Management of Crohn's Disease of the Ileoanal Pouch With Infliximab

Jean Frederic Colombel, Elena Ricart, Edward V. Loftus, William J. Tremaine, Tonia Young-Fadok, Eric J. Dozois, Bruce G. Wolff, Richard Devine, John H. Pemberton, William J. Sandborn

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125 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2239-2244
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume98
Issue number10
DOIs
StatePublished - Oct 2003

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ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Colombel, J. F., Ricart, E., Loftus, E. V., Tremaine, W. J., Young-Fadok, T., Dozois, E. J., Wolff, B. G., Devine, R., Pemberton, J. H., & Sandborn, W. J. (2003). Management of Crohn's Disease of the Ileoanal Pouch With Infliximab. American Journal of Gastroenterology, 98(10), 2239-2244. https://doi.org/10.1111/j.1572-0241.2003.07675.x