Advertisement

International Journal of Colorectal Disease

, Volume 32, Issue 9, pp 1289–1294 | Cite as

Topic infliximab injection for refractory rectal stenosis in Crohn’s disease: long-term follow-up in two patients

  • Niels TeichEmail author
  • Ingo Wallstabe
  • Ingolf Schiefke
Original Article

Abstract

Purpose

TNF blockers are approved for intravenous or subcutaneous systemic therapy of many chronic inflammatory diseases. As it is not possible to achieve a sufficient local clinical improvement through systemic therapy in every patient, diverse approaches of topical therapy using TNF blockers have been investigated in recent years.

Methods

In this paper, we report on long-term clinical results of originator infliximab (IFX) injections into symptomatic combined scarring and inflammatory stenoses of the rectum in two patients with Crohn’s disease. Aiming at high tissue IFX levels, 25 mg of IFX was injected into each quadrant of the stenosis after endoscopic balloon dilatation. This off-label treatment was repeated as necessary, depending on the clinical success.

Results

Topic IFX injection after balloon dilation reduced imperative stool pressure, isolated episodes of incontinence and incomplete emptying. Improvement lasted between 4 and 14 weeks in one patient and the treatment was repeated 13 times in the following 6.6 years. In the other patient, the technique was necessary only twice with no symptom recurrence in the subsequent 5.3 years.

Conclusion

Our experience suggests that topic application of a systemically approved anti-TNF substance may be a successful individualized therapy for refractory stenosis of the rectum in patients with Crohn’s disease.

Keywords

Infliximab Crohn’s disease Rectal stenosis Endoscopic balloon dilation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. This study had no funding source.

