Abdominal phlegmons in Crohnʼs disease: Outcomes following antitumor necrosis factor therapy

Cullen, Garret; Vaughn, Byron P.; Ahmed, Awais; Peppercorn, Mark A.; Smith, Martin P.; Moss, Alan C.; Cheifetz, Adam S.

doi:10.1002/ibd.21783

Cited by 45 publications

(28 citation statements)

References 27 publications

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“…Cullen et al . 2 reported that 15.4% (2/13) of CD patients with abdominal phlegmons eventually had surgery more than a year after starting anti-TNF therapy. Besides, the risk of disease recurrence after surgery is high in penetrating CD, and repeat surgical resection can lead to the short bowel syndrome.…”

Section: Discussionmentioning

confidence: 99%

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Multiple fresh fecal microbiota transplants induces and maintains clinical remission in Crohn’s disease complicated with inflammatory mass

Zhu

et al. 2017

Sci Rep

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The ancient Chinese medical literature, as well as our prior clinical experience, suggests that fecal microbiota transplantation (FMT) could treat the inflammatory mass. We aimed to evaluate the efficacy and safety of multiple fresh FMTs for Crohn’s disease (CD) complicated with intraabdominal inflammatory mass. The "one-hour FMT protocol" was followed in all patients. Twenty-five patients were diagnosed with CD and related inflammatory mass by CT or MRI. All patients received the initial FMT followed by repeated FMTs every 3 months. The primary endpoint was clinical response (improvement and remission) and sustained clinical remission at 12 months. Secondary endpoints were improvement in size of phegmon/abscess based upon cross-sectional imaging and safety of FMT. 68.0% (17/25) and 52.0% (13/25) of patients achieved clinical response and clinical remission at 3 months post the initial FMT, respectively. The proportion of patients at 6 months, 12 months and 18 months achieving sustained clinical remission with sequential FMTs was 48.0% (12/25), 32.0% (8/25) and 22.7% (5/22), respectively. 9.5% (2/21) of patients achieved radiological healing and 71.4% (15/21) achieved radiological improvement. No severe adverse events related to FMT were observed. This pragmatic study suggested that sequential fresh FMTs might be a promising, safe and effective therapy to induce and maintain clinical remission in CD with intraabdominal inflammatory mass.

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Section: Discussionmentioning

confidence: 99%

“…Crohn’s disease (CD) is characterized by a transmural inflammatory process, which may lead to the formation of intraabdominal inflammatory masses (phlegmon or abscess) 1, 2 . Phlegmons originate from deep fissuring ulcerations, and typically extends to the adjacent mesentery and the affected loop of bowel.…”

Section: Introductionmentioning

confidence: 99%

Multiple fresh fecal microbiota transplants induces and maintains clinical remission in Crohn’s disease complicated with inflammatory mass

Zhu

et al. 2017

Sci Rep

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“…We have evidence of treatment with biologics in the prevention of recurrence in CD 18 and severe UC, 19,20 pouchitis, 21 abdominal phlegmons, 22 patients infected with hepatitis B or C virus 23 or during pregnancy, 24 situations that were excluded from the pivotal RCTs. The patients are heterogeneous and, as we have seen, treatments are given in situations not considered in the pivotal studies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and effectiveness of biologic therapy in inflammatory bowel disease. EFIFECT study

Ginard

Khorrami

Pérez-Carazo

et al. 2016

Gastroenterología y Hepatología (English Edition)

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“…This distinction is important because Specifically walled-off fluid collections, which show marked restricted diffusion and peripheral post-contrast enhancement at MRE, often require drainage (either percutaneous using image guidance or surgical), whereas areas of phlegmon represent more ill-defined inflammatory processes that generally do not contain frank fluid, have a discrete wall, or markedly restrict diffusion and therefore can be managed with continued medical and antibiotic therapies (Fig. 8) [41].…”

Section: Characterization Of Complications Abscess Vs Phlegmonmentioning

confidence: 99%

MR enterography: how to deliver added value

2016

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MR enterography (MRE) is increasingly vital to the diagnosis and follow-up of children with Crohn disease. This diagnostic test, which can provide valuable information regarding the presence of intestinal inflammation, intestinal and intra-abdominal complications, and extra-intestinal disease-related manifestations, has the potential to directly impact both medical and surgical decision-making. Consequently, it is imperative that the interpretation and reporting of these examinations provide as much clinical information as possible. This article reviews specific ways radiologists can provide added value when interpreting MRE examinations in the setting of pediatric Crohn disease by (1) establishing the true extent of disease involvement, (2) subjectively and objectively assessing response to medical treatment and (3) accurately characterizing disease-related complications.

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Abdominal phlegmons in Crohnʼs disease: Outcomes following antitumor necrosis factor therapy

Abstract: Penetrating CD complicated by phlegmon formation may be safely and effectively managed with a combination of antibiotics and anti-TNF therapy. Larger, prospective trials are required to confirm these initial findings.

Cited by 45 publications

References 27 publications

Multiple fresh fecal microbiota transplants induces and maintains clinical remission in Crohn’s disease complicated with inflammatory mass

Multiple fresh fecal microbiota transplants induces and maintains clinical remission in Crohn’s disease complicated with inflammatory mass

Efficacy and effectiveness of biologic therapy in inflammatory bowel disease. EFIFECT study

MR enterography: how to deliver added value

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