Intestinal strictures complicating initially successful infliximab treatment for luminal Crohn's disease

Fibrotic Strictures and Anti-TNF-α Therapy in Crohn’s Disease

“…We do not know whether the patient, in time, would have developed a clinical obstruction due to the scarring process. It is tempting to suggest that patients with an advanced disease, such as our patient, were those originally described as developing strictures or obstruction as an apparent complication of infliximab therapy [1][2][3] . Although this case indicates that infliximab can be used in the presence of strictures, medical therapy should not delay surgery in the presence of an urgent indication, i.e.…”

“…The powerful and rapid healing effect of infliximab in Crohn's disease has been deemed responsible for later development of strictures, due to collagen deposition in the deep layers of the gut wall [1][2][3] . For this reason, up to this day, the presence of strictures is considered by many a contraindication to infliximab.…”

“…Although infliximab, an anti-TNF-␣ monoclonal antibody, is very effective in active Crohn's disease it has been reported to cause stricture development in some patients [1][2][3] . Although recent studies suggest that these and other results might have been affected by unadjusted analysis [4] it still remains unknown whether infliximab could be safely used to treat an inflammatory process in a patient who already has a fibrotic stricture (in the obvious absence of clinical indications for surgery).…”

Iléite terminale sténosante sur maladie de Crohn: prise en charge médicale ou chirurgicale ?

“…Une exploration complète de l'intestin grêle est pratiquée dans le même temps, pour la mesure de sa longueur, et à la recherche d'atteintes suspendues du grêle (sténoses, sclérolipomatose) méconnues par l'imagerie ; -les bénéfices de l'abord coelioscopique en termes de durée d'hospitalisation, de morbidité, de retour à la vie active et de résultats cosmétiques font proposer cet abord en première intention. Les bénéfices postopératoires de la coelioscopie ne se font pas au détriment de l'efficacité à plus long terme, la qualité de vie et les récidives étant équivalen-tes à celles observées chez les patients opérés par laparotomie [2,3] ; -l'absence d'épisode infectieux récent et d'opération antérieure, en étant à distance de l'occlusion aiguë, rendent faible la probabilité de conversion de la coelioscopie en laparotomie ;…”

Maintenance treatment with infliximab for the management of Crohn’s disease in adults

“…Moreover, following reports of stricture and bowel obstruction occurring after IFX treatment, the concept that rapid mucosal healing with consequent excessive fi brogenesis, induced by this biologic agent, has given rise to concern that this treatment could lead to symptomatic intestinal stenosis, stricture, or obstruction (SSO). 43,44 In order to shed further light on this issue, Lichtenstein et al analyzed data from the observational TREAT (Crohn's Therapy, Resource, Evaluation, and Assessment Tool) Registry and ACCENT I study in order to establish whether IFX treatment could increase the risk of intestinal stenosis. 45 In the TREAT registry, 3,179 patients with 5,621 patient/years (pt/y) of follow-up were on IFX treatment and 3,111 patients with 4,651 pt/y of follow-up on other CD treatments.…”