Intra‐abdominal abscesses in CD – When to treat with biologics?

Abstract

Management of intra‐abdominal abscesses complicating Crohn's disease (CD) is challenging. After initial drainage and antibiotherapy treatment, surgery with delayed intestinal resection is often recommended but new data suggests efficacy of biotherapies in this context. This review aims to summarize new data regarding efficacy and safety of anti‐TNF in the management of intra‐abdominal abscesses complicating CD. We performed a review of the literature on medical management of intra‐abdominal abscesses complicating CD. After effective drainage of abscess, treatment with anti‐TNF can allow resolving of abscess. In some patients and at a specific timing, the use of biotherapies could avoid delayed surgery and long‐term abscess recurrence.

Posterior Reversible Encephalopathy Syndrome After Infliximab Infusion for Fistulizing Crohn's Disease

“…Notably, the use of anti-TNF therapy did not appear to elevate the risk of infectious complications, underscoring its favorable safety profile in this scenario. 6 , 7 …”

“…Notably, the use of anti-TNF therapy did not appear to elevate the risk of infectious complications, underscoring its favorable safety profile in this scenario. 6,7 Eight days following the first infliximab dose, the patient developed signs and symptoms of increased intracranial pressure, defined as a severe headache that was associated with nausea, vomiting, and high blood pressure readings exceeding 160/ 90 mm Hg. A CT scan without contrast was performed promptly and rolled out hemorrhage (Figure 2).…”

Changing paradigms in management of inflammatory bowel disease

“…Regarding treatment, Haas et al 13 . summarized new data regarding the efficacy and safety of anti‐TNF drugs in the management of intra‐abdominal abscesses complicating CD.…”

“…Regarding treatment, Haas et al. 13 summarized new data regarding the efficacy and safety of anti‐TNF drugs in the management of intra‐abdominal abscesses complicating CD. This review discussed the “no surgery” strategy, which starts with antibiotic therapy combined with radiologic drainage, followed by anti‐TNF therapy, avoiding delayed surgery.…”

“…summarized new data regarding the efficacy and safety of anti‐TNF drugs in the management of intra‐abdominal abscesses complicating CD. This review discussed the “no surgery” strategy, which starts with antibiotic therapy combined with radiologic drainage, followed by anti‐TNF therapy, avoiding delayed surgery 13 . Future studies are warranted to clarify the type of patient and drug, including vedolizumab and ustekinumab, to be considered in this setting.…”