Is really megacolon a contraindication to infliximab in Crohn's disease?

Toxic megacolon (TM) is a rare complication of severe ulcerative colitis (UC) and colonic Crohn's disease (CD), defined as a clinical syndrome accompanied by radiographic evidence of colonic dilatation that in many cases must be treated aggressively with surgical intervention (1). We report two...

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Bibliographic Details
Published inActa gastro-enterologica belgica Vol. 76; no. 4; p. 442
Main Authors Sinagra, Emanuele, Orlando, Ambrogio, Renna, Sara, Criscuoli, Valeria, La Seta, Francesco, Olivo, Mirko, Ciofalo, Marco, Cottone, Mario
Format Journal Article
LanguageEnglish
Published Belgium 01.12.2013
Subjects
Adolescent
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Antibodies, Monoclonal - therapeutic use
Crohn Disease - complications
Crohn Disease - drug therapy
Female
Follow-Up Studies
Humans
Infliximab
Megacolon, Toxic - etiology
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Summary:Toxic megacolon (TM) is a rare complication of severe ulcerative colitis (UC) and colonic Crohn's disease (CD), defined as a clinical syndrome accompanied by radiographic evidence of colonic dilatation that in many cases must be treated aggressively with surgical intervention (1). We report two cases of steroid and antibiotic-refractory fulminant Crohn's colitis, complicated by toxic megacolon, who were successfully treated with infliximab (IFX), thus avoiding surgical intervention. Although there are no well defined recommendation about the correct timing of colectomy in CD-associated TM, and despite the fact that it may be imprudent to advocate delaying surgery in favour of anti-tumor necrosis (anti-TNF) factor therapy in these cases, we think that a medical "rescue therapy" can be considered in a subset of patients with stable clinical condition during corticosteroid treatment.
ISSN:1784-3227