Unlike inflammatory disease, where swelling may respond quickly to drugs, fibrostenotic changes are structural and often irreversible, making them harder to treat.
FSCD develops in more than 50% of Crohn’s patients over their lifetime. It is one of the most burdensome complications of Crohn’s, often leading to obstructive symptoms, repeated surgeries, and reduced quality of life.
Despite its prevalence, FSCD remains a major challenge in both clinical practice - where strictures can be difficult to assess and manage - and in drug development, where reliable and reproducible endpoints are lacking.
Patient-reported outcomes (PROs) can capture symptoms but often underestimate the burden of FSCD, as patients adapt diets and lifestyles to mask severity.
Endoscopy provides valuable mucosal information but offers limited insight into deeper layers of fibrosis or the functional impact of strictures.
Imaging (MRE, CTE, IUS) is already used in clinical practice to guide management - but in research and trials we face the added challenge of standardising measures across sites and correlating them with histology and outcomes.
Quantifying fibrosis is methodologically difficult. It is patchy, heterogeneous, and not directly visible on most standard clinical imaging sequences. This creates a major barrier for drug development, where regulators demand robust and reproducible measures.
The clinical burden is substantial: over 50% of Crohn’s patients develop strictures, and many ultimately require surgery, often with recurrence. Meanwhile, most current therapies are designed to control inflammation, not fibrosis - leaving a major unmet need in both clinical practice and clinical trials.
Motilent specialises in imaging FSCD and developing practical, scalable methods to capture treatment response in both trials and clinical practice.
Traditional measures such as bowel wall thickness often remain unchanged, even when symptoms improve. Motilent develops more sensitive imaging endpoints - such as disease length and volume - which offer a greater dynamic range and can be expressed as reproducible, cross-modality scores (MRE, CTE, IUS).
FSCD is not just about structure. Motility (bowel wall motion) can be readily measured with MRE and may detect changes invisible to static imaging. Peristaltic activity upstream, within, and downstream of strictures provides critical insights into disease phenotype and treatment response.
Motilent’s flagship product, GIQuant, is already being used to quantify motility and build objective endpoints. Entrolytics complements this by providing an efficient way to review and interrogate cine loops across modalities.
Several publications are in development exploring these metrics in early-phase anti-fibrotic trials, with the goal of establishing practical endpoints that can be deployed at scale.
Together, these approaches enable a multi-dimensional view of FSCD: structure, function, and patient relevance.
FSCD is highly heterogeneous. Some patients experience “fibrotic strictures” where mechanical obstruction dominates. For example, balloon dilation can dramatically improve symptoms even when there is little measurable change in bowel wall thickness, morphology, or motility. This heterogeneity poses major challenges for trials, as patient subtypes may respond very differently to therapy (ECCO p670 U. Derby & Burton).
Strictures exist on a continuum - from predominantly inflammatory to predominantly fibrotic. Imaging must reflect this complexity, helping to differentiate which patients are most likely to benefit from specific interventions.
While advanced imaging techniques and histology-based validation are being explored, they are often impractical at scale. Motilent focuses on methods that are robust, rapid, and deployable across sites in real-world settings. MRE remains the most systematic and objective option today, but ultrasound offers a powerful complementary modality - particularly for point-of-care assessment and patient follow-up.
Selecting the wrong stricture phenotype risks enrolling patients unlikely to benefit, diluting trial outcomes. Imaging endpoints that capture both structure and function can help Sponsors stratify patients more effectively and design studies that reflect the underlying biology of FSCD.
Patients with FSCD often face a lifetime of recurrent obstructive symptoms, dietary restriction, hospitalisations, and multiple surgeries. The unpredictability of strictures - sudden blockages, pain, and fear of recurrence - creates a significant burden on quality of life.
Currently, regulators only recognise PROs in this space. Yet many patients learn to “cope” by modifying diet or behaviour, masking the true impact of their disease. This gap highlights the importance of finding more meaningful ways to capture the patient experience.
Beyond personal impact, FSCD drives substantial health-economic burden: high rates of hospital admissions, surgical interventions, and repeat procedures. These costs add urgency to the search for better diagnostic and therapeutic strategies.
Motilent is addressing this not only through imaging but also by supporting patient engagement and education via IBDrelief and IBDmate. Patient-facing resources improve understanding, help patients feel more in control, and can also support clinical trial recruitment and retention - ensuring patients are better informed and more engaged throughout the study process.
Example study:
In an early-phase study, the Sponsor aimed to identify patients with a history of obstructive disease, combining:
Motilent’s imaging solutions were integrated to help standardise how strictures were identified, measured, and tracked. This approach provided both the Sponsor and investigators with reproducible metrics to inform eligibility, disease monitoring, and treatment response.
Motilent’s work in fibrostenotic Crohn’s is supported by a growing body of peer-reviewed research and collaborative studies.
Motilent actively collaborates with clinical partners to validate these imaging approaches, with several publications in progress.
Motilent partners with pharma, CROs, and clinical teams to deliver imaging endpoints that make FSCD trials more robust, reproducible, and patient-relevant.
Let’s talk about how Motilent can support your study or clinical programme.