BibTex RIS Kaynak Göster

Report of infliximab therapy in gastroduodenal and fistulizing Crohn disease

Yıl 2009, Cilt: 17 Sayı: 2, 78 - 81, 01.08.2009

Öz

A 54-year-old female with long-standing ileocolic Crohn's disease was admitted to the hospital with abdominal pain and weight loss. The patient underwent surgery because of obstructive syndrome and had undergone a diverting ileostomy 26 months earlier. She had enterocutaneous fistulizing disease. In our case, there were endoscopic lesions, including mucosal edema, focal and diffuse erythema, nodular lesions, erosion, and ulcers in the antrum and corpus with a paving-stone appearance. Upper endoscopy was suspicious for gastric Crohn involvement. Multiple endoscopic biopsies of the stomach showed granuloma and chronic lymphoplasmacytic inflammation. She had been treated with multiple therapies during that time, including azathioprine 75 mg given daily. Infliximab therapy was initiated to control the patient's underlying Crohn's disease. We stopped infliximab treatment because of side effects, which included hypersensitivity reactions, and then started adalimumab, which is an effective and safe treatment for the induction and maintenance of response in gastric and fistulizing Crohn's disease. Crohn's disease of the stomach is rare. There is nearly always concomitant disease in the small bowel or colon. Endoscopic findings of proximal Crohn's disease resemble those of distal Crohn's disease. Fistulae will develop in approximately one-third of patients with Crohn's disease. The current gold standard of medical treatment to induce and maintain remission for fistulizing Crohn's disease is infliximab. Adalimumab is an effective and safe treatment for the induction and maintenance of response in luminal and perianal fistulizing Crohn's disease.

Kaynakça

  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999;340:1398- 405.
  • E F Stange, S P Travis, S Vermiere et al. European evidence based con- sensus on the diagnosis and management of Crohn’s disease: definitons and diagnosis. 6th ECCO educational Workshop-Istanbul, November 8, 2008.
  • Stenson WF, Korzenik J. Inflammatory Bowel Disease. In: Yamada T, Al- pers DH, Kaplowitz N, Laine L, Owyang C, Powell DW (eds). Textbook of Gastroenterology. 4th edition. Philadelphia: Lippincott Williams & Wilkins. 2003;1699-759.
  • Abrahão LJ Jr, Abrahão LJ, Vargas C, et al. Gastroduodenal Crohn's di- sease - report of 4 cases and review of the literature. Arq Gastroenterol 2001;38:57-62.
  • Maàmouri N, Cheikh I, Belkahla N, et al. Case report of isolated Crohn's disease of the stomach presenting as plastica linitis. Tunis Med 2006;84:513-6.
  • Witte AM, Veenendaal RA, Van Hogezand RA, et al. Crohn's disease of the upper gastrointestinal tract: the value of endoscopic examination. Scand J Gastroenterol Suppl 1998;225:100-5.
  • Wagtmans MJ, van Hogezand RA, Griffioen G, et al. Crohn's disease of the upper gastrointestinal tract. Neth J Med 1997;50:2-7.
  • Wright, Cheryl L, Riddell, Robert H. Histology of the stomach and du- odenum in Crohn's disease. Am J Surg Pathol 1998;22:383-90.
  • Kurtz B, Steinhardt HJ, Malchow H. The radiological and endoscopic ap- pearances of Crohn's disease of the upper gastro-intestinal tract (author's transl). Rofo 1982;136:124-8.
  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999;340:1398- 405.
  • Witte AM, Veenendaal RA, Van Hogezand RA, et al. Crohn's disease of the upper gastrointestinal tract: the value of endoscopic examination. Scand J Gastroenterol Suppl 1998;225:100-5.
  • Turner D, Griffiths AM. Esophageal, gastric, and duodenal manifestati- ons of IBD and the role of upper endoscopy in IBD diagnosis. Curr Gas- troenterol Rep 2007;9:475-8.
  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999;340:1398- 405.
  • Nash PT, Florin TH. Tumour necrosis factor inhibitors. Med J Aust 2005;183:205-8.
  • Sandborn WJ, Rutgeerts P, Enns R, et al. Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med 2007;146:829-38. Epub 2007 Apr 30.
  • López Palacios N, Mendoza JL, Taxonera C, et al. Adalimumab inducti- on and maintenance therapy for Crohn's disease. An open-label study. Rev Esp Enferm Dig 2008;100:676-81.

