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 21 May 2018

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News

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

Infliximab is beneficial in patients with an ileal-pouch anstomosis performed for a presumed diagnosis of ulcerative colitis, find physicians in the latest issue of the American Journal of Gastroenterology.

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Crohn's disease (CD) in patients with an ileal-pouch anstomosis (IPAA) may result in severe morbidity and significant chance of reservoir loss.

In this study, physicians from the United States report their experience using infliximab in these patients.
62% of patients had a complete response.
American Journal of Gastroenterology

The team reviewed the medical records of 26 patients with an IPAA and CD-related complications.

Reasons for changing the original diagnosis of ulcerative colitis to CD included complex perianal or pouch fistulizing disease (54%), prepouch ileitis (19%), and both prepouch ileitis and complex fistula (27%).

Patients received 1 to 3 doses of infliximab over 8 weeks. This was followed by a variable number of maintenance infusions.

At a short term follow-up, the physicians found that 62% of patients had a complete response, 23% a partial response, and 15% no response.

At a median follow-up of 21.5 months 33% had their pouch resected or had a persistent diverting ileostomy.

The pouch was functional in 67% of patients, with good or acceptable clinical results in 58%.

Dr Jean-Frederic Colombel's team concluded, "Infliximab is beneficial in…[the] 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".

Am J Gastroenterol 2003; 98(10): 2239-44
22 October 2003

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