Abstract
Although infliximab has been shown to improve the clinical course of Crohn’s disease, its effect on intestinal strictures is controversial. We describe the case of a woman with steroid-resistant colonic Crohn’s disease presenting with intermittent obstruction because of a tight stricture in the splenic flexure. Compared with uninvolved areas, biopsies showed intense edema and inflammatory cell infiltration and immunohistochemistry revealed an excess of TNF-α. Her symptoms responded promptly (CDAI went from 444 to 168) to an infliximab infusion (10 mg kg−1 BW), which also had a dramatic effect on the stricture, now presenting radiologically as a moderate residual, apparently fibrotic, narrowing of the lumen. Endoscopy and histology confirmed the resolution of inflammation and TNF-α virtually disappeared. The patient refused additional infusions and after a few months the disease recurred with features identical to the pre-treatment phase. She then opted for surgery. Histology of the resected strictured colon revealed edema, inflammation, and fibrosis, with TNF-α back to pre-treatment levels. This case indicates that, in the colon, infliximab specifically relieves the TNF-α-mediated inflammatory component of the stricture while having no effect on fibrosis and suggests that the response to infliximab treatment may depend on the nature of the, stricture itself.
Abbreviations
- TNF:
-
tumor necrosis factor
- CDAI:
-
Crohn’s disease activity index
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Sorrentino, D., Avellini, C., Beltrami, C.A. et al. Selective effect of infliximab on the inflammatory component of a colonic stricture in Crohn’s disease. Int J Colorectal Dis 21, 276–281 (2006). https://doi.org/10.1007/s00384-005-0739-0
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DOI: https://doi.org/10.1007/s00384-005-0739-0