BACKGROUND: Some reports have suggested that infliximab may induce obstructive symptoms and, although there is no firm evidence, it is usually contra-indicated in-patients with Crohn's disease (CD) and strictures. AIMS: To evaluate the effect of infliximab on symptomatic strictures of the small intestine in CD and to identify predictive factors of clinical response. METHODS: This retrospective study included symptomatic patients treated with infliximab after conventional treatment had failed. The short-term (week 8) and long-term results were classified according to predefined criteria as complete, partial response, or failure. RESULTS: Before infliximab, 18 patients had complete obstruction or intermittent chronic abdominal pain. Fourteen patients were treated by corticosteroids and 13 received immunosuppressive drugs. At week 8, complete, partial response and failure were observed in 10, 7 and 1 patients, respectively. Fourteen patients continued maintenance infliximab treatment after week 8. During the most recent evaluation (median follow-up: 18 months), 8 patients were on maintenance infliximab treatment; only eight were still on prednisone; there were five complete responses, 10 partial responses and three failures. Initiating prednisone or increasing its dosage was the only factor associated with a short-term complete response. CONCLUSIONS: Infliximab may be effective in patients with symptomatic strictures from CD, and should be tested before considering surgery.
BACKGROUND: Some reports have suggested that infliximab may induce obstructive symptoms and, although there is no firm evidence, it is usually contra-indicated in-patients with Crohn's disease (CD) and strictures. AIMS: To evaluate the effect of infliximab on symptomatic strictures of the small intestine in CD and to identify predictive factors of clinical response. METHODS: This retrospective study included symptomatic patients treated with infliximab after conventional treatment had failed. The short-term (week 8) and long-term results were classified according to predefined criteria as complete, partial response, or failure. RESULTS: Before infliximab, 18 patients had complete obstruction or intermittent chronic abdominal pain. Fourteen patients were treated by corticosteroids and 13 received immunosuppressive drugs. At week 8, complete, partial response and failure were observed in 10, 7 and 1 patients, respectively. Fourteen patients continued maintenance infliximab treatment after week 8. During the most recent evaluation (median follow-up: 18 months), 8 patients were on maintenance infliximab treatment; only eight were still on prednisone; there were five complete responses, 10 partial responses and three failures. Initiating prednisone or increasing its dosage was the only factor associated with a short-term complete response. CONCLUSIONS:Infliximab may be effective in patients with symptomatic strictures from CD, and should be tested before considering surgery.
Authors: Cécile Campos; Antoine Perrey; Céline Lambert; Bruno Pereira; Marion Goutte; Anne Dubois; Felix Goutorbe; Michel Dapoigny; Gilles Bommelaer; Constance Hordonneau; Anthony Buisson Journal: Dig Dis Sci Date: 2017-04-11 Impact factor: 3.199
Authors: Bethany A Reutemann; Joshua A Turkeltaub; Mahmoud Al-Hawary; Akbar K Waljee; Peter D R Higgins; Ryan W Stidham Journal: Inflamm Bowel Dis Date: 2017-10 Impact factor: 5.325
Authors: Heiko De Schepper; Elisabeth Macken; Veerle Van Marck; Maarten Spinhoven; Paul Pelckmans; Tom Moreels Journal: World J Gastroenterol Date: 2013-03-14 Impact factor: 5.742
Authors: Nicola de'Angelis; Maria Clotilde Carra; Osvaldo Borrelli; Barbara Bizzarri; Francesca Vincenzi; Fabiola Fornaroli; Giuseppina De Caro; Gian Luigi de'Angelis Journal: World J Gastroenterol Date: 2013-05-07 Impact factor: 5.742