BACKGROUND Crohn's disease(CD)is a type of inflammatory bowel disease,with chronic and progressive characteristics.Infliximab(IFX)can rapidly relieve CD-related symptoms and promote mucosal healing.However,some pa...BACKGROUND Crohn's disease(CD)is a type of inflammatory bowel disease,with chronic and progressive characteristics.Infliximab(IFX)can rapidly relieve CD-related symptoms and promote mucosal healing.However,some patients may occur secondary loss of response(SLOR)during the maintenance treatment,leading to the recurrence or progression of CD.The current IFX efficacy prediction models for CD have limited applicability to SLOR.Radiomics,as a non-invasive te-chnique,is expected to serve as a more accurate tool for predicting the risk of SLOR.AIM To develop a radiomics-based model via integrative analysis of intestinal wall and creeping fat to predict SLOR in CD.METHODS We retrospectively analyzed clinical and imaging data from 220 CD patients in two centers.Univariate and multivariate analyses were used to screen out clinically independent predictors of SLOR.Radiomics features of the intestinal wall and creeping fat were extracted and fused together for analysis.Univariate and least absolute shrinkage and selection operator analyses were used to select the most valuable radiomics features to calculate Radscore and develop radiomics predictive model.A combined predictive model was developed based on the Radscore and clinically independent predictors through multivariate logistic regression analysis.Area under the receiver operating characteristic curve(AUC),calibration curve and the decision curve analysis were used to verify model performance.RESULTS White blood cell count,disease duration and Harvey-Bradshaw Index were identified as clinically independent predictors of SLOR to develop the clinical model.Fifteen most valuable radiomics features were selected to develop the radiomics model.Compared with the clinical and radiomics models,the combined model achieved the best prediction performance,with AUCs were 0.871(95%CI:0.814-0.929)in the training cohort and 0.854(95%CI:0.759-0.949)in the validation cohort.CONCLUSION The combined model that integrates intestinal wall and creeping fat analysis is valuable for predicting the SLOR of IFX in CD.展开更多
BACKGROUND Visceral adipose tissue(VAT)plays a role in the pathogenesis of Crohn's disease(CD)and is associated with treatment outcomes following infliximab(IFX)therapy.We developed and validated the first delta-r...BACKGROUND Visceral adipose tissue(VAT)plays a role in the pathogenesis of Crohn's disease(CD)and is associated with treatment outcomes following infliximab(IFX)therapy.We developed and validated the first delta-radiomics model to quantify VAT heterogeneity as a predictive biomarker for IFX response in patients with CD.AIM To develop a longitudinal computed tomography(CT)-based delta-radiomics model of VAT for predicting secondary loss of response(SLR)in patients with CD.METHODS This retrospective study included 161 patients with CD who achieved clinical remission following IFX induction therapy between 2015 and 2023.All patients underwent CT enterography before IFX initiation and after completing induction therapy.VAT volume was delineated by two radiologists in consensus.Radiomics features were extracted from pre-treatment and post-induction CT images,and delta-radiomics features were calculated as follows:Delta features=Feature-post-Feature-pre.A radiomics model was constructed using logistic regression.Model performance was assessed using discrimination,calibration,and decision curve analyses.RESULTS Nine significant delta-radiomics features were used to develop the delta-radiomics model,yielding an area under the receiver operating characteristic curve(AUC)of 0.816(95%CI:0.737-0.896)in the training cohort and 0.750(95%CI:0.605-0.895)in the validation cohort.Multivariable logistic regression identified platelet count,Montreal behavior classification,and the VAT/subcutaneous adipose tissue volume ratio prior to treatment as independent risk factors for SLR.The combined model integrating clinical predictors and delta-radiomics features achieved superior predictive performance,with an AUC of 0.853(95%CI:0.786-0.921)in the training cohort and 0.812(95%CI:0.677-0.948)in the validation cohort.CONCLUSION We developed a predictive model based on longitudinal changes in VAT,demonstrating significant potential for identifying patients with CD at high risk of SLR to IFX therapy.展开更多
We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn's disease at a different institution...We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn's disease at a different institution,although the clinical and radiological picture was not typical and the response to corticosteroids was poor.We performed a single-balloon enteroscopy showing a short,ulcerous stenosis 50 cm proximal from Bauhin's valve.The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis(CMUSE).High dose corticosteroids were again started,without effect.The monoclonal tumor necrosis factor-α(TNF-α) antibody infliximab was added to the medical therapy.After induction therapy,both clinical and endoscopic amelioration was obtained.Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE.展开更多
