One-year infliximab administration for the treatment of chronic refractory pouchitis.
OBJECTIVE
To determine the efficacy of infliximab in the treatment of chronic refractory pouchitis, following ileo-pouch anal anastomosis (IPAA) for ulcerative colitis (UC).


METHODS
Seven patients (4 females, 3 males) with chronic refractory pouchitis were included in an open study. Pouchitis was diagnosed by clinical plus endoscopic and histological criteria. Three patients also had fistulae (pouch-bladder in 1 and perianal in 2). Extraintestinal manifestations were also present in 4 patients (erythema nodosum in 2, arthralgiae in 2). All patients were refractory to standard therapy. Crohn's disease was carefully excluded in all patients after re-evaluation of the history and examination of the small bowel with enteroclysis or small bowel capsule endoscopy. Patients received Infliximab 5 mg/kg at 0, 2 and 6 weeks and thereafter every 2 months for 1 year. Clinical response was classified as complete, partial, and no response. Fistulae closure was classified as complete, partial, and no closure. The pouchitis disease activity index (PDAI) was also used as an outcome measure.


RESULTS
Clinically, all patients improved. After 1 year of follow-up, 5 of the 7 patients had a complete clinical response, and 2 of the 3 patients with a fistula had complete fistulae closure. At the end of the follow-up period the median PDAI dropped from 11 (baseline) (range, 10-14) to 5 (range, 3-8). Extraintestinal manifestations were in complete remission at the end of the followup period as well.


CONCLUSIONS
Our results indicate that infliximab may be recommended for the treatment of chronic refractory pouchitis complicated or not by fistulae following IPAA for UC.
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Nikos
N
Viazis
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Marios
M
Giakoumis
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Theodoros
T
Koukouratos
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Efstathios
E
Saprikis
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Elias
E
Anastasopoulos
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Mousa
M
Al-Odat
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Georgios
G
Kechagias
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Georgios
G
Zacharakis
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Konstantinos
K
Markoglou
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Paraskevi
P
Gouma
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Demetrios G
DG
Karamanolis
Ulcerative colitis; chronic refractory pouchitis; ileal pouch anal anastomosis