References

  1. 1.
    Solberg IC, Vatn MH, Hoie O, Stray N, Sauar J, Jahnsen J, Moum B, Lygren I, IBSEN Study Group (2007) Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol 5:1430–1438. doi: 10.1016/j.cgh.2007.09.002 CrossRefPubMedGoogle Scholar
  2. 2.
    Bettenworth D, Gustavsson A, Atreja A, Lopez R, Tysk C, van Assche G, Rieder F (2017) A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing Crohn’s disease. Inflamm Bowel Dis 23:133–142. doi: 10.1097/MIB.0000000000000988 CrossRefPubMedGoogle Scholar
  3. 3.
    Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sandborn WJ, Loftus EV Jr (2012) Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970–2004). Am J Gastroenterol 107:1693–1701. doi: 10.1038/ajg.2012.298 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Navaneethan U, Lourdusamy V, Njei B, Shen B (2016) Endoscopic balloon dilation in the management of strictures in Crohn’s disease: a systematic review and meta-analysis of non-randomized trials. Surg Endosc 30:5434–5443. doi: 10.1007/s00464-016-4902-1 CrossRefPubMedGoogle Scholar
  5. 5.
    Chen M, Shen B (2014) Comparable short- and long-term outcomes of colonoscopic balloon dilation of Crohn’s disease and benign non-Crohn’s disease strictures. Inflamm Bowel Dis 20:1739–1746. doi: 10.1097/MIB.0000000000000145 CrossRefPubMedGoogle Scholar
  6. 6.
    Ding NS, Yip WM, Choi CH, Saunders B, Thomas-Gibson S, Arebi N, Humphries A, Hart A (2016) Endoscopic dilatation of Crohn’s anastomotic strictures is effective in the long term, and escalation of medical therapy improves outcomes in the biologic era. J Crohns Colitis 10:1172–1178. doi: 10.1093/ecco-jcc/jjw072 CrossRefPubMedGoogle Scholar
  7. 7.
    Brooker JC, Beckett CG, Saunders BP, Benson MJ (2003) Long-acting steroid injection after endoscopic dilation of anastomotic Crohn’s strictures may improve the outcome: a retrospective case series. Endoscopy 35:333–337. doi: 10.1055/s-2003-38145 CrossRefPubMedGoogle Scholar
  8. 8.
    van der Have M, Noomen C, Oldenburg B, Walter D, Houben MH, Wasser MN, Siersema PD, Hommes D, Fidder HH (2015) Balloon dilatation with or without intralesional and oral corticosteroids for anastomotic Crohn’s disease strictures. J Gastrointestin Liver Dis 24:537–539. doi: 10.15403/jgld.2014.1121.244.hav PubMedGoogle Scholar
  9. 9.
    Biancone L, Cretella M, Tosti C, Palmieri G, Petruzziello C, Geremia A, Calabrese E, Pallone F (2006) Local injection of infliximab in the postoperative recurrence of Crohn’s disease. Gastrointest Endosc 63:486–492. doi: 10.1016/j.gie.2005.08.047 CrossRefPubMedGoogle Scholar
  10. 10.
    Swaminath A, Lichtiger S (2008) Dilation of colonic strictures by intralesional injection of infliximab in patients with Crohn’s colitis. Inflamm Bowel Dis 14:213–216. doi: 10.1002/ibd.20318 CrossRefPubMedGoogle Scholar
  11. 11.
    Bettenworth D, Rieder F (2014) Medical therapy of stricturing Crohn’s disease: what the gut can learn from other organs—a systematic review. Fibrogenesis Tissue Repair 7:5. doi: 10.1186/1755-1536-7-5 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Rieder F, Kessler S, Sans M, Fiocchi C (2012) Animal models of intestinal fibrosis: new tools for the understanding of pathogenesis and therapy of human disease. Am J Physiol Gastrointest Liver Physiol 303:G786–G801. doi: 10.1152/ajpgi.00059.2012 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Schatteman L, Gyselbrecht L, De Clercq L, Mielants H (2006) Treatment of refractory inflammatory monoarthritis in ankylosing spondylitis by intraarticular injection of infliximab. J Rheumatol 33:82–85PubMedGoogle Scholar
  14. 14.
    Conti F, Ceccarelli F, Priori R, Iagnocco A, Signore A, Valesini G (2008) Intra-articular infliximab in patients with rheumatoid arthritis and psoriatic arthritis with monoarthritis resistant to local glucocorticoids. Clinical efficacy extended to patients on systemic anti-tumour necrosis factor alpha. Ann Rheum Dis 67:1787–1790. doi: 10.1136/ard.2008.091900 CrossRefPubMedGoogle Scholar
  15. 15.
    Poggioli G, Laureti S, Pierangeli F, Rizzello F, Ugolini F, Gionchetti P, Campieri M (2005) Local injection of infliximab for the treatment of perianal Crohn’s disease. Dis Colon rectum 48:768–774. doi: 10.1007/s10350-004-0832-4
  16. 16.
    Asteria CR, Ficari F, Bagnoli S, Milla M, Tonelli F (2006) Treatment of perianal fistulas in Crohn’s disease by local injection of antibody to TNF-alpha accounts for a favourable clinical response in selected cases: a pilot study. Scand J Gastroenterol 41:1064–1072. doi: 10.1080/00365520600609941 CrossRefPubMedGoogle Scholar
  17. 17.
    Alessandroni L, Kohn A, Cosintino R, Marrollo M, Papi C, Monterubbianesi R, Tersigni R (2011) Local injection of infliximab in severe fistulating perianal Crohn’s disease: an open uncontrolled study. Tech Coloproctol 15:407–412. doi: 10.1007/s10151-011-0759-4 CrossRefPubMedGoogle Scholar
  18. 18.
    Poggioli G, Laureti S, Pierangeli F, Bazzi P, Coscia M, Gentilini L, Gionchetti P, Rizzello F (2010) Local injection of adalimumab for perianal Crohn’s disease: better than infliximab? Inflamm Bowel Dis 16:1631. doi: 10.1002/ibd.21210 CrossRefPubMedGoogle Scholar
  19. 19.
    Tonelli F, Giudici F, Asteria CR (2012) Effectiveness and safety of local adalimumab injection in patients with fistulizing perianal Crohn’s disease: a pilot study. Dis Colon rectum 55:870–875. doi: 10.1097/DCR.0b013e31825af532
  20. 20.
    Lorenzo-Zúñiga V, Boix J, Mañosa M, Lezcano C, Cabré E, de Vega VM, Domènech E (2013) Local injection of infliximab in symptomatic isolated mucosal lesions: a novel scenario for endoscopic therapy? Inflamm Bowel Dis 19:E59–E61. doi: 10.1002/ibd.23018 CrossRefPubMedGoogle Scholar
  21. 21.
    D'Alessandria C, Malviya G, Viscido A, Aratari A, Maccioni F, Amato A, Scopinaro F, Caprilli R, Signore A (2007) Use of a 99mTc labeled anti-TNFalpha monoclonal antibody in Crohn’s disease: in vitro and in vivo studies. Q J Nucl Med Mol Imaging 51:334–342PubMedGoogle Scholar
  22. 22.
    Conti F, Malviya G, Ceccarelli F, Priori R, Iagnocco A, Valesini G, Signore A (2012) Role of scintigraphy with (99m)Tc-infliximab in predicting the response of intraarticular infliximab treatment in patients with refractory monoarthritis. Eur J Nucl Med Mol Imaging 39:1339–1347. doi: 10.1007/s00259-012-2133-9 CrossRefPubMedGoogle Scholar
  23. 23.
    Atreya R, Neumann H, Neufert C, Waldner MJ, Billmeier U, Zopf Y, Willma M, App C, Münster T, Kessler H, Maas S, Gebhardt B, Heimke-Brinck R, Reuter E, Dörje F, Rau TT, Uter W, Wang TD, Kiesslich R, Vieth M, Hannappel E, Neurath MF (2014) In vivo imaging using fluorescent antibodies to tumor necrosis factor predicts therapeutic response in Crohn’s disease. Nat Med 20:313–318. doi: 10.1038/nm.3462 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und SchkeuditzLeipzigGermany
  2. 2.Klinikum St. Georg gGmbH, Klinik für Gastroenterologie und HepatologieLeipzigGermany

Personalised recommendations