AIM: To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn’s disease. METHODS: We performed a retrospective chart review of 36 patients with Crohn’s diseas...AIM: To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn’s disease. METHODS: We performed a retrospective chart review of 36 patients with Crohn’s disease. Ten patients (group A) were treated with mesalamine after induction therapy with oral prednisolone, and 13 patients (group B) were treated with azathioprine after induction therapy with oral prednisolone. Thirteen patients (group C) received infliximab and azathioprine for induction and maintenance therapy for the first year, and were treated with azathioprine after 1 year. All patients were followed for at least 24 mo. Efficacy was determined by the relapse rate using the pediatric Crohn’s disease activity index score in each group at 12 and 24 mo. RESULTS: At the 1 year follow-up, the relapse ratee, Mi Jin Kim, Hae Jeong Lee, Yon Ho Choe (23.1%, 3 of 13 patients) in group C was lower than that (61.5%, 8 of 13 patients) in group B (P = 0.047). At the 2 years follow-up, the relapse rate (38.5%, 5 of 13 patients) in group C was lower than that (76.9%, 10 of 13 patients) in group B (P = 0.047). Adverse events in group C were fewer than in groups A and B. CONCLUSION: Early induction with infliximab at diagnosis, known as "top-down" therapy, was effective for reducing the relapse rate compared to conventional therapies for at least 2 years.展开更多
AIM:To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received inf...AIM:To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received infliximab combined withsurgery to treat perianal fistulizing CD,which was followed by an immunosuppressive agent as maintenance therapy.RESULTS:A total of 28 patients with perianal fistulizing CD were included.At week 30,89.3%(25/28)of the patients were clinically cured with an average healing time of 31.4 d.The CD activity index decreased to70.07±77.54 from 205.47±111.13(P<0.01)after infliximab treatment.The perianal CD activity index was decreased to 0.93±2.08 from 8.54±4.89(P<0.01).C-reactive protein,erythrocyte sedimentation rate,platelets,and neutrophils all decreased significantly compared with the pretreatment levels(P<0.01).Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up.After a median follow-up of 26.4 mo(range:14-41 mo),96.4%(27/28)of the patients had a clinical cure.CONCLUSION:Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD,and this treatment was associated with better longterm outcomes.展开更多
AIM: To evaluate the safety and efficacy of a long- term therapy with infliximab in Crohn’s disease (CD) and ulcerative colitis (UC) patients retrospectively. METHODS: The medical charts of 50 patients (40 CD and 10 ...AIM: To evaluate the safety and efficacy of a long- term therapy with infliximab in Crohn’s disease (CD) and ulcerative colitis (UC) patients retrospectively. METHODS: The medical charts of 50 patients (40 CD and 10 UC), who received after a loading dose of 3 infl iximab infusions scheduled re-treatments every 8 wk as a maintenance protocol, were reviewed. RESULTS: Median (range) duration of treatment was 27 (4-64) mo in CD patients and 24.5 (6-46) mo in UC patients. Overall, 32 (80%) CD and 9 (90%) UC patients showed a sustained clinical response or remission throughout the maintenance period. Three CD patients shortened the interval between infusions. Eight (20%) CD patients and 1 UC patient underwent surgery for flare up of disease. Nine out of 29 CD and 4 out of 9 UC patients, who discontinued infliximab scheduled treatment, are still relapse-free after a median of 16 (5-30) and 6.5 (4-16) mo following the last infusion, respectively. Ten CD patients (25%) and 1 UC patient required concomitant steroid therapy during maintenance period, compared to 30 (75%) and 9 (90%) patients at enrolment. Of the 50 patients, 16 (32%) experienced at least 1 adverse event and 3 patients (6%) were diagnosed with cancer during maintenance treatment. CONCLUSION: Scheduled infl iximab strategy is effective in maintaining long-term clinical remission both in CD and UC and determines a marked steroid sparing effect. Long-lasting remission was observed following infliximab withdrawal.展开更多
AIM: To study the response to infliximab in pediatric inflammatory bowel disease (IBD), as reflected in fecal calprotectin levels. METHODS: Thirty-six pediatric patients with IBD [23 Crohn's disease (CD), 13 ulcer...AIM: To study the response to infliximab in pediatric inflammatory bowel disease (IBD), as reflected in fecal calprotectin levels. METHODS: Thirty-six pediatric patients with IBD [23 Crohn's disease (CD), 13 ulcerative colitis (UC); median age 14 years] were treated with infliximab. Fecal calprotectin was measured at baseline, and 2 and 6 wk after therapy, and compared to blood inflammatory markers. Maintenance medication was unaltered until the third infusion but glucocorticoids were tapered off if the patient was doing well. RESULTS: At introduction of infliximab, median