Fibrotic strictures are one of the most severe complications of Crohn’s Disease (CD).
They occur in about 50% of patients at five years and in 70% at ten years of the diagnosis. The only
treatment available for symptomatic fibrotic strictures is surgical resection and endoscopic dilation.
Both strategies are associated with a high rate of recurrence, and with multiple surgical resections,
which pose the threat of surgical morbidity and short bowel syndrome. Therefore, it is crucial
to identify, early, the patients more prone to develop intestinal fibrosis to intensify follow-ups,
switch to more aggressive treatments, and suggest lifestyle modifications. Scarce data are available
concerning biomarkers and genetic determinants to predict which patient will develop intestinal fibrosis.
Biologic or clinical markers would be useful to determine this subgroup of CD patients and
to predict the onset of intestinal fibrosis and, ideally, its severity. Furthermore, the identification of
environmental risk factors may suggest lifestyle changes aimed at modifying the natural course,
thus decreasing the risk of complicated CD. In this review, we will critically revise clinical, environmental,
genetic, and serologic factors that have been associated with a complicated CD course
with a particular focus on the fibrostenosing phenotype and their possible implications as predictive
factors of intestinal fibrosis.