Successful treatment of cap polyposis with infliximab

Successful Management of Cap Polyposis with Eradication of <i>Helicobacter pylori</i> Relapsing 15 Years after Remission on Steroid Therapy

“…Although various medical treatments based on the etiological hypothesis had been advocated, optical treatment has not yet been established. Metronidazole has been useful in some cases (10, 11), but not in others (4,7,8,12). Shimizu et al (11) speculated that the role of metronidazole may be related to its anti-inflammatory action rather than its antibiotic action against specific pathogens.…”

“…Several reports (9) have recommended avoidance of straining at defecation, but in most cases (4,5,13), including the present case, the effect is temporal or absent. Recently, Bookman et al (8) demonstrated that infusion with infliximab resulted in complete remission, and Kim et al (12) reported a case resolved by treatment with infliximab that maintained remission for 3 years. In contrast, another study (13) observed no effect from treatment with infliximab.…”

Cap Polyposis (CP) Which Relapsed after Remission by Avoiding Straining at Defecation, and was Cured by Helicobacter pylori Eradication Therapy

“…Oriuchi et al reported two cases of successful treatment of CP by avoidance of intraluminal trauma, and suggested that CP might be a subtype of MPS (6). But, avoidance of straining at defecation was not effective in the other five cases of CP including our case (10,17), and some cases of CP had no evidence of abnormal colonic motility, fibromuscular obliteration or intramucosal elastin (7,11,17 (23), idiopathic thrombocytopenic purpura (24), iron deficiency anemia (25), chronic urticaria (26) …”

“…Lesions are mainly located in the rectum and sigmoid colon, but some cases extend to the oral side of the colon (2,4,5,(7)(8)(9) 10-12, 14). It Hi s t o p a t h o l o g i c a l e x a mi n a t i o n o f b i o p s y s p e c i me n s r e v e a l e d i n f l a me d mu c o s a wi t h e l o n g a t e d c r y p t s a n d g r a n u l a t i o n t i s s u e , a s o -c a l l e d "c a p " , o n t (5,6,(10)(11)(12)(13)(14)(16)(17)(18), steroid therapy (2,4,7,10,11,13,14,16,17), Argon plasma coagulation (APC) and endoscopic mucosal resection (EMR) (10,13,15) (13). Four cases of spontaneous improvement of CP were reported (9,16,19), but complete recovery was achieved in only one case (19).…”

Nine-year Follow-up from Onset to Spontaneous Complete Remission of Cap Polyposis

“…The etiology of cap polyposis is unknown; however, rectal prolapse and Helicobacter pylori (H. pylori) infection have been implicated (2)(3)(4)(5)(6). It has been reported that some cases have been treated successfully by the avoidance of straining at defecation (2), metronidazole (7), steroids (8), H. pylori eradication therapy (5,6), infliximab (9) and surgical resection (3). However, no curative standard treatments for this condition have been established.…”