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

Abstract

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.

The clinical characteristics of patients with free perforation in Korean Crohn’s disease: results from the CONNECT study

“…Similis et al similarly reported a higher rate of operative recurrences among patients with CD and perforations compared with those who did not have perforations [ 28 ]. However, with improvement in surgical procedures [ 29 - 31 ] and the availability of newer medication including biologics, this may lead to the successful treatment of patients [ 32 ].…”

Efficacy and safety of CT‐P13, a biosimilar of infliximab, in patients with inflammatory bowel disease: A retrospective multicenter study

“…Biological therapy with monoclonal antibodies to tumor necrosis factor alpha (TNF‐α), such as infliximab and adalimumab, was shown in large clinical trials to be effective in inducing and maintaining remission in patients with moderate to severe luminal and fistulizing Crohn's disease (CD) and ulcerative colitis (UC) . Infliximab, the first anti‐TNF‐α biologic drug, has significantly improved inflammatory bowel disease (IBD) patient outcomes by preventing structural damage progression, thereby reducing complications and the need for surgery and hospitalization . However, the major concern associated with the use of biologics is their high cost.…”

“…[1][2][3][4][5] Infliximab, the first anti-TNF-α biologic drug, has significantly improved inflammatory bowel disease (IBD) patient outcomes by preventing structural damage progression, thereby reducing complications and the need for surgery and hospitalization. [6][7][8] However, the major concern associated with the use of biologics is their high cost. Although biologics are cost-effective in that they achieve better disease control, the long-term use of these agents can place a significant burden on national healthcare systems.…”

Factors Associated with Anxiety and Depression in Korean Patients with Inactive Inflammatory Bowel Disease

“…Inflammatory bowel disease (IBD), which is comprised of ulcerative colitis (UC) and Crohn’s disease (CD), is an idiopathic disease with chronic or recurring immune response and inflammation of the gastrointestinal tract associated with various complications. 1 – 4 Intestinal inflammation in IBD can be lead to many physical symptoms, such as abdominal pain and diarrhea, which have a direct negative impact on quality of life (QOL). 5 , 6 Poorer health-related QOL is known to be associated with higher levels of anxiety and depression.…”