El Grupo de Trabajo de Enfermedad Inflamatoria Intestinal de la AEG está formado mayoritariamente por miembros del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU). Es objetivo primordial del grupo el estudio y la investigación de la Enfermedad Inflamatoria Intestinal (EII): enfermedad de Crohn y colitis ulcerosa y la homologación de criterios clínico-terapéuticos en el diagnóstico y tratamiento de la misma.
Autores: Barreiro-de Acosta M, García-Bosch O, Souto R, Mañosa M, Miranda J, García-Sanchez V, Gordillo J, Chacon S, Loras C, Carpio D, Maroto N, Menchén L, Rojas-Feria M, Sierra M, Villoria A, Marin-Jimenez I; Grupo joven GETECCU. Referencia: Inflamm Bowel Dis. 2012 May;18(5):812-7. doi: 10.1002/ibd.21821. Epub 2011 Aug 8.
Despite medical therapy, 30% of patients with ulcerative colitis (UC) need to undergo surgery. Around 50% of patients with proctocolectomy with ileal pouch-anal anastomosis (IPAA) develop complications of the pouch. Clinical evidence for the use of infliximab (IFX) in refractory pouchitis is limited. The aim of this study was to report efficacy of IFX in these patients.
A retrospective, multicenter study was designed. Patients older than 18 years with chronic refractory pouchitis treated with IFX (5 mg/kg) were included. Short-term IFX efficacy was evaluated at week 8 and mid-term efficacy at weeks 26 and 52. Complete response was defined as cessation of diarrhea and urgency and partial response as marked clinical improvement but persisting symptoms. The modified Pouchitis Disease Activity Index (mPDAI) without endoscopy was calculated when available.
Thirty-three consecutive UC patients with chronic refractory pouchitis were included (18 male, mean age 45 years, range 21-67). At week 8, 21% patients achieved complete response and 63% showed partial clinical response. At weeks 26 and 52, 33% and 27% achieved complete response and 33% and 18% showed partial clinical response, respectively. Thirteen patients (39%) withdrew treatment (four for lack of efficacy, four for loss of response and five for adverse events). None of the potential factors analyzed had an influence on response to IFX.
IFX was effective in the short- and mid-term in patients with chronic refractory pouchitis. However, medication had to be discontinued in a high number of patients.