Abstract
Purpose
Infliximab may represent an adjuvant to surgical therapy in patients with severe anal Crohn’s disease as it has been shown to affect rapid remissions in a proportion of cases.
Patients and methods
Nineteen patients underwent infliximab therapy 5 mg/kg perioperatively to scheduled anal reconstructive surgery for complicated fistulising anal Crohn’s disease.
Results
One adverse event was recorded (generalised exanthema with subsequent resolution). Eight patients showed complete clinical remission refusing further surgery. One of the eight relapsed during follow-up and was continued on infliximab. Surgery consisted of advancement flaps. It was successful at first attempt in nine of the remaining 11 patients (82%). Operative fistula closure remained unsuccessful in two patients. Overall, 16 of 19 patients (84%) with advanced anal Crohn’s disease had a favourable outcome.
Conclusion
The use of infliximab as adjuvant to surgery in this series of patients with complicated anal Crohn’s disease was safe. Although the data is uncontrolled a positive effect of infliximab on the outcome of surgery may be postulated since our results compare favourably with other studies.
Similar content being viewed by others
References
Buchmann P, Keighley MR, Allan RN, Thompson H, Alexander-Williams J (1980) Natural history of perianal Crohn’s disease. Ten year follow-up: a plea for conservatism. Am J Surg 140:642–644
Keighley MR, Allan RN (1986) Current status and influence of operation on perianal Crohn’s disease. Int J Colorectal Dis 1:104–107
Corman ML (1989) Colon and Rectal Surgery, 2nd edn. Lippincott, Philadelphia
Ackermann C, Tondelli P (1991) Chronisch entzündliche Darmerkrankungen. Möglichkeiten und Grenzen der chirurgischen Therapie. Ther Umsch 48:471–479
van der Hagen SJ, Baeten CG, Soeters PB, Beets-Tan RG, Russel MG, van Gemert WG (2005) Staged mucosal advancement flap for the treatment of complex anal fistulas: pretreatment with noncutting Setons and in case of recurrent multiple abscesses a diverting stoma. Colorectal Dis. 7:513–518
Penninckx F, D’Hoore A, Filez L (2001) Advancement flap plasty for the closure of anal and recto-vaginal fistulas in Crohn’s disease. Acta Gastroenterol Belg 64:223
Sangwan YP, Schoetz DJ Jr, Murray JJ, Roberts PL, Coller JA (1996) Perianal Crohn’s disease. Results of local surgical treatment. Dis Colon Rectum 39:529–535
Fleshner PR, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1995) Anal fissure in Crohn’s disease: a plea for aggressive management. Dis Colon Rectum 38:1137–1143
Williamson PR, Hellinger MD, Larach SW, Ferrara A (1995) Twenty-year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum 38:389–392
Strong SA, Fazio VW (1999) Surgical treatment of inflammatory bowel disease. Curr Opin Gastroenterol 15:326–330
Kroesen A-J, Buhr H-J (1999) Anorektale Fisteln bei Morbus Crohn. Zentralbl-Chir 124(Suppl 23):4–8
Marchesa P, Hull T-L, Fazio V-W (1998) Advancement sleeve flaps for treatment of severe perianal Crohn’s disease. Br J Surg 85:1695–1698
O’Leary D-P, Milroy C-E, Durdey P (1998) Definitive repair of anovaginal fistula in Crohn’s disease. Ann R Coll Surg Engl 80:250–252
Halme L, Sainio AP (1995) Factors related to frequency, type, and outcome of anal fistulas in Crohn’s disease. Dis Colon Rectum 38:55–59
Michelassi F, Melis M, Rubin M, Hurst R-D (2000) Surgical treatment of anorectal complications in Crohn’s disease. Surgery 128:597–603
Hull T-L, Fazio V-W (1997) Surgical approaches to low anovaginal fistula in Crohn’s disease. Am J Surg 173:95–98