fecal calprotectin level was 1150 μg/g (range 54-6032 μg/g). By week 2, the fecal calprotectin level had declined to amedian 261 μg/g (P < 0.001). In 37% of the patients, fecal calprotectin was normal (< 100 μg/g) at 2 wk. By week 6, there was no additional improvement in the fecal calprotectin level (median 345 μg/g). In 22% of the patients, fecal calprotectin levels increased by week 6 to pretreatment levels or above, suggesting no response (or a loss of early response). Thus, in CD, the proportion of non-responsive patients by week 6 seemed lower, because only 9% showed no improvement in their fecal calprotectin level when compared to the respective figure of 46% of the UC patients (P < 0.05). CONCLUSION: When treated with infliximab, fecal calprotectin levels reflecting intestinal inflammation normalized rapidly in one third of pediatric patients suggesting complete mucosal healing.展开更多
Weber-Christian disease(WCD) is an inflammatory disease whose main histological feature is lobular panniculitis of adipose tissue. The location of panniculitis determines the clinical presentation,being the subcutaneo...Weber-Christian disease(WCD) is an inflammatory disease whose main histological feature is lobular panniculitis of adipose tissue. The location of panniculitis determines the clinical presentation,being the subcutaneous adipose tissue the most frequent one,followed by liver,spleen,bone marrow and mesenteric adipose tissue.Systemic corticosteroids are first line treatment,but other options should be considered if systemic symptoms are observed or in case of refractory clinical situation.We report herein a case with WCD showing orbital,mesenteric and ileocolonic involvement,which required surgical treatment and also developed postoperative recurrence.Symptoms were resolved by administration of thalidomide and,afterwards,infliximab.To our knowledge,this is the first report of Weber-Christian disease with luminal ileocolonic involvement,treated with infliximab.展开更多
AIM: To assess prospectively small bowel stenoses in Crohn's disease (CD) patients treated with infliximab using Small Intestine Contrast Ultrasonography (SICUS). METHODS: Twenty patients (M 12, age, 42.7 ± 1...AIM: To assess prospectively small bowel stenoses in Crohn's disease (CD) patients treated with infliximab using Small Intestine Contrast Ultrasonography (SICUS). METHODS: Twenty patients (M 12, age, 42.7 ± 11.8 years), 15 of whom showed obstructive symptoms indicating the presence of small bowel stenosis, and 5 without stenosis, were treated with infliximab (5 mg/kg at wk 0, 2, 6 and 5 mg/kg every 8 wk thereafter) for steroid refractoriness, fistulizing disease, or to avoid high-risk surgery. SICUS was performed at the induction phase and at regular time intervals during the follow-up period of 34.7 ± 16.1 mo (range 7-58). Small bowel stenoses were detected by SICUS, endoscopy and MRI. RESULTS: In no case was progression of stenoses or the appearance of new ones seen. Of the 15 patients with stenosis, 5 stopped treatment after the induction phase (2 for no response, 3 for drug intolerance, one of whom showed complete regression of one stenosis). Among the remaining 10 patients, a complete regression of 8 stenoses (1 stenosis in 5 patients and 3 stenoses in one patient) was observed after 6-22 infliximab infusions. CONCLUSION: In patients with CD treated with infliximab we observed: (a) No progression of small bowel stenosis and no appearance of new ones, (b) Complete regression of 1/22 stenosis after the induction phase and of 8/15 (53.3%) stenosis after 6-22 infusionsduring maintenance therapy.展开更多
Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases.However,lung toxicity can be induced by conventional medications used to maintain remission,and similar evidence is a...Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases.However,lung toxicity can be induced by conventional medications used to maintain remission,and similar evidence is also emerging for biologics.We present the case of a young woman affected by colonic Crohn’s disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab.She was referred to our clinic with a severe relapse and was treated with infliximab,an antitumor necrosis factor α(TNF-α)antibody,to induce remission.After an initial benefit,with decreases in bowel movements,rectal bleeding and C-reactive protein levels,she experienced shortness of breath after the 5thinfusion.Noninfectious interstitial lung disease was diagnosed.Both mesalamine and infliximab were discontinued,and steroids were introduced with slow but progressive improvement of symptoms,radiology and functional tests.This represents a rare case of interstitial lung disease associated with infliximab therapy and the effect of drug withdrawal on these lung alterations.Given the increasing use of anti-TNF-α therapies and the increasing reports of pulmonary abnormalities in patients with inflammatory bowel diseases,this case underlines the importance of a careful evaluation of respiratory symptoms in patients undergoing infliximab therapy.展开更多
基金Supported by Natural Science Foundation of Anhui Province,China,No.2308085MH241.
