Inflixmab as a possible treatment for the hemorrhagic type of Crohn?s disease

Abstract

Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease (CD). Although anti-tumor necrosis factor-alpha (TNF-alpha, infliximab) therapy has been established for patients with inflammatory and fistulous CD, there has been little evidence on whether infliximab is effective for the hemorrhagic type of CD. We report a case of a 31-year-old man with CD who had recurrent sudden-onset bloody stool. After a second surgery, he visited our hospital because of bloody stool. Infusion of infliximab stopped the bleeding and promoted the healing of ulcers in the ileum and ileocolon anastomosis. We suggest that infliximab therapy should be tried to stop acute gastrointestinal bleeding in CD before there is a surgical emergency.

Acute hemorrhagic Crohnʼs disease controlled with infliximab

“…The current literature describes 5 previous patients with hemorrhagic CD treated with infliximab. [7][8][9] All of these patients demonstrated severe hematochezia that ceased after infusion with infliximab, similar to our current patient. Overall, these patients treated with infliximab were heterogeneous with respect to disease duration and location, but all were naïve to immunomodulators and biologics.…”

Evidence-based clinical practice guidelines for Crohn’s disease, integrated with formal consensus of experts in Japan

“…However, arterial embolization may cause intestinal ischemia leading to intestinal necrosis. It was reported that the administration of infliximab was effective for treating the hemorrhagic type of CD [138]. …”

Evaluation of Infliximab Effects on Gastrointestinal Bleeding in Crohn’s Disease Using Double-Balloon Endoscopy

“…Infliximab treatment of severe, recurrent CD presenting as massive lower gastrointestinal bleeding has been shown to result in rapid mucosal healing and to prevent recurrent bleeding [12,13], suggesting that infliximab may offer a viable treatment alternative to surgery for patients with acute massive or chronic refractory bleeding [14]. Furthermore, infliximab could potentially modify the expected time course of the disease in a relevant number of patients by stopping further development of, or causing regression of, stenotic lesions, thereby postponing or avoiding surgical interventions [15].…”