Management of Crohn's disease of the heoanal pouch with infliximab

被引:114
作者
Colombel, JF
Ricart, E
Loftus, EV
Tremaine, WJ
Young-Fadok, T
Dozois, EJ
Wolff, BG
Devine, R
Pemberton, JH
Sandborn, WJ
机构
[1] Mayo Clin, Div Gastroenterol & Hepatol, Rochester, MN 55905 USA
[2] Mayo Clin, Div Colorectal Surg, Rochester, MN 55905 USA
关键词
D O I
10.1016/S0002-9270(03)00660-9
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
OBJECTIVES: The occurrence of Crohn's disease (CD) in a patient with an ileal-pouch anstomosis (IPAA) often results in severe morbidity and significant chance of reservoir loss. We report our experience of the use of infliximab in these patients. METHODS: Medical records of 26 patients with an IPAA and CD-related complications were reviewed. The median time between the IPAA and the diagnosis of CD was 4.5 yr (range 0.1-16 yr). The main reasons for changing the original ulcerative colitis diagnosis to CD were complex perianal or pouch fistulizing disease in 14 patients (54%), prepouch ileitis in five (19%), and both prepouch ileitis and complex fistula in seven (27%). Patients received one to three doses of infliximab over 8 wk as induction therapy. Subsequently the patients received a variable number of maintenance infusions. RESULTS: At a short term follow-up, 16/26 patients (62%) had a complete response, six of 26 (23%) had a partial response, and four of 26 (15%) had no response. Information regarding long term follow-up was available in 24 patients. After a median follow-up of 21.5 months (range 3-44 months), eight patients (33%) either had their pouch resected or had a persistent diverting ileostomy. The pouch was functional in 16/24 (67%) patients, with either good (n = 7) or acceptable (n = 7) clinical results in 14/24 (58%). Of those 14 patients, 11 were under long term, on demand, or systematic maintenance treatment with infliximab. CONCLUSIONS: Infliximab is beneficial in both the short and long term treatment of patients with an IPAA performed for a presumed diagnosis of ulcerative colitis who subsequently develop CD-related complications. Good pouch function requires long term treatment with infliximab in most patients.
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页码:2239 / 2244
页数:6
相关论文
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