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".