title: Selective effect of infliximab on the inflammatory component of a colonic stricture in Crohn's disease.
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-alpha. 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-alpha 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-alpha back to pre-treatment levels. This case indicates that, in the colon, infliximab specifically relieves the TNF-alpha-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.
authors.affiliation: G.I. Unit, Internal Medicine of the Department of Clinical and Experimental Pathology, University of Udine School of Medicine, Udine, Italy. Sorrentino@uniud.it
authors.forename: Dario
authors.initials: D
authors.lastname: Sorrentino
authors.forename: Claudio
authors.initials: C
authors.lastname: Avellini
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Beltrami
authors.forename: Enrico
authors.initials: E
authors.lastname: Pasqual
authors.forename: Ester
authors.initials: E
authors.lastname: Zearo
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003108:Colonic Diseases / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000473:pathology; D000069285:Infliximab; D007413:Intestinal Mucosa / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D000069285:Infliximab