Archives of Gynecology and Obstetrics

, Volume 288, Issue 2, pp 341–347

Flare up of ulcerative colitis during pregnancy treated by adsorptive granulocyte and monocyte apheresis: therapeutic outcomes in three pregnant patients

Authors

    • Department of GastroenterologySendai Medical Center
  • Kaori Sugawara
    • Department of GastroenterologySendai Medical Center
  • Mikako Sugimura
    • Department of GastroenterologySendai Medical Center
  • Masahiro Iwabuchi
    • Department of GastroenterologySendai Medical Center
  • Yutaka Mano
    • Department of GastroenterologySendai Medical Center
  • Katsuaki Ukai
    • Department of GastroenterologySendai Medical Center
  • Keiichi Tadokoro
    • Department of GastroenterologySendai Medical Center
General Gynecology

DOI: 10.1007/s00404-013-2748-5

Cite this article as:
Takahashi, H., Sugawara, K., Sugimura, M. et al. Arch Gynecol Obstet (2013) 288: 341. doi:10.1007/s00404-013-2748-5

Abstract

Purpose

Treatment of ulcerative colitis with drugs during pregnancy potentially may harm the mother and the unborn child. Granulocytapheresis depletes elevated/activated myeloid lineage leucocytes as sources of inflammatory cytokines. We were interested in the safety and efficacy of granulocytapheresis in patients who had ulcerative colitis flare up during pregnancy.

Methods

Three pregnant cases with active ulcerative colitis received Adacolumn granulocytapheresis, up to 10 sessions within 3–6 weeks. Case 1: a 33-year-old woman with left-sided colitis and bloody diarrhoea 7–9 times/day showed loss of mucosal vascular patterns, and contact bleeding from the rectum to the sigmoid colon. Case 2: a 36-year-old woman with pancolitis and bloody diarrhoea 6–8 times/day had loss of mucosal vascular patterns and pus from the rectum to the sigmoid colon. Case 3: a 36-year-old woman with pancolitis and diarrhoea 4–5 times/day (first episode) had erosions and pus in the mucosa from the rectum to the transverse colon.

Results

Colitis flare was in weeks 5, 13 and 22 of pregnancy in cases 1, 2, 3, respectively. The corresponding granulocytapheresis sessions were 5, 7, and 10, reflecting an increasing trend with the pregnancy week. Patients 1 and 2 achieved complete remission, patient 3 achieved clinical remission.

Conclusion

In these three cases with active ulcerative colitis during pregnancy, granulocytapheresis as a non-pharmacologic treatment was effective and safe. In case 3 that did not respond well to the initial granulocytapheresis sessions, a moderate dose of prednisolone enhanced the efficacy of granulocytapheresis and tapering of prednisolone shortly after administration was not associated with relapse.

Keywords

Ulcerative colitis flare upPregnancyAdsorptive granulocyte and monocyte apheresisMucosal healingComplete remission

Copyright information

© Springer-Verlag Berlin Heidelberg 2013