Selective effect of infliximab on the inflammatory component of a colonic stricture in Crohn's disease.
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.
Sorrentino
Dario
D
G.I. Unit, Internal Medicine of the Department of Clinical and Experimental Pathology, University of Udine School of Medicine, Udine, Italy. Sorrentino@uniud.it
Avellini
Claudio
C
Beltrami
Carlo Alberto
CA
Pasqual
Enrico
E
Zearo
Ester
E
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
D000911:Antibodies, Monoclonal; D000069285:Infliximab