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World J Clin Cases. Sep 16, 2013; 1(6): 191-196
Published online Sep 16, 2013. doi: 10.12998/wjcc.v1.i6.191
Infliximab for the treatment of pouchitis
Maddalena Zippi, Claudio Cassieri, Eleonora Veronica Avallone, Roberta Pica
Maddalena Zippi, Roberta Pica, Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, 00157 Rome, Italy
Claudio Cassieri, Eleonora Veronica Avallone, Gastroenterology Unit, Department of Internal Medicine and Medical Specialties, ” La Sapienza” University, 00161 Rome, Italy
Author contributions: Zippi M made a substantial contribution to the study conception and design; Cassieri C and Avallone EV were involved in the acquisition, analysis and interpretation of data; Pica R and Zippi M were involved in drafting the article and revising it critically for important intellectual content; Pica R gave final approval of the version to be published.
Correspondence to: Maddalena Zippi, MD, Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy. maddyzip@yahoo.it
Telephone: +39-6-41735005 Fax: +39-6-41735005
Received: June 12, 2013
Revised: July 30, 2013
Accepted: August 5, 2013
Published online: September 16, 2013
Abstract

Pouchitis is not a rare complication that develops after an ileal-pouch anastomosis, performed after colectomy in patients refractory to treatment or with complicated ulcerative colitis. This condition may become chronic and unresponsive to medical therapies, including corticosteroids, antibiotics and probiotics. The advent of biological therapies (tumor necrosis factor-α inhibitors) has changed the course of these complications. In particular, in these cases, infliximab (IFX) may represent a safe and effective therapy in order to avoid the subsequent operation for a permanent ileostomy. This article reviews the therapeutic effects of one of the most widely used anti-tumor necrosis factor-α molecules, IFX, for the treatment of complicated pouchitis (refractory to conventional treatment and/or fistulizing).

Keywords: Ileal pouch-anal anastomosis, Infliximab, Pouchitis, Tumor necrosis factor-α, Ulcerative colitis

Core tip: Pouchitis represents the most frequent long term complication of the ileal pouch anal anastomosis and consists of an idiopathic nonspecific inflammation of the ileal mucosa of the pouch. Several studies show the effectiveness of treatment with anti-tumor necrosis factor-α in chronic forms in reducing the synthesis of pro-inflammatory molecules and in restoring the balance between pro-inflammatory and anti-inflammatory cytokines.