Infliximab as a therapy for non-Crohn?s enterocutaneous fistulae

Date, Ravindra; Panesar, K. J. S.; Neilly, Paul

doi:10.1007/s00384-004-0595-3

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…41 Infliximab has also been used efficaciously as a treatment for non-Crohn's disease ECF in three cases. 42 The authors postulated that infliximab decreased the persistent inflammation that was causing these ECF to fail to close spontaneously despite maximal conservative treatment. Infliximab in Crohn's ECF and non-Crohn's ECF patients certainly deserves further investigation.…”

Section: Underlying Diseasementioning

confidence: 99%

Postoperative Enterocutaneous Fistula: When to Reoperate and How to Succeed

Galie¹,

Whitlow

2006

Clinics in Colon and Rectal Surgery

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An enterocutaneous fistula (ECF) is a potentially catastrophic postoperative complication. Although the morbidity and mortality associated with ECF have decreased over the past 50 years with modern medical and surgical care, the overall mortality is still surprisingly high, up to 39% in recent literature. It seems prudent, then, for every surgeon to have a thorough grasp of optimal treatment strategies for ECF to minimize their patients' mortality. Ultimately, the algorithm must begin with prevention. Once an ECF is diagnosed, the first step is to resuscitate and treat sepsis. The second is to control fistula output. The third step is to optimize the patient medically and nutritionally. The last step is definitive restoration of gastrointestinal continuity when necessary. Special mention is given in this article to exceptionally refractory fistulas such as those arising in the presence of inflammatory bowel disease and irradiated bowel. This plan gives a framework for the difficult task of successfully treating the postoperative ECF with a multidisciplinary approach.KEYWORDS: Enterocutaneous fistula, nutritional support, sepsis, radiation enteritis Objectives: Upon completion of this article, the reader should be able to summarize the management of postoperative enterocutaneous fistulas.

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Section: Underlying Diseasementioning

confidence: 99%

Postoperative Enterocutaneous Fistula: When to Reoperate and How to Succeed

Galie¹,

Whitlow

2006

Clinics in Colon and Rectal Surgery

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“…A recent small case series of three patients has reported healing of persistent ECF not associated with IBD to have healed following a single infusion of infliximab[22]. There are no other studies to support this series in the use of infliximab for non-IBD ECF.…”

Section: Introductionmentioning

confidence: 84%

Prospective study of immunological factors in non-inflammatory bowel disease enterocutaneous fistulas

et al. 2011

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BackgroundEnterocutaneous fistulas (ECF) are debilitating and usually result following complex abdominal surgery. While there is an association with inflammatory bowel disease (IBD), a large number of fistulas occur after surgery not related to IBD. The consequences of ECF include short bowel syndrome and the need for long term parenteral nutrition.ECF can heal spontaneously and in the case of IBD can be cured by medical therapy in some instances. Those that do not resolve spontaneously have to be cured by surgery which is complex and associated with a high morbidity. It is not considered traditional treatment to use the same medical therapy as in IBD to cure ECF caused by other conditions.A small case series has reported three patients with persistent ECF not related to IBD to have healed following use of Infliximab which is the treatment commonly used for ECF caused by IBD. Infliximab acts by inhibiting the activity of the inflammatory cytokine TNF- alpha. It is not known if this cytokine is present in ECF tissue in the absence of IBD.The aim of this study is to demonstrate the presence of inflammatory markers in tissue surrounding non-IBD ECF and in particular to quantify the presence of the cytokine TNF- alpha. We hypothesise that TNF - alpha levels are raised in non-IBD ECF.Methods/DesignTissue and serum from ECF of IBD and non-IBD patients will be prospectively collected at St. Mark's Hospital Intestinal Failure Unit. The control group will consist of patients undergoing colonoscopy for bowel cancer screening, with normal findings. Biopsies of the terminal ileum will be obtained from this group during colonoscopy. The fistula tract and serum cytokine profiles of interleukins (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, TNF- alpha, IFN-y, MCP-1, EGF and VEGF will be assessed.DiscussionThis study aims to assess the presence or absence of TNF- alpha expression in the ECF tissue in non-IBD origin. If our hypothesis is correct we would then be able to study the use of the TNF- alpha inhibitor Infliximab as a therapeutic option in the treatment of non-IBD ECF. Secondary aims include assessing the spectrum of inflammatory cytokines and markers present in tissue and serum of non-IBD ECF when compared with IBD ECF and normal controls.Trial registrationISRCTN44000447

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“…However, it is clear that in the few studies that have evaluated or compared infliximab in perianal and enterocutaneous fistulas, the results have always been worse when compared with enterocutaneous fistulas. There has even been a case described of an ECF that resolved with infliximab in a patient who did not have CD (8). These data may be explained by the fact that ECF has a pathophysiology distinct from perianal fistulas.…”

Section: Discussionmentioning

confidence: 99%