文摘BACKGROUND Crohn's disease(CD)is a type of inflammatory bowel disease,with chronic and progressive characteristics.Infliximab(IFX)can rapidly relieve CD-related symptoms and promote mucosal healing.However,some patients may occur secondary loss of response(SLOR)during the maintenance treatment,leading to the recurrence or progression of CD.The current IFX efficacy prediction models for CD have limited applicability to SLOR.Radiomics,as a non-invasive te-chnique,is expected to serve as a more accurate tool for predicting the risk of SLOR.AIM To develop a radiomics-based model via integrative analysis of intestinal wall and creeping fat to predict SLOR in CD.METHODS We retrospectively analyzed clinical and imaging data from 220 CD patients in two centers.Univariate and multivariate analyses were used to screen out clinically independent predictors of SLOR.Radiomics features of the intestinal wall and creeping fat were extracted and fused together for analysis.Univariate and least absolute shrinkage and selection operator analyses were used to select the most valuable radiomics features to calculate Radscore and develop radiomics predictive model.A combined predictive model was developed based on the Radscore and clinically independent predictors through multivariate logistic regression analysis.Area under the receiver operating characteristic curve(AUC),calibration curve and the decision curve analysis were used to verify model performance.RESULTS White blood cell count,disease duration and Harvey-Bradshaw Index were identified as clinically independent predictors of SLOR to develop the clinical model.Fifteen most valuable radiomics features were selected to develop the radiomics model.Compared with the clinical and radiomics models,the combined model achieved the best prediction performance,with AUCs were 0.871(95%CI:0.814-0.929)in the training cohort and 0.854(95%CI:0.759-0.949)in the validation cohort.CONCLUSION The combined model that integrates intestinal wall and creeping fat analysis is valuable for predicting the SLOR of IFX in CD.
基金Supported by the National Natural Science Foundation of China,No.82372072 and No.82071986.
文摘BACKGROUND Visceral adipose tissue(VAT)plays a role in the pathogenesis of Crohn's disease(CD)and is associated with treatment outcomes following infliximab(IFX)therapy.We developed and validated the first delta-radiomics model to quantify VAT heterogeneity as a predictive biomarker for IFX response in patients with CD.AIM To develop a longitudinal computed tomography(CT)-based delta-radiomics model of VAT for predicting secondary loss of response(SLR)in patients with CD.METHODS This retrospective study included 161 patients with CD who achieved clinical remission following IFX induction therapy between 2015 and 2023.All patients underwent CT enterography before IFX initiation and after completing induction therapy.VAT volume was delineated by two radiologists in consensus.Radiomics features were extracted from pre-treatment and post-induction CT images,and delta-radiomics features were calculated as follows:Delta features=Feature-post-Feature-pre.A radiomics model was constructed using logistic regression.Model performance was assessed using discrimination,calibration,and decision curve analyses.RESULTS Nine significant delta-radiomics features were used to develop the delta-radiomics model,yielding an area under the receiver operating characteristic curve(AUC)of 0.816(95%CI:0.737-0.896)in the training cohort and 0.750(95%CI:0.605-0.895)in the validation cohort.Multivariable logistic regression identified platelet count,Montreal behavior classification,and the VAT/subcutaneous adipose tissue volume ratio prior to treatment as independent risk factors for SLR.The combined model integrating clinical predictors and delta-radiomics features achieved superior predictive performance,with an AUC of 0.853(95%CI:0.786-0.921)in the training cohort and 0.812(95%CI:0.677-0.948)in the validation cohort.CONCLUSION We developed a predictive model based on longitudinal changes in VAT,demonstrating significant potential for identifying patients with CD at high risk of SLR to IFX therapy.
