As stated, both diseases are uncommon, yet the number of reported patients presenting with these diseases remains very rare. We argue that this fact might result in an underdiagnosis, which in turn causes the lack of efficient treatment and a large number of patients suffering from the disease. In summary, the number of reported patients may be underestimated because of an lack of standard investigations and procedures.
Crohn´s disease and intestinal tuberculosis have been linked to both diseases causing the intestinal fibrosis which leads to the stenosis of small intestine. There are many theories proposing etiology. In our country the tuberculosis-Crohn´s disease connection is not well known. The authors of the study suggest to perform further research to identify the etiological factors.
A high level of iga and irofuzam and a decreased level of iota are the most specific and sensitive lab results in Crohn's disease with an enterocutane-type localization.
In active cases of Crohn´s disease with colon involvement, surgical resection is always the preferred treatment. For refractory cases, a number of endoscopic or surgical techniques can be offered such as conventional surgical resection, endoscopic mucosectomy, or surgical strictureplasty.
Despite a high rate of fibrostenotic disease in patients with Crohn's disease in the United States, the numbers of patients newly diagnosed are decreasing. This could be attributable to earlier detection and improved medical knowledge among patients. In addition to continuing to educate patients about Crohn's disease and increase the awareness of fibrostenotic Crohn's disease, studies of more effective treatment algorithms could also be helpful.
Stricturing, fistulizing and abscessing Crohn´s disease does not have to be necessarily fatal. Some patients with a surgically treated disease can be spared from having surgery for a considerable time, and be still in a good condition at last examination, with the effect of avoiding surgery.
There are no differences between the average disease onset age of IBD patients suffering from CD compared with fibrostenotic CD; both are diagnosed in the age of 30 years.
The most important side effect of spesolimab is an increase in infectious disease and death. The rate is extremely low and should be treated as an emergency. There is a significant risk that a new infectious disease may be caused by spesolimab treatment. The risk is highest in patients and the elderly.
The data presented here show that spesolumab reduces relapse rates, reduces the amount of inflamed bowel, and improves symptoms in patients with Crohn´s disease. It may be an effective alternative treatment for this patient group, therefore, the use of spesolumab in Crohn´s disease treatment could be considered for patients that are not fit for surgery and surgery.
Although in our study we used an objective validated score, our results were less conclusive. Moreover, there was a small bias of doctors' preferences towards the drugs in patients with fistulizing disease. In the future, we should focus on studies including patients presenting with mixed phenotype.
The current treatment for FSCD is based on the presumed underlying mechanism of the disease, i.e. increased production of TNFα, the blocking of which seems to be a possible therapeutic option.
There was no significant difference in the prevalence of primary location, the disease phenotype, or fecal calprotectin levels in patients with stricturing Crohn´s disease and those with non-stricturing disease; however, the median fecal calprotectin levels were higher in the stricturing group compared to the non-stricturing group.