Gastroduodenal tutulumu olan, infliksimab tedavisi ile anaflaktik reaksiyon gelişen kronik fistülizan Crohn hastalığı olgusu

Yıl 2009, Cilt: 17 Sayı: 2, 78 - 81, 01.08.2009

Öz

Uzun süredir ileokolonik Crohn hastalığı ile takip edilen 54 yaşındaki kadın hasta karın ağrısı ve kilo kaybı şikayetleri ile kliniğimize kabul edildi. 26 ay önce Crohn hastalığına bağlı gelişen obstrüksiyon nedeni ile opere olmuş sonrasında gelişen enterokütan fistül nedeni ile diversiyon kolostomisi açılmış. Hastamızın üst gastrointestinal endoskopik incelemesi Crohn hastalığı ile uyumluydu. Endoskopik incelemede korpus ve antrumda mukozal ödem, diffuz eritem, nodüler lezyonlar, ülser, erozyonlar ve kaldırım taşı görünümü gözlendi. Üst gastrointestinal sistem endoskopik biyopsilerinin histopatolojik incelemesinde kronik lenfoplazmositer iltihap ve granülom izlendi. Hasta şimdiye kadar birçok tedavi almıştı ve hastayı kabul ettiğimizde günlük 150 mg azotiopürin tedavisi alıyordu. Hastalığın kontrolü için infliksimab tedavisi başlandı. İkinci dozda infliksimaba bağlı gelişen hipersensitivite reaksiyonu nedeni ile infliksimab tedavisi kesilip gastrik ve fistülizan Crohn hastalığı'nda etkili adalimumab tedavisi başlandı. Gastrik Crohn hastalığı nadirdir ve olguların çoğu ileokolik Crohn hastalığı'na eşlik eder. Üst gastrointestinal sistem Crohn hastalığı'nda endoskopik bulgular distal Crohn hastalığı ile benzerdir. Crohn hastalığı hastalarının 1/3'ünde fistüller gelişir. Fistulizan Crohn hastalığı'nda indüksiyon ve idamede infliksimab tedavisi günümüzde altın standarttır. Adalimumab tedavisi de gastrik ve fistülizan Crohn hastalığı'nda etkili ve güvenilirdir.

Kaynakça

  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999;340:1398- 405.
  • E F Stange, S P Travis, S Vermiere et al. European evidence based con- sensus on the diagnosis and management of Crohn’s disease: definitons and diagnosis. 6th ECCO educational Workshop-Istanbul, November 8, 2008.
  • Stenson WF, Korzenik J. Inflammatory Bowel Disease. In: Yamada T, Al- pers DH, Kaplowitz N, Laine L, Owyang C, Powell DW (eds). Textbook of Gastroenterology. 4th edition. Philadelphia: Lippincott Williams & Wilkins. 2003;1699-759.
  • Abrahão LJ Jr, Abrahão LJ, Vargas C, et al. Gastroduodenal Crohn's di- sease - report of 4 cases and review of the literature. Arq Gastroenterol 2001;38:57-62.
  • Maàmouri N, Cheikh I, Belkahla N, et al. Case report of isolated Crohn's disease of the stomach presenting as plastica linitis. Tunis Med 2006;84:513-6.
  • Witte AM, Veenendaal RA, Van Hogezand RA, et al. Crohn's disease of the upper gastrointestinal tract: the value of endoscopic examination. Scand J Gastroenterol Suppl 1998;225:100-5.
  • Wagtmans MJ, van Hogezand RA, Griffioen G, et al. Crohn's disease of the upper gastrointestinal tract. Neth J Med 1997;50:2-7.
  • Wright, Cheryl L, Riddell, Robert H. Histology of the stomach and du- odenum in Crohn's disease. Am J Surg Pathol 1998;22:383-90.
  • Kurtz B, Steinhardt HJ, Malchow H. The radiological and endoscopic ap- pearances of Crohn's disease of the upper gastro-intestinal tract (author's transl). Rofo 1982;136:124-8.
  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999;340:1398- 405.
  • Witte AM, Veenendaal RA, Van Hogezand RA, et al. Crohn's disease of the upper gastrointestinal tract: the value of endoscopic examination. Scand J Gastroenterol Suppl 1998;225:100-5.
  • Turner D, Griffiths AM. Esophageal, gastric, and duodenal manifestati- ons of IBD and the role of upper endoscopy in IBD diagnosis. Curr Gas- troenterol Rep 2007;9:475-8.
  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999;340:1398- 405.
  • Nash PT, Florin TH. Tumour necrosis factor inhibitors. Med J Aust 2005;183:205-8.
  • Sandborn WJ, Rutgeerts P, Enns R, et al. Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med 2007;146:829-38. Epub 2007 Apr 30.
  • López Palacios N, Mendoza JL, Taxonera C, et al. Adalimumab inducti- on and maintenance therapy for Crohn's disease. An open-label study. Rev Esp Enferm Dig 2008;100:676-81.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Mustafa Yakut Bu kişi benim

