Efficacy of anti-TNFα drugs in patients with stricturing Crohn's disease

Introduction: Half of Crohn's disease patients develop stenosis around 20 years after the disease onset. For a long time, surgery has been the only therapeutic approach for strictures. The introduction of anti-TNF alpha could be revolutionary in the management of these patients due to their potential role in stenoses' treatment. The aim of our work was to summarize efficacy data of anti-TNF alpha drugs in stricturing CD patients. Areas covered: Several case series and observational studies have shown that infliximab and adalimumab are effective in determining improvement and remission of stenosis in CD patients in both clinical trials and clinical practice. The injection of intralesional infliximab could be a valid alternative in patients not responding to systemic therapy. Expert opinion: Despite the promising literature data, the low level of evidence and the heterogeneity of the available studies do not allow to draw definitive conclusions on the use of TNF alpha inhibitors for the treatment of strictures. Further prospective randomized studies are needed to confirm and validate this therapeutic approach.