Infliximab therapy in pediatric Crohn's pouchitis

Objective: We describe the prolonged clinical benefit of murine chimeric antitumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab, on pediatric patients with Crohn's disease and ileal pouch anal anastomosis (IPAA). Methods: A retrospective review of patients originally diagnosed with ulcerative colitis, status post colectomy and IPAA, who developed findings compatible with Crohn's disease was undertaken, Refractory pouchitis developed in all patients as well as protracted symptoms of diarrhea, abdominal pain, joint pain, and incontinence. All patients received infliximab. Results: Four pediatric patients (2 males and 2 females) with mean age of 14.5 years (range 11-18 years) were studied. The development of perianal fistulas in 2 patients, granuloma on biopsy in I patient and perianal skin tag in I patient, led to a diagnosis change of CD. After failure to respond to antibiotics, aminosalicylates and immunomodulators such as azathioprine and 6-mercaptopurine (6-MP), all patients were treated with infliximab. Patients received infliximab infusions at a dose of 5 mg/kg, initially at weeks 0, 2 and 6 and subsequently at 8 weeks intervals in combination with an immunomodulator drug. All patients showed marked improvement clinically, endoscopically, and histologically. Conclusion: infliximab can be used successfully for the treatment of pediatric patients with Crohn's disease and IPAA who are refractory to conventional therapies.