Gülnihan Kırbaş Bu kişi benim

Hakan Bozkaya Bu kişi benim

Yayımlanma Tarihi 1 Ağustos 2009
Yayımlandığı Sayı Yıl 2009 Cilt: 17 Sayı: 2

Kaynak Göster

APA Yakut, M., Kırbaş, G., & Bozkaya, H. (2009). Gastroduodenal tutulumu olan, infliksimab tedavisi ile anaflaktik reaksiyon gelişen kronik fistülizan Crohn hastalığı olgusu. Endoskopi Gastrointestinal, 17(2), 78-81.
AMA Yakut M, Kırbaş G, Bozkaya H. Gastroduodenal tutulumu olan, infliksimab tedavisi ile anaflaktik reaksiyon gelişen kronik fistülizan Crohn hastalığı olgusu. Endoskopi Gastrointestinal. Ağustos 2009;17(2):78-81.
Chicago Yakut, Mustafa, Gülnihan Kırbaş, ve Hakan Bozkaya. “Gastroduodenal Tutulumu Olan, Infliksimab Tedavisi Ile Anaflaktik Reaksiyon gelişen Kronik fistülizan Crohn hastalığı Olgusu”. Endoskopi Gastrointestinal 17, sy. 2 (Ağustos 2009): 78-81.
EndNote Yakut M, Kırbaş G, Bozkaya H (01 Ağustos 2009) Gastroduodenal tutulumu olan, infliksimab tedavisi ile anaflaktik reaksiyon gelişen kronik fistülizan Crohn hastalığı olgusu. Endoskopi Gastrointestinal 17 2 78–81.
IEEE M. Yakut, G. Kırbaş, ve H. Bozkaya, “Gastroduodenal tutulumu olan, infliksimab tedavisi ile anaflaktik reaksiyon gelişen kronik fistülizan Crohn hastalığı olgusu”, Endoskopi Gastrointestinal, c. 17, sy. 2, ss. 78–81, 2009.
ISNAD Yakut, Mustafa vd. “Gastroduodenal Tutulumu Olan, Infliksimab Tedavisi Ile Anaflaktik Reaksiyon gelişen Kronik fistülizan Crohn hastalığı Olgusu”. Endoskopi Gastrointestinal 17/2 (Ağustos 2009), 78-81.
JAMA Yakut M, Kırbaş G, Bozkaya H. Gastroduodenal tutulumu olan, infliksimab tedavisi ile anaflaktik reaksiyon gelişen kronik fistülizan Crohn hastalığı olgusu. Endoskopi Gastrointestinal. 2009;17:78–81.
MLA Yakut, Mustafa vd. “Gastroduodenal Tutulumu Olan, Infliksimab Tedavisi Ile Anaflaktik Reaksiyon gelişen Kronik fistülizan Crohn hastalığı Olgusu”. Endoskopi Gastrointestinal, c. 17, sy. 2, 2009, ss. 78-81.
Vancouver Yakut M, Kırbaş G, Bozkaya H. Gastroduodenal tutulumu olan, infliksimab tedavisi ile anaflaktik reaksiyon gelişen kronik fistülizan Crohn hastalığı olgusu. Endoskopi Gastrointestinal. 2009;17(2):78-81.