From the Guidelines
Conservative management of a jejunal stricture should prioritize a diet with adapted texture, or distal (post-stenosis) enteral nutrition (EN), as recommended by the ESPEN practical guideline 1. This approach is particularly relevant for patients with Crohn's disease (CD) and intestinal strictures or stenosis, where a diet with adapted texture or distal EN can help alleviate obstructive symptoms. Key considerations in conservative management include:
- Dietary modifications: A low-residue diet, avoiding high-fiber foods, nuts, seeds, and tough meats, to reduce the risk of obstructing the narrowed intestinal segment 1.
- Medications: Proton pump inhibitors, such as omeprazole or pantoprazole, to reduce gastric acid production, and anti-inflammatory agents, like prednisone or mesalamine, for inflammatory conditions 1.
- Supportive care: Adequate hydration, monitoring for signs of complete obstruction, and consideration of endoscopic balloon dilation for suitable strictures 1. It is essential to note that conservative management is most appropriate for partial strictures without complete obstruction, as complete obstructions generally require surgical intervention 1. In patients with symptomatic fibrostenotic disease and obstruction, an interventional approach, either surgical or endoscopic, may be necessary 1. The goal of conservative management is to alleviate symptoms, improve quality of life, and avoid surgical intervention whenever possible, while carefully monitoring the patient's condition and adjusting the treatment plan as needed 1.
From the Research
Conservative Management of Jejunal Stricture
The conservative management approach for a jejunal stricture involves several methods, including:
- Endoscopic balloon dilation, which is a common treatment for strictures in inflammatory bowel disease, as seen in Crohn's disease and ulcerative colitis 2
- Exclusive enteral nutritional therapy, which has been shown to relieve inflammatory bowel stricture in Crohn's disease by reducing inflammation and improving nutritional parameters 3
- Medical management of underlying conditions, such as peptic ulcer disease, which can cause gastric outlet obstruction and strictures 4
Endoscopic Balloon Dilation
Endoscopic balloon dilation is an effective treatment for gastrojejunal strictures after gastric bypass surgery, with a higher success rate for "early" strictures (those occurring within 90 days after surgery) compared to "late" strictures 5, 6
- The procedure involves using a balloon to dilate the stricture, and can be repeated if necessary
- The success of the procedure depends on the timing and location of the stricture, as well as the underlying cause
Exclusive Enteral Nutritional Therapy
Exclusive enteral nutritional therapy has been shown to be effective in relieving inflammatory bowel stricture in Crohn's disease, with improvements in symptoms, nutritional parameters, and radiologic parameters 3
- The therapy involves providing all nutritional needs through an enteral feeding tube, and can be used for a period of 12 weeks or more
- The exact mechanisms of the therapy are not fully understood, but it is thought to reduce inflammation and promote healing in the intestinal wall
Medical Management
Medical management of underlying conditions, such as peptic ulcer disease, is also an important part of conservative management for jejunal stricture 4
- This can involve the use of medications, such as proton pump inhibitors, to reduce acid production and promote healing
- In some cases, surgical intervention may be necessary to treat the underlying condition and relieve the stricture.