Abstract
PURPOSE: Infliximab has been reported to improve fistulizing Crohn’s disease. Moreover, prompt healing of mucosal ulcers has been described. Whether fistulas disappear or remainders of fistulas persist is unknown. This study documents fistulous tracts before and after infliximab therapy by means of hydrogen peroxide-enhanced endosonography METHODS: Eight patients with perianal, vaginal, or perineal fistulas were treated with a triplet of infliximab 5 mg/kg infusions. At baseline, and at Week 4 after the last infusion, fistulas were documented by local inspection, digital examination, and hydrogen peroxide-enhanced anal or vaginal endosonography. RESULTS: Patients with vaginal or perineal fistulas did not respond clinically to therapy, whereas patients with perianal fistulas improved considerably. However, in all patents remainders of fistulous tracts were demonstrated by endosonographic techniques. CONCLUSIONS: Short-term treatment of Crohn’s disease-associated fistulas with infliximab does not induce disappearance of fistulous tracts, irrespective of therapeutic response.
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References
DR Williams JA Coller ML Corman FW Nugent MC Veidenheimer (1981) ArticleTitleAnal complications in Crohn’s disease. Dis Colon Rectum 24 22–24
MJ Solomon RS McLeod BI O’Connor AH Steinhart GR Greenberg Z Cohen (1993) ArticleTitleCombination ciprofloxacin and metronidazole in severe perianal Crohn’s disease. Can J Gastroenterol 7 571–573
DH Present BI Korelitz N Wisch JL Glass DB Sachar BS Pasternack (1980) ArticleTitleTreatment of Crohn’s disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med 302 981–987
DC Pearson GR May GH Fick LR Sutherland (1995) ArticleTitleAzathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med 123 132–142
DH Present S Lichtiger (1994) ArticleTitleEfficacy of cyclosporine in treatment of fistula of Crohn’s disease. Dig Dis Sci 39 374–380
GR d’Haens SJ van Deventer RA van Hogezand et al. (1999) ArticleTitleEndoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in Crohn’s disease: Gastroenterology 116 1029–1034
FJ Baert GR d’Haens M Peeters et al. (1999) ArticleTitleTumor necrosis factor alpha antibody (infliximab) therapy profoundly down-regulates the inflammation in Crohn’s ileocolitis. Gastroenterology 116 22–28
P Rutgeerts G d’Haens S Targan et al. (1999) ArticleTitleEfficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease. Gastroenterology 117 761–769
DH Present P Rutgeerts S Targan et al. (1999) ArticleTitleInfliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340 1398–1405
AC Poen RJ Felt-Bersma QA Eijsbouts MA Cuesta SG Meuwissen (1998) ArticleTitleHydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano. Dis Colon Rectum 41 1147–1152
G Maconi F Parente G Bianchi Porro (1999) ArticleTitleHydrogen peroxide enhanced ultrasound-fistulography in the assessment of enterocutaneous fistulas complicating Crohn’s disease. Gut 45 874–878
RJ Felt-Bersma MA Cuesta M Koorevaar (1996) ArticleTitleAnal sphincter repair improves anorectal function and endosonographic image: Dis Colon Rectum 39 878–885
DM Cheong JJ Nogueras SD Wexner DG Jagelman (1993) ArticleTitleAnal endosonography for recurrent anal fistulas: Dis Colon Rectum 36 1158–1160
AC Poen RJ Felt-Bersma MA Cuesta SG Meuwissen (1998) ArticleTitleVaginal endosonography of the anal sphincter complex is important in the assessment of faecal incontinence and perianal sepsis. Br J Surg 85 359–363
A Parks P Gordon J Hardcastle (1976) ArticleTitleA classification of fistula-in-ano. Br J Surg 63 1–12
E Ricart R Panacicione EV Loftus WJ Tremaine WJ Sandborn (1999) ArticleTitleSuccessful management of Crohn’s disease of the ileoanal pouch with infliximab. Gastroenterology 117 429–432
K van der Linde MA Meyssen AA van Bodegraven et al. (2000) ArticleTitleInfliximab for treatment of perineal metastatic Crohn’s disease [abstract]. Gastroenterology 118 588–432
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van Bodegraven, A.A., Sloots, C.E., Felt-Bersma, R.J. et al. Endosonographic Evidence of Persistence of Crohn’s Disease-Associated Fistulas After Infliximab Treatment, Irrespective of Clinical Response. Dis Colon Rectum 45, 39–45 (2002). https://doi.org/10.1007/s10350-004-6111-6
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DOI: https://doi.org/10.1007/s10350-004-6111-6