Related Experiment Video

Updated: Jan 18, 2026

Scaled-Up Preparation of an Intermediate of Upatinib, ACT051-3
08:36

Scaled-Up Preparation of an Intermediate of Upatinib, ACT051-3

Published on: April 7, 2023

1.5K

Crohn's disease exacerbated by ghost pills of upadacitinib

Chihiro Yunomura1, Shunsuke Kojimahara1, Keiichi Tominaga2

  • 1Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.

Clinical Journal of Gastroenterology
|September 8, 2025
PubMed

Insights

A patient with severe Crohn's disease (CD) experienced treatment failure due to a unique surgical complication called the "ghost pill phenomenon." This highlights the critical need to consider patient anatomy when prescribing extended-release medications for CD.

Area of Science:

  • Gastroenterology
  • Pharmacology

Background:

  • Crohn's disease (CD) is a chronic inflammatory bowel disease requiring long-term management.
  • Refractory CD often necessitates treatment with multiple biologic agents and surgical interventions.
  • Previous therapies including infliximab, adalimumab, ustekinumab, and vedolizumab failed to achieve remission in this patient.

Purpose of the Study:

  • To report a case of treatment failure with upadacitinib (UPA) in a patient with Crohn's disease.
  • To illustrate the impact of the "ghost pill phenomenon" on oral medication efficacy in post-surgical CD patients.
  • To emphasize the importance of considering patient-specific gastrointestinal anatomy in therapeutic decisions for extended-release formulations.

Main Methods:

  • Case report of a female patient in her 40s with a 30-year history of CD.
  • Review of treatment history including multiple biologic agents and surgical procedures (partial small intestine resection, colostomy).
  • Analysis of treatment response to upadacitinib, identifying the cause of failure as the "ghost pill phenomenon" due to short bowel syndrome.

Main Results:

  • The patient's Crohn's disease remained difficult to control despite numerous treatments.
  • Upadacitinib, an extended-release agent, was ineffective due to rapid expulsion of pills via colostomy, a phenomenon termed "ghost pill phenomenon".
  • This complication prevented the therapeutic efficacy of the oral medication in a patient with significant postsurgical anatomical changes.

Conclusions:

  • The "ghost pill phenomenon" can significantly impede the efficacy of extended-release oral medications in Crohn's disease patients with specific surgical histories.
  • Careful consideration of a patient's gastrointestinal anatomy and surgical status is crucial when prescribing extended-release agents like upadacitinib.
  • Effective communication among healthcare professionals is vital to ensure appropriate patient management and prevent therapeutic failures.

Keywords:
Crohn’s diseaseExtended-release formulationGhost pillsShort bowelSmall intestinal resectionUpadacitinib

More Related Videos

Multimodal Quantitative Phase Imaging with Digital Holographic Microscopy Accurately Assesses Intestinal Inflammation and Epithelial Wound Healing07:38

Multimodal Quantitative Phase Imaging with Digital Holographic Microscopy Accurately Assesses Intestinal Inflammation and Epithelial Wound Healing

Published on: September 13, 2016

8.7K
Evaluating Therapeutic Interventions in the SHIP-deficient Mouse Model of Crohn Disease-like Ileitis and Fibrosis09:44

Evaluating Therapeutic Interventions in the SHIP-deficient Mouse Model of Crohn Disease-like Ileitis and Fibrosis

Published on: October 14, 2025

410

Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
495
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids01:21

Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids

Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
439
Inflammatory Bowel Disease II: Crohn's Disease01:30

Inflammatory Bowel Disease II: Crohn's Disease

Introduction
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
961
Drugs for Treatment of Ulcerative Colitis in IBD01:29

Drugs for Treatment of Ulcerative Colitis in IBD

Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
463
Inflammatory Bowel Disease IV: Pharmacological Management01:29

Inflammatory Bowel Disease IV: Pharmacological Management

Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
531
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
506