Halme L, Sainio AP (1995) Factors related to frequency, type, and outcome of anal fistulas in Crohn’s disease. Dis Colon Rectum 38:55–59
Poupardin C, Lémann M, Gendre JP, Sabaté JM, Marteau P, Chaussade S, Delchier JC, Bouhnik Y, Chaput JC, Poupon R, Soulé JC, Benhamou Y, Grangé JD, Coffin B (2006) Efficacy of infliximab in Crohn’s disease. Results of a retrospective multicenter study with a 15-month follow-up. Gastroenterol Clin Biol 30:247–252
Rudolph SJ, Weinberg DI, McCabe RP (2008) Long-Term Durability of Crohn’s Disease Treatment with Infliximab. Dig Dis Sci 53(4):1033–1041
Caviglia R, Ribolsi M, Rizzi M, Emerenziani S, Annunziata ML, Cicala M (2007) Maintenance of remission with infliximab in inflammatory bowel disease: efficacy and safety long-term follow-up. World J Gastroenterol 13:5238–5244
Baert FJ, D’Haens GR, Peeters M, Hiele MI, Schaible TF, Shealy D, Geboes K, Rutgeerts PJ (1999) Tumor necrosis factor alpha antibody (infliximab) therapy profoundly down-regulates the inflammation in Crohn’s ileocolitis. Gastroenterology 116:22–28
Ricart E, Panaccione R, Loftus EV, Tremaine WJ, Sandborn WJ (1999) Successful management of Crohn’s disease of the ileoanal pouch with infliximab. Gastroenterology 117:429–432
Barabino A, Castellano E, Gandullia P, Biscaldi E (2000) A girl with severe fistulizing Crohn’s disease. Dig Liver Dis 32:792–794
Farrell RJ, Shah SA, Lodhavia PJ, Alsahli M, Falchuk KR, Michetti P, Peppercorn MA (2000) Clinical experience with infliximab therapy in 100 patients with Crohn’s disease. Am J Gastroenterol 95:3490–3497
Cohen RD (2001) Efficacy and safety of repeated infliximab infusions for Crohn's disease: 1-year clinical experience. Inflamm Bowel Dis 7(Suppl 1):S17–22
Fefferman DS, Shah SA, Alsahlil M, Gelrud A, Falchulk KR, Farrell RJ (2001) Successful treatment of refractory esophageal Crohn’s disease with infliximab. Dig Dis Sci 46:1733–1735
Miller AM, Elliott PR, Fink R, Connell W (2001) Rapid response of severe refractory metastatic Crohn’s disease to infliximab. J Gastroenterol Hepatol 16:940–942
Hanauer SB (1999) Review article: safety of infliximab in clinical trials. Aliment Pharmacol Ther 13(Suppl 4):16–22
Rutgeerts P, D’Haens G, Targan S, Vasiliauskas E, Hanauer SB, Present DH, Mayer L, Van-Hogezand RA, Braakman T, DeWoody KL, Schaible TF, Van-Deventer SJ (1999) Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease. Gastroenterology 117:761–769
Regueiro M, Mardini H (2003) Treatment of perianal fistulising Crohn’s disease with Infliximab alone or as an adjunct to exam under anesthesia with seton placement. Inflamm Bowel Dis 9:98–103
Topstad DR, Pannacione R, Heine JA, Johnson DR, MacLean AR, Buie WD (2003) Combined seton placement, Infliximab infusion, and maintenance immunosuppressive improve healing rate in fistulising anorectal Crohn’s disease: a single center experience. Dis Colon Rectum 46:577–583
Talbot C, Sagar PM, Johnston MJ, Finan PJ, Burke D (2005) Infliximab in the surgical management of complex fistulating anal Crohn’s disease. Colorectal Dis 7:164–168
Hyder SA, Travis SP, Jewell DP, McC Mortensen NJ, George BD (2006) Fistulating anal Crohn’s disease: results of combined surgical and Infliximab treatment. Dis Colon Rectum 49:1837–1841
Sorrentino D, Terrosu G, Avellini C, Beltrami CA, Bresadola V, Toso F (2006) Prevention of postoperative recurrence of Crohn’s disease by Infliximab. Eur J Gastroenterol Hepatol 18:457–459
van der Hagen SJ, Baeten CG, Soeters PB, Russel MG, Beets-Tan RG, van Gemert WG (2005) Anti-TNF-alpha (infliximab) used as induction treatment in case of active proctitis in a multistep strategy followed by definite surgery of complex anal fistula in Crohn’s disease: a preliminary report. Dis Colon Rectum 48:758–767
