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

  • General Gynecology
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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.

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Acknowledgments

No external fund was used to carry out this investigation. Further, the authors hereby declare having no conflict of interest in connection with the publication of this manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology, Sendai Medical Center, 2-8-8 Miyagino, Sendai, Miyagi, 983-8520, Japan

    Hiroki Takahashi, Kaori Sugawara, Mikako Sugimura, Masahiro Iwabuchi, Yutaka Mano, Katsuaki Ukai & Keiichi Tadokoro

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  1. Hiroki Takahashi
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  2. Kaori Sugawara
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  3. Mikako Sugimura
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  4. Masahiro Iwabuchi
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  7. Keiichi Tadokoro
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Correspondence to Hiroki Takahashi.

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Takahashi, H., Sugawara, K., Sugimura, M. et al. Flare up of ulcerative colitis during pregnancy treated by adsorptive granulocyte and monocyte apheresis: therapeutic outcomes in three pregnant patients. Arch Gynecol Obstet 288, 341–347 (2013). https://doi.org/10.1007/s00404-013-2748-5

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  • DOI: https://doi.org/10.1007/s00404-013-2748-5

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