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Infliximab for severe recurrent Crohn's disease presenting with massive gastrointestinal hemorrhage
Claudio Papi1, Loredana Gili, Maurizio Tarquini
1Department of Gastroenterology and Internal Medicine, S. Filippo Neri Hospital, Rome, Italy. c.papi@sanfilipponeri.roma.it
Insights
Severe gastrointestinal bleeding in Crohn's disease is challenging to manage. Monoclonal anti-TNFalpha antibodies like infliximab rapidly heal mucosa, preventing recurrent bleeding in severe cases.
Area of Science:
- Gastroenterology
- Immunology
Background:
- Severe gastrointestinal hemorrhage is a rare but serious complication of Crohn's disease, often originating from colonic ulcers.
- Managing severe bleeding in Crohn's disease presents significant therapeutic challenges with high recurrence rates.
Observation:
- Two cases of severe, recurrent Crohn's disease with massive lower gastrointestinal bleeding were reported.
- These patients experienced significant bleeding episodes that were difficult to control with conventional therapies.
Findings:
- Treatment with monoclonal anti-TNFalpha antibodies (infliximab) led to rapid mucosal healing in both patients.
- Infliximab administration effectively prevented recurrent bleeding episodes in these severe cases.
Implications:
- Infliximab offers a promising therapeutic option for managing severe gastrointestinal bleeding in Crohn's disease.
- Rapid mucosal healing induced by infliximab may be key to preventing future bleeding events in Crohn's patients.
Abstract:
Severe gastrointestinal hemorrhage is an uncommon complication of Crohn's disease. Most bleeding episodes originate from colonic ulcers or ulcerated areas. The management of severe gastrointestinal bleeding in Crohn's disease is a therapeutic challenge. Several approaches including surgical resection, specific medical therapy of Crohn's disease, endoscopic treatment, or angiographic intervention have been attempted, but recurrence of bleeding is high. Monoclonal anti TNFalpha antibodies (infliximab) can induce relatively rapid mucosal healing. We report two cases of severe recurrent Crohn's disease presenting with massive lower gastrointestinal bleeding in which infliximab induced rapid mucosal healing and prevented recurrent bleeding.