Willis S, Rau M, Schumpelick V (2000) Chirurgische Therapie hoher anorectaler und rectovaginaler Fisteln mittels transanaler endorectaler Verschiebelappenplastik. Chirurg 71:836–840
Hyman N (1999) Endoanal advancement flap repair for complex anal fistula. Am J Surg 178:337–340
Del Pino A, Nelson RL, Pearl RK, Abcarian H (1996) Island flap anoplasty for treatment of transsphincteric fistula-in-ano. Dis Colon Rectum 39:224–226
Gemsenjager E (1996) Erfahrungen mit einem neuen Therapiekonzept bei Analfistel: Naht des analen Sphinkters. Schweiz Med Wochenschr 126:2021–2025
Kohler A, Athanasiadis S (1996) Die anodermale Verschiebelappenplastik als alternative Behandlungsmethode zu den endorectalen Verschlusstechniken bei der Therapie hoher Analfisteln. Eine prospektive Studie bei 31 Patienten. Chirurg 67:1244–1250
Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van-Hogezand RA, Podolsky DK, Sands BE, Braakman T, DeWoody KL, Schaible TF, van-Deventer SJ (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340:1398–1405
Rutgeerts P (2000) Management of perianal Crohn’s disease. Can J Gastroenterol 14(Suppl C):7C–12C
Serrano MS, Schmidt-Sommerfeld E, Kilbaugh TJ, Brown RF, Udall JN Jr, Mannick EE (2001) Use of infliximab in pediatric patients with inflammatory bowel disease. Ann Pharmacother 35:823–828
van-Bodegraven AA, Sloots CEJ, Felt-Bersma RJF, Meuwissen SGM (2002) Endosonographic evidence of persistence of Crohn’s disease-associated fistulas after infliximab treatment, irrespective of clinical response. Dis Colon Rectum 45:39–45
Bell SJ, Halligan S, Windsor AC, Williams AB, Wiesel P, Kamm MA (2003) Response of fistulating Crohn’s disease to infliximab treatment assessed by magnetic resonance imaging. Aliment Pharmacol Ther 17:387–393
Van Assche G, Vanbeckevoort D, Bielen D, Coremans G, Aerden I, Noman M, D’Hoore A, Penninckx F, Marchal G, Cornillie F, Rutgeerts P (2003) Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease. Am J Gastroenterol 98:332–339
Ardizzone S, Maconi G, Colombo E, Manzionna G, Bollani S, Bianchi Porro G (2004) Perianal fistulae following infliximab treatment: clinical and endosonographic outcome. Inflamm Bowel Dis 10:91–96
Rasul I, Wilson SR, MacRae H, Irwin S, Greenberg GR (2004) Clinical and radiological responses after infliximab treatment for perianal fistulizing Crohn’s disease. Am J Gastroenterol 99:82–88
Blonski W, Lichtenstein GR (2007) Safety of biologic therapy. Inflamm Bowel Dis 13:769–796
Lichtenstein GR, Feagan BG, Cohen RD, Salzberg BA, Diamond RH, Chen DM, Pritchard ML, Sandborn WJ (2006) Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol 4:621–630
Rutgeerts P (2002) A critical assessment of new therapies in inflammatory bowel disease. J Gastroenterol Hepatol 17(Suppl):S176–S185
Andus T, Stange EF, Höffler D, Keller-Stanislawski B (2003) Verdachtsfälle schwerwiegender Nebenwirkungen nach Infliximab (Remicade) aus Deutschland. Med Klin 98:429–436
Lichtenstein GR (2000) Treatment of fistulizing Crohn’s disease. Gastroenterology 119:1132–1147
Pehl C, Schepp W (2005) Medikamentöse Therapie anorektaler Crohn-Fisteln. Deutsches Ärzteblatt 102:433–437
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kraemer, M., Kirschmeier, A. & Marth, T. Perioperative adjuvant therapy with infliximab in complicated anal crohn’s disease. Int J Colorectal Dis 23, 965–969 (2008). https://doi.org/10.1007/s00384-008-0500-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-008-0500-6