Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2018.068
Autopsy and Case Reports
Article / Clinical Case Report

Early intestinal obstruction after infliximab therapy in Crohn’s disease

Mitsuro Chiba; Yuichi Tanaka; Iwao Ono

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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

Infliximab, Ileus, Crohn’s Disease

References

Chiba M, Abe T, Tsuda H, et al. Lifestyle-related disease in Crohn’s disease: relapse prevention by a semi-vegetarian diet. World J Gastroenterol. 2010;16(20):2484-95. [https://doi.org/10.3748/wjg.v16.i20.2484]. [PMID:20503448]

Chiba M, Tsuji T, Nakane K, et al. Induction with infliximab and a plant-based diet as first-line (IPF) therapy in Crohn disease: a single-group trial. Perm J. 2017;21(4):17-009. [PMID:29035182]

Chiba M, Tsuji T, Nakane K, Ishii H, Komatsu M. How to avoid primary nonresponders to infliximab in Crohn’s disease. Inflamm Bowel Dis. 2017;23(11):E55-6. [https://doi.org/10.1097/MIB.0000000000001281]. [PMID:28991860]

Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130(2):323-33. [https://doi.org/10.1053/j.gastro.2005.11.030]. [PMID:16472588].

D’Haens G, Van Deventer S, Van Hogezand R, et al. Endoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in Crohn’s disease: a European multicenter trial. Gastroenterology. 1999;116(5):1029-34. [https://doi.org/10.1016/S0016-5085(99)70005-3]. [PMID:10220494]

Toy LS, Scherl EJ, Kornbluth A, et al. Complete bowel obstruction following initial response to infliximab therapy for Crohn’s disease: a series of newly described complication. Gastroenterology. 2000;118:A569.

Vasilopoulos S, Kugathasan S, Saeian K, et al. Intestinal strictures complicating initially successful infliximab treatment for luminal Crohn’s disease. Am J Gastroenterol. 2000;95:2503.

Sandborn WJ, Hanauer SB. Infliximab in the treatment of Crohn’s disease: a user’s guide for clinicians. Am J Gastroenterol. 2002;97(12):2962-72. [https://doi.org/10.1111/j.1572-0241.2002.07093.x]. [PMID:12492177]

Chiba M, Nakane K, Takayama Y, et al. Development and application of a plant-based diet scoring system for Japanese patients with inflammatory bowel disease. Perm J. 2016;20(4):62-8. [PMID:27768566]

Hanauer SB, Sandborn W, Practice Parameters Committee of the American College of Gastroenterology. Management of Crohn’s disease in adults. Am J Gastroenterol. 2001;96(3):635-43. [https://doi.org/10.1111/j.1572-0241.2001.03671.x]. [PMID:11280528]

Greenstein AJ, Lachman P, Sachar DB, et al. Perforating and non-perforating indications for repeated operations in Crohn’s disease: evidence for two clinical forms. Gut. 1988;29(5):588-92. [https://doi.org/10.1136/gut.29.5.588]. [PMID:3396946]

Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J. Predictors of Crohn’s disease. Gastroenterology. 2006;130(3):650-6. [https://doi.org/10.1053/j.gastro.2005.12.019]. [PMID:16530505]

Solberg IC, Vatn MH, Høie O, et al. Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007;5(12):1430-8. [https://doi.org/10.1016/j.cgh.2007.09.002]. [PMID:18054751]

Rutgeerts P, D’Haens G, Targan S, et al. Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease. Gastroenterology. 1999;117(4):761-9. [https://doi.org/10.1016/S0016-5085(99)70332-X]. [PMID:10500056]

Lichtenstein GR, Olson A, Travers S, et al. Factors associated with the development of intestinal strictures or obstructions in patients with Crohn’s disease. Am J Gastroenterol. 2006;101(5):1030-8. [https://doi.org/10.1111/j.1572-0241.2006.00463.x]. [PMID:16606351]

Bouhnik Y, Carbonnel F, Laharie D, et al. Efficacy of adalimumab in patients with Crohn’s disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study. Gut. 2018;67(1):53-60. [https://doi.org/10.1136/gutjnl-2016-312581]. [PMID:28119352]

Louis E, Boverie J, Dewit O, Baert F, De Vos M, D’Haens G. Treatment of small bowel subocclusive Crohn’s disease with infliximab: an open pilot study. Acta Gastroenterol Belg. 2007;70(1):15-9. [PMID:17619533]

Chiba M, Sugawara T, Tsuda H, Abe T, Tokairin T, Kashima Y. Esophageal ulcer in Crohn’s disease: disappearance in 1 week with infliximab. Inflamm Bowel Dis. 2009;15(8):1121-2. [https://doi.org/10.1002/ibd.20769]. [PMID:18942761]

Torres J, Boyapati RK, Kennedy NA, Louis E, Colombel JF, Satsangi J. Systematic review of effects of withdrawal of immunomodulators or biologic agents from patients with inflammatory bowel disease. Gastroenterology. 2015;149(7):1716-30. [https://doi.org/10.1053/j.gastro.2015.08.055]. [PMID:26381892]

Sorrentino D. Role of biologics and other therapies in stricturing Crohn’s disease: what have we learnt so far? Digestion. 2008;77(1):38-47. [https://doi.org/10.1159/000117306]. [PMID:18285676]

Pelletier AL, Kalisazan B, Wienckiewicz J, Bouarioua N, Soule JC. Infliximab treatment for symptomatic Crohn’s disease strictures. Aliment Pharmacol Ther. 2009;29(3):279-85. [https://doi.org/10.1111/j.1365-2036.2008.03887.x]. [PMID:19035967]

Fumery M, Seksik P, Auzolle C, et al. Postoperative complications after ileocecal resection in Crohn’s disease: a prospective study from the REMIND Group. Am J Gastroenterol. 2017;112(2):337-45. [https://doi.org/10.1038/ajg.2016.541]. [PMID:27958285]

Kotze PG, Saab MP, Saab B, et al. Tumor necrosis factor alpha inhibitors did not influence postoperative morbidity after elective surgical resection in Crohn’s disease. Dig Dis Sci. 2017;62(2):456-64. [https://doi.org/10.1007/s10620-016-4400-2]. [PMID:27933472]

 

 

 


Publication date:
01/14/2019

5c3cdb920e88251509cd6225 autopsy Articles
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