Infliximab

Miehsler, Wolfgang; Reinisch, Walter; Kazemi-Shirazi, Lili; Dejaco, Clemens; Novacek, Gottfried; Ferenci, Péter; Herbst, F.; Karner, J.; Teleky, B.; Schober, Ewald; Vogelsang, Harald

doi:10.1097/00054725-200401000-00006

Cited by 34 publications

(11 citation statements)

References 30 publications

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“…In patients with perianal fistulas, biologic and immunomodulator therapies are associated with reduced hospitalization and surgical intervention [ 35 ]. However, these results may not be generalized to internal fistulas [ 36 , 37 ]. Therefore, the European Crohn’s and Colitis Organization (ECCO) and the European Society of Colo Proctology (ESCP) stated that, in the case of internal fistulas, due to poorer response to medical therapies, the possibility of surgical removal should always be considered [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Crohn’s disease: prevalence, MR features, and clinical significance of enteric and colonic sinus tracts

et al. 2020

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Objectives Enteric and colonic sinus tracts are inflammatory complications that precede intestinal fistulas in patients with Crohn’s disease (CD). The aim of this study was to retrospectively determine the prevalence, morphologic features, and outcome of sinus tracts using MR imaging. Methods A consecutive cohort of 642 patients with known CD, referred for MR enterography or MR enteroclysis (study period 01/2014–09/2019), was evaluated retrospectively for the presence of sinus tracts, their locations, presence and length of coexisting strictures, bowel wall thickness, CDMI score, upstream dilation, and bowel distension. Clinical outcome was assessed using medical records. For metric data, means and standard deviation, as well as one-way ANOVA and Pearson’s correlation coefficient, were calculated. Results In 36/642 patients with CD undergoing MRE, 49 sinus tracts (forty in small intestine, nine in left-sided colon) were detected with a prevalence of 6.9% in patients with MR-visible signs of CD (n = 519, overall prevalence of 5.6%). Mean segmental bowel wall thickness was 8.9 mm, and mean CDMI score was 9.3. All sinus tracts were located within a stenotic segment, showing mesenteric orientation within the small bowel and upstream dilation in 13 patients. Of 36 patients, 19 underwent immediate surgery and seven developed clinical progression within the segment containing the sinus tract. Conclusions Sinus tracts occur in 6.9% of patients with visible signs of CD. They are located within stenotic, severely thickened bowel segments with high MR inflammation scores. Their detection is clinically important, because they indicate a more aggressive phenotype and, if left untreated, may show severe progression. Key Points • Sinus tracts occur in 6.9% of patients with MR-visible signs of Crohn’s disease. • Sinus tracts are a radiological indicator of early penetrating Crohn’s disease, with a high risk of progression, and require dedicated treatment. • Sinus tracts can be recognized by characteristic findings and typically occur in stenotic, severely thickened bowel segments with high MR inflammation scores.

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Section: Discussionmentioning

confidence: 99%

Crohn’s disease: prevalence, MR features, and clinical significance of enteric and colonic sinus tracts

et al. 2020

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“…Fistulas formed by these mechanisms may react less to anti-inflammatory agents due to fixed fibrotic tissues and muscular hyperplasia. 9 …”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Postoperative Fistula with Infliximab in a Patient with Crohn's Disease

et al. 2014

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Nearly 80% of patients with Crohn's disease (CD) require surgical treatment for complications or failure of medical management. We managed a 31-year-old man with CD who presented with a post-operative fistula. The patient had undergone surgery due to multiple strictures and a fistula. However, a new fistula developed that connected to the intraperitoneal abscess. Intravenous antibiotics were started and multiple percutaneous drainage tubes were inserted to treat the abdominal abscess. However, the amount of drainage was consistently high, even one month after the operation. To treat the postoperative fistula, 5 mg/kg of infliximab was started, and the amount of drainage decreased dramatically to less than 10 cc a day. Some studies have reported that infliximab decreases the recurrence of CD after surgery. The effect of infliximab on post-operative fistulas in patients with CD has not been sufficiently studied. Our results indicated that the use of infliximab to treat post-operative fistula should be explored further in future clinical studies.

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“…We followed an aggressive medical management with hyper-alimentation (TPN), antibiotics, aminosalicylates and immunosuppressive agents (corticosteroids and azathioprine). Infliximab was not considered as the best approach both because it could complicate the intra-abdominal abscess with sepsis and because of the reported low efficacy in healing internal fistulas [13]. We could not perform percutaneous CT-guided drainage of the abscess because it was not well defined (phlegmon) and located in an area relatively difficult to access (lesser sac).…”

Section: Discussionmentioning

confidence: 99%

Simultaneous occurrence of hyperthyroidism and fistulizing Crohn's disease complicated with intra-abdominal fistulas and abscess: a case report and review of the literature

Pachiadakis

Nakos

Tatsi

et al. 2009

Cases J

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IntroductionFistula formation in patients with Crohn’s disease is a common complication during the course of the disease. Perianal and enteroenteric are the most common forms of fistulas, whereas the involvement of the upper gastrointestinal tract with gastrocolic and duodenocolic fistulas represents an extremely unusual condition. Moreover, hyperthyroidism in association with Crohn’s disease has been rarely described.Case presentationWe present here a rare case of a 25-year-old male with simultaneous onset of hyperthyroidism and fistulizing Crohn’s disease. Crohn’s disease was complicated with intra-abdominal fistulas involving the upper gastrointestinal tract (duodenocolic, gastrocolic) and an intra-peritoneal abscess formation in the lesser sac. We describe the clinical presentation and therapeutic management of the patient including both medical treatment and surgical intervention. Despite intense medical treatment with total parenteral nutrition, antibiotics, aminosalicylates and corticosteroids the clinical course of the disease was suboptimal. Finally, the patient underwent laparotomy and right hemi-colectomy with ileo-transverse anastomosis performed, with simultaneous drainage of the abdominal abscess and primary closure of the upper gastrointestinal tract openings (gastric, duodenal and jejunal) at one stage operation. Although the surgical approach definitively cured the perforating complications of the disease (fistulas and abscess), the luminal disease in the colon remnant was still active and steroid-refractory. The subsequent successful treatment with infliximab, azathioprine and mesalazine resulted in the induction and maintenance of the disease remission. Thyrotoxicosis was successfully treated with methimazole and the hyperthyroidism has definitely subsided.ConclusionThe management of intra-abdominal fistulas in Crohn’s disease is a complex issue, requiring a multi-disciplinary approach and ‘tailoring’ of the treatment to the individual patient’s needs. Probably, a sensible approach involves early surgical intervention with prior optimization of the patient’s general condition when feasible. Common autoimmune mechanisms are probably involved in thyroid dysfunction associated with Crohn’s disease. Moreover, diagnosis and treatment of coexisting thyroid disorder in patients with Crohn’s disease has a favorable impact in disease prognosis.

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Infliximab

Cited by 34 publications

References 30 publications

Crohn’s disease: prevalence, MR features, and clinical significance of enteric and colonic sinus tracts

Crohn’s disease: prevalence, MR features, and clinical significance of enteric and colonic sinus tracts

Successful Treatment of Postoperative Fistula with Infliximab in a Patient with Crohn's Disease

Simultaneous occurrence of hyperthyroidism and fistulizing Crohn's disease complicated with intra-abdominal fistulas and abscess: a case report and review of the literature

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