Early intestinal obstruction after infliximab therapy in Crohn s disease
Open Access
- 1 January 2019
- journal article
- Published by Editora Cubo in Autopsy Case Reports
- Vol. 9 (1), e2018068
- https://doi.org/10.4322/acr.2018.068
Abstract
There is scarce knowledge on early intestinal obstruction in Crohn’s disease (CD) after infliximab treatment. Therefore, we describe two cases of early intestinal obstruction in a series of 46 CD patients treated with infliximab. Both our two cases were 21-year-old men with newly diagnosed CD who were diagnosed with perianal disease 2 years previously. They were suffering from diarrhea and abdominal pain, but there were no symptoms indicating bowel obstruction. Radiographic studies revealed stenotic sites in the terminal ileum in both cases. In both cases, infliximab 300 mg was infused, after which their abnormal laboratory data as well as symptoms such as diarrhea and abdominal pain clearly improved. However, on the 11th or 13th day post-treatment, they presented abdominal distension with air-fluid levels on imaging studies. Ileocolonic resection was performed in both cases. Early intestinal obstruction after infliximab therapy is characterized by initial improvement of the symptoms and the laboratory data, which is soon followed by clinical deterioration. This outcome indicates that infliximab is so swiftly effective that the healing process tapers the stenotic site, resulting in bowel obstruction. Thus, although unpleasant and severe, the obstruction cannot be considered as a side effect but rather a consequence of infliximab’s efficacy. CD patients with intestinal stricture, particularly the penetrating type with stricture, should be well informed about the risk of developing intestinal obstruction after infliximab therapy and the eventual need for surgical intervention.Keywords
This publication has 21 references indexed in Scilit:
- Induction with Infliximab and a Plant-Based Diet as First-Line (IPF) Therapy for Crohn Disease: A Single-Group TrialThe Permanente Journal, 2017
- How to Avoid Primary Nonresponders to Infliximab in Crohn's Disease.Inflammatory Bowel Diseases, 2017
- Development and Application of a Plant-Based Diet Scoring System for Japanese Patients with Inflammatory Bowel DiseaseThe Permanente Journal, 2016
- Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian dietWorld Journal of Gastroenterology, 2010
- Predictors of Crohn’s DiseaseGastroenterology, 2006
- Human Anti–Tumor Necrosis Factor Monoclonal Antibody (Adalimumab) in Crohn’s Disease: the CLASSIC-I TrialGastroenterology, 2006
- Infliximab in the Treatment of Crohn's Disease: A User's Guide for CliniciansAmerican Journal Of Gastroenterology, 2002
- Management of Crohn's disease in adults.Published by Emerald ,2001
- Endoscopic and histological healing with infliximab anti–tumor necrosis factor antibodies in Crohn's disease: A European multicenter trialGastroenterology, 1999
- Perforating and non-perforating indications for repeated operations in Crohn's disease: evidence for two clinical forms.Gut, 1988