文摘We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn's disease at a different institution,although the clinical and radiological picture was not typical and the response to corticosteroids was poor.We performed a single-balloon enteroscopy showing a short,ulcerous stenosis 50 cm proximal from Bauhin's valve.The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis(CMUSE).High dose corticosteroids were again started,without effect.The monoclonal tumor necrosis factor-α(TNF-α) antibody infliximab was added to the medical therapy.After induction therapy,both clinical and endoscopic amelioration was obtained.Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE.
文摘AIM: To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn’s disease. METHODS: We performed a retrospective chart review of 36 patients with Crohn’s disease. Ten patients (group A) were treated with mesalamine after induction therapy with oral prednisolone, and 13 patients (group B) were treated with azathioprine after induction therapy with oral prednisolone. Thirteen patients (group C) received infliximab and azathioprine for induction and maintenance therapy for the first year, and were treated with azathioprine after 1 year. All patients were followed for at least 24 mo. Efficacy was determined by the relapse rate using the pediatric Crohn’s disease activity index score in each group at 12 and 24 mo. RESULTS: At the 1 year follow-up, the relapse ratee, Mi Jin Kim, Hae Jeong Lee, Yon Ho Choe (23.1%, 3 of 13 patients) in group C was lower than that (61.5%, 8 of 13 patients) in group B (P = 0.047). At the 2 years follow-up, the relapse rate (38.5%, 5 of 13 patients) in group C was lower than that (76.9%, 10 of 13 patients) in group B (P = 0.047). Adverse events in group C were fewer than in groups A and B. CONCLUSION: Early induction with infliximab at diagnosis, known as "top-down" therapy, was effective for reducing the relapse rate compared to conventional therapies for at least 2 years.
基金Supported by Grants from Priority Academic Program Development of Jiangsu Higher Education Institutions,Jiangsu Provincial Clinical Medicine of Science and Technology Project,No.BL2014100
文摘AIM:To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received infliximab combined withsurgery to treat perianal fistulizing CD,which was followed by an immunosuppressive agent as maintenance therapy.RESULTS:A total of 28 patients with perianal fistulizing CD were included.At week 30,89.3%(25/28)of the patients were clinically cured with an average healing time of 31.4 d.The CD activity index decreased to70.07±77.54 from 205.47±111.13(P<0.01)after infliximab treatment.The perianal CD activity index was decreased to 0.93±2.08 from 8.54±4.89(P<0.01).C-reactive protein,erythrocyte sedimentation rate,platelets,and neutrophils all decreased significantly compared with the pretreatment levels(P<0.01).Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up.After a median follow-up of 26.4 mo(range:14-41 mo),96.4%(27/28)of the patients had a clinical cure.CONCLUSION:Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD,and this treatment was associated with better longterm outcomes.
文摘AIM: To evaluate the safety and efficacy of a long- term therapy with infliximab in Crohn’s disease (CD) and ulcerative colitis (UC) patients retrospectively. METHODS: The medical charts of 50 patients (40 CD and 10 UC), who received after a loading dose of 3 infl iximab infusions scheduled re-treatments every 8 wk as a maintenance protocol, were reviewed. RESULTS: Median (range) duration of treatment was 27 (4-64) mo in CD patients and 24.5 (6-46) mo in UC patients. Overall, 32 (80%) CD and 9 (90%) UC patients showed a sustained clinical response or remission throughout the maintenance period. Three CD patients shortened the interval between infusions. Eight (20%) CD patients and 1 UC patient underwent surgery for flare up of disease. Nine out of 29 CD and 4 out of 9 UC patients, who discontinued infliximab scheduled treatment, are still relapse-free after a median of 16 (5-30) and 6.5 (4-16) mo following the last infusion, respectively. Ten CD patients (25%) and 1 UC patient required concomitant steroid therapy during maintenance period, compared to 30 (75%) and 9 (90%) patients at enrolment. Of the 50 patients, 16 (32%) experienced at least 1 adverse event and 3 patients (6%) were diagnosed with cancer during maintenance treatment. CONCLUSION: Scheduled infl iximab strategy is effective in maintaining long-term clinical remission both in CD and UC and determines a marked steroid sparing effect. Long-lasting remission was observed following infliximab withdrawal.
