Infliximab to Treat Refractory Inflammation After Pelvic Pouch Surgery for Ulcerative Colitis.

Area of Science:

• Gastroenterology
• Immunology
• Surgical Gastroenterology

Background:

• Inflammatory pouch complications are a significant challenge following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).
• First-line therapies often fail, necessitating evaluation of alternative treatments like infliximab.

Purpose of the Study:

• To assess the efficacy of infliximab in treating chronic refractory pouchitis (CP) and Crohn's disease (CD)-like outcomes post-IPAA.
• To identify factors associated with therapeutic response to infliximab.

Main Methods:

• Retrospective review of patients undergoing colectomy and IPAA for UC between 2000-2014.
• Inclusion of patients with CP or CD-like outcomes treated with infliximab, analyzing pre-treatment parameters and response at 8 and 48 weeks.
• Assessment of serum antibodies including ASCA, anti-OmpC, anti-CBir1, and pANCA.

Main Results:

• Infliximab treatment led to a 74% initial response and 62.6% sustained response in 42 patients.
• Significant reductions in modified Pouchitis Disease Activity Index (mPDAI) and C-reactive protein were observed (p < 0.001).
• Pre-treatment mPDAI <10 and early endoscopic resolution of rectal bleeding were associated with sustained response.

Conclusions:

• Infliximab demonstrates effectiveness in managing inflammatory pouch complications refractory to other treatments.
• Identifying patients with pre-treatment mPDAI <10 and utilizing early endoscopy can help predict sustained response to infliximab.