full thickness of the bowel wall. Repeated or ongoing inflammation can lead to healing with scar tissue, resulting in fixed narrowing of the bowel.

Crohn’s-related strictures may be predominantly inflammatory, predominantly fibrotic, or a combination of both. This distinction is important because inflammatory strictures may respond to medical therapy, whereas fibrotic strictures usually require endoscopic or surgical treatment.

3. Symptoms of Crohn’s-Related Strictures

Symptoms vary depending on the site and length of the stricture.

Common symptoms include abdominal pain, bloating, nausea, vomiting, early fullness, constipation, alternating bowel habits, and symptoms of partial or complete bowel obstruction. Symptoms may worsen after meals and can fluctuate over time.

4. How Are Strictures Assessed?

Assessment of strictures in Crohn’s disease involves a combination of clinical evaluation, imaging, and endoscopic assessment.

Investigations may include colonoscopy, gastroscopy, CT or MR enterography, and blood or stool tests to assess inflammation. These tests help determine the location, length, and severity of the stricture, and whether active inflammation is present.

5. What Is Endoscopic Dilatation?

Endoscopic dilatation is a minimally invasive procedure used to widen a narrowed segment of bowel. It is most commonly performed using a balloon that is gently inflated within the stricture under direct vision.

Dilatation is performed gradually to reduce the risk of complications. In Crohn’s disease, it is best suited to short, accessible strictures without deep ulceration or fistulae.

6. Effectiveness of Dilatation in Crohn’s Disease

Balloon dilatation is an effective treatment for selected Crohn’s-related strictures and can significantly improve symptoms and quality of life.

Many patients experience immediate symptom relief. However, strictures may recur over time, and repeat dilatation sessions are sometimes required. Importantly, dilatation can delay or avoid the need for surgery in many patients.

7. Risks & Safety Considerations

When performed by experienced endoscopists, stricture dilatation is generally safe.

Potential risks include bleeding, perforation, and infection. The risk is higher in long, severely fibrotic strictures or when active ulceration is present. Careful patient selection and imaging review are essential.

8. Ongoing Management After Dilatation

Dilatation treats the narrowing but does not cure Crohn’s disease.

Long-term management usually includes optimisation of medical therapy to control inflammation, reduce recurrence, and prevent progression. Regular follow-up and surveillance are important to monitor symptoms and bowel health.

9. When Is Surgery Required?

Surgery may be required if strictures are long, multiple, associated with fistulae or abscesses, or if symptoms do not respond to dilatation and medical therapy.

The decision between endoscopic dilatation and surgery is individualised and made within a multidisciplinary team involving gastroenterologists, surgeons, and radiologists.

10. When to Seek Medical Advice

You should seek medical advice if you have Crohn’s disease and develop worsening abdominal pain, vomiting, bloating, or changes in bowel habits.

Urgent assessment is required for severe pain, persistent vomiting, fever, or signs of bowel obstruction.