Experience in the treatment of severe bleeding in Crohn’s disease with anti-TNF therapy

Česká verze

Authors: J. Ulbrych ¹; K. Šlapalová ¹; A. Ondrejková ¹; J. Drábková ²; J. Vaníček ²; B. Kianička ¹
Authors place of work: II. interní klinika LF MU a FN U sv. Anny v Brně ¹; Klinika zobrazovacích metod LF MU a FN u sv. Anny v Brně ²
Published in the journal: Gastroent Hepatol 2018; 72(3): 251-256
Category: IBD: kazuistika
doi: https://doi.org/10.14735/amgh2018251

Summary

Massive bleeding into the gastrointestinal tract (enterorrhagia) is a rare and life-threatening complication of Crohn’s disease (CD) and occurs in up to 4% of patients. The most common cause of enterorrhagia is a deep ulceration caused by inflammation of a part of the gastrointestinal tract. Risk factors for enterorrhagia have not yet been identified. Determination of the source of the bleeding and the extent of the inflammatory disorder are vital for successful treatment. Based on the results of examinations, a decision on the optimal treatment can be made. In this work, we describe two CD cases who were hospitalized at our workplace in 2016–2017. The first case was a patient who required hospitalization because of CD relapse in the colon area. The patient did not respond to conventional therapy and did not enter remission. Despite treatment, enterorrhagia propagated. The second case was a patient with massive enterorrhagia that appeared as the primary manifestation of CD relapse in the terminal ileum and colon. Conventional therapy did not lead to cessation of bleeding or remission. Instead, enterorhagia propagated. Using these selected case studies, we aim to demonstrate the efficacy of anti-TNF therapy in preventing gastrointestinal bleeding in CD patients. We note that anti-TNF therapy has the advantage of rapid onset in cases where conventional therapy has failed or in cases where other therapeutic methods such as mini-invasive procedures or surgical treatment cannot be used due to the high risk of “short-bowel syndrome”.

Key words: Crohn’s disease – enterorrhagia – anti-TNF – infliximab

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted: 29. 1. 2018

Accepted: 24. 4. 2018

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