title: Anti-TNF, infliximab, and adalimumab can be effective in eosinophilic bowel disease.
abstract: BACKGROUND
  Eosinophilic enterocolitis (EEC) is an emerging distinct inflammatory bowel disease of unknown etiology. There are no published data on the effect of infliximab (IFX) or adalimumab (ADA) for the treatment of refractory cases.
  
  
  METHODS
  A report of all pediatric cases with EEC treated with anti-tumor necrosis factor, identified after an open international call.
  
  
  RESULTS
  We describe here the first 8 children with refractory EEC who were treated with IFX (75% boys; mean age at diagnosis 8.6 ± 4.03 [range 1.6-14 years]; mean age at IFX treatment 11.7 ± 4.4 [range 4.2-16 years]). Allergic and infectious causes of EEC were excluded in all cases. Rapid and complete clinical remission was documented in 6 (75%) children following the induction infusions: 3 (38%) with endoscopic remission, 2 (25%) with endoscopic improvement, and 1 unknown. Four of the 6 responders had secondary loss of response and were switched to ADA, 3 of whom with sustained remission using high doses. Overall, the 6 responders were followed for a median of 7 years (range 4-12; interquartile range 6.4-8.8 years) without evidence of developing Crohn disease or ulcerative colitis. The only case with macroscopic findings on endoscopy was a primary nonresponder.
  
  
  CONCLUSIONS
  IFX and ADA may be effective in cases of refractory idiopathic EEC; however, because this is an uncontrolled report, further prospective studies are warranted.
authors.affiliation: Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel. turnerd@szmc.org.il
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
authors.forename: Victorien M
authors.initials: VM
authors.lastname: Wolters
authors.forename: Richard K
authors.initials: RK
authors.lastname: Russell
authors.forename: Valentina
authors.initials: V
authors.lastname: Shakhnovich
authors.forename: Aleixo M
authors.initials: AM
authors.lastname: Muise
authors.forename: Oren
authors.initials: O
authors.lastname: Ledder
authors.forename: Bo
authors.initials: B
authors.lastname: Ngan
authors.forename: Craig
authors.initials: C
authors.lastname: Friesen
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D004760:Enterocolitis / Q000188:drug therapy* / Q000378:metabolism; D004802:Eosinophilia / Q000188:drug therapy* / Q000378:metabolism; D004804:Eosinophils / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000378:metabolism; D000069285:Infliximab; D008297:Male; D012074:Remission Induction; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab