Short-term treatment with Infliximab in chronic refractory pouchitis and ileitis.

Background: Chronic refractory pouchitis (CRP) is a long-term complication after ileal-pouch-anal-anastomosis (IPAA) and it my be associated with ileal inflammation. Aim: to determinate the efficacy of infliximab in treatment of CRP complicated by ileitis, using a wireless capsule endoscopy (WCE). Methods: 16 patients with CRP complicated by ileitis were enrolled. Pouchitis was diagnosed by clinical, endoscopic and histological criteria. Ileitis was documented using WCE. Duodenum-jejunum and proximal-middle ileum were evaluated and the presence of small lesions and large lesions were noted. Crohn’s disease, intestinal infections were excluded in all patients. Patients are treated with infliximab and clinical response was recorded. WCE was repeated at week 10 and PDAI score was determined. Results: 10 patients were enrolled and completed the study. Clinical remission was achieved in 9 patients. At WCE and pouch endoscopy a complete recovery of lesions was observed in 8 patients. One patient presented 4 small lesions of the ileum at the 6-week of treatment and 1 patient did not show any modification. Clinical and endoscopic remission was maintained in these 8 patients at least 6 months. Conclusions: these preliminary results indicate that infliximab may be recommended for the treatment of CRP complicated by ileitis.