Endosonographic evidence of persistence of Crohn's disease-associated fistulas after infliximab treatment, irrespective of clinical response.
OBJECTIVE
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.
van Bodegraven
Ad A
AA
Department of Gastroenterology, Free University Hospital, Amsterdam, The Netherlands.
Sloots
Cornelius E J
CE
Felt-Bersma
Richelle J F
RJ
Meuwissen
Stephan G M
SG
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D019160:Endosonography; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D012007:Rectum / Q000000981:diagnostic imaging / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina / Q000000981:diagnostic imaging / Q000187:drug effects; D014624:Vaginal Fistula / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab