Stricture-Related Resections Rising in Crohn’s Disease Despite Overall Decline in Surgical Rates
A nationwide analysis reveals that while overall bowel resection rates in Crohn’s disease (CD) have declined during the biologics era, resections specifically for obstructive indications are on the rise. The findings, based on data from the Nationwide Inpatient Sample between 1998 and 2020, suggest that current medical therapies may have limited impact on the progression of stricturing CD.
Researchers aimed to assess longitudinal trends in CD-related bowel surgeries, particularly for obstruction, following the introduction of infliximab in 1998 by identifying hospitalizations for CD with bowel resection for obstruction and analyzed trends over 2 decades.
Between 1998 and 2020, the proportion of hospitalizations involving any CD-related resection decreased markedly—from 12.0% to 6.9%. In contrast, hospitalizations involving bowel resection specifically for obstruction increased from 1.3% to 2.0%. Most notably, resections for obstruction now account for a much larger share of all CD-related resections, rising from 10.8% in 1998 to 29.1% in 2020.
These patterns were consistent regardless of whether admissions were elective or nonelective. In multivariable models, advancing year was independently associated with a higher likelihood of undergoing resection for obstruction. For elective admissions, the odds ratio was 1.06 (95% CI, 1.04–1.08); for nonelective admissions, the odds ratio was 1.01 (95% CI, 1.00–1.02).
“Our findings highlight the effect of medical therapy on surgical rates overall but suggest limited impact of current medical therapy on need of resection for stricturing disease,” the authors reported.
The results underscore a key clinical insight for gastroenterologists: although biologic therapies have improved the overall management of inflammatory CD and reduced the frequency of surgeries, they appear less effective in preventing fibrotic complications that lead to obstruction. This shift has implications for long-term care planning and surgical consultation. As strictures emerge as a growing surgical indication, clinicians should remain vigilant in monitoring disease phenotype and progression despite apparent symptom control.
The authors concluded that the data call for renewed focus on therapeutic strategies that can address fibrotic pathways and stricturing complications in CD. Until such options are available, earlier identification and management of strictures may be necessary to reduce the growing burden of obstruction-related surgery.
Reference
Fansiwala K, Spartz EJ, Roney AR, et al. Increasing rates of bowel resection surgery for stricturing crohn's disease in the biologic era. Inflamm Bowel Dis. 2025;31(4):935-943. doi:10.1093/ibd/izae113