基金Supported by The Finnish Pediatric Research Foundationthe Pivikki and Sakari Sohlberg Foundation+1 种基金the Mary and Georg C Ehrnrooth Foundationthe Helsinki University Central Hospital Research Fund
文摘AIM: To study the response to infliximab in pediatric inflammatory bowel disease (IBD), as reflected in fecal calprotectin levels. METHODS: Thirty-six pediatric patients with IBD [23 Crohn's disease (CD), 13 ulcerative colitis (UC); median age 14 years] were treated with infliximab. Fecal calprotectin was measured at baseline, and 2 and 6 wk after therapy, and compared to blood inflammatory markers. Maintenance medication was unaltered until the third infusion but glucocorticoids were tapered off if the patient was doing well. RESULTS: At introduction of infliximab, median fecal calprotectin level was 1150 μg/g (range 54-6032 μg/g). By week 2, the fecal calprotectin level had declined to amedian 261 μg/g (P < 0.001). In 37% of the patients, fecal calprotectin was normal (< 100 μg/g) at 2 wk. By week 6, there was no additional improvement in the fecal calprotectin level (median 345 μg/g). In 22% of the patients, fecal calprotectin levels increased by week 6 to pretreatment levels or above, suggesting no response (or a loss of early response). Thus, in CD, the proportion of non-responsive patients by week 6 seemed lower, because only 9% showed no improvement in their fecal calprotectin level when compared to the respective figure of 46% of the UC patients (P < 0.05). CONCLUSION: When treated with infliximab, fecal calprotectin levels reflecting intestinal inflammation normalized rapidly in one third of pediatric patients suggesting complete mucosal healing.
文摘Weber-Christian disease(WCD) is an inflammatory disease whose main histological feature is lobular panniculitis of adipose tissue. The location of panniculitis determines the clinical presentation,being the subcutaneous adipose tissue the most frequent one,followed by liver,spleen,bone marrow and mesenteric adipose tissue.Systemic corticosteroids are first line treatment,but other options should be considered if systemic symptoms are observed or in case of refractory clinical situation.We report herein a case with WCD showing orbital,mesenteric and ileocolonic involvement,which required surgical treatment and also developed postoperative recurrence.Symptoms were resolved by administration of thalidomide and,afterwards,infliximab.To our knowledge,this is the first report of Weber-Christian disease with luminal ileocolonic involvement,treated with infliximab.
文摘AIM: To assess prospectively small bowel stenoses in Crohn's disease (CD) patients treated with infliximab using Small Intestine Contrast Ultrasonography (SICUS). METHODS: Twenty patients (M 12, age, 42.7 ± 11.8 years), 15 of whom showed obstructive symptoms indicating the presence of small bowel stenosis, and 5 without stenosis, were treated with infliximab (5 mg/kg at wk 0, 2, 6 and 5 mg/kg every 8 wk thereafter) for steroid refractoriness, fistulizing disease, or to avoid high-risk surgery. SICUS was performed at the induction phase and at regular time intervals during the follow-up period of 34.7 ± 16.1 mo (range 7-58). Small bowel stenoses were detected by SICUS, endoscopy and MRI. RESULTS: In no case was progression of stenoses or the appearance of new ones seen. Of the 15 patients with stenosis, 5 stopped treatment after the induction phase (2 for no response, 3 for drug intolerance, one of whom showed complete regression of one stenosis). Among the remaining 10 patients, a complete regression of 8 stenoses (1 stenosis in 5 patients and 3 stenoses in one patient) was observed after 6-22 infliximab infusions. CONCLUSION: In patients with CD treated with infliximab we observed: (a) No progression of small bowel stenosis and no appearance of new ones, (b) Complete regression of 1/22 stenosis after the induction phase and of 8/15 (53.3%) stenosis after 6-22 infusionsduring maintenance therapy.
文摘Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases.However,lung toxicity can be induced by conventional medications used to maintain remission,and similar evidence is also emerging for biologics.We present the case of a young woman affected by colonic Crohn’s disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab.She was referred to our clinic with a severe relapse and was treated with infliximab,an antitumor necrosis factor α(TNF-α)antibody,to induce remission.After an initial benefit,with decreases in bowel movements,rectal bleeding and C-reactive protein levels,she experienced shortness of breath after the 5thinfusion.Noninfectious interstitial lung disease was diagnosed.Both mesalamine and infliximab were discontinued,and steroids were introduced with slow but progressive improvement of symptoms,radiology and functional tests.This represents a rare case of interstitial lung disease associated with infliximab therapy and the effect of drug withdrawal on these lung alterations.Given the increasing use of anti-TNF-α therapies and the increasing reports of pulmonary abnormalities in patients with inflammatory bowel diseases,this case underlines the importance of a careful evaluation of respiratory symptoms in patients undergoing infliximab therapy.
