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* = Presenting author

P471. Infliximab therapy in patients with chronic refractory pouchitis: efficacy and safety

A. Indriolo1, L. Campanati2, L. Ansaloni2, F. Caprioli3, E. Contessini Avesani4, P. Ravelli1, 1Ospedali Riuniti di Bergamo, Gastroenterology and Digestive Endoscopy Unit II, Bergamo, Italy, 2Ospedali Riuniti di Bergamo, Surgery I Unit, Bergamo, Italy, 3University of Milan, Department of Gastroenterology, Milan, Italy, 4University of Milan, Division II of General Surgery, Milan, Italy

Background

25% of patients with inflammatory bowel disease (IBD) need surgery during the course of their life because of refractory intestinal disease at medical therapy or dysplasia e/o colorectal cancer. Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical procedure of choice in these patients. 23–46% of patients with IPAA develop chronic pouchitis not responding to antibiotics. Only a few studies evaluated the biological therapy in patients with chronic refractory pouchitis.

The aim of this study is analyze the clinical and endoscopic efficacy and related complications in patients with chronic refractory pouchitis (CRP).

Methods

A total of 431 patients with IBD were evaluated in our Center from January 2001 to October 2012. 14 patients (3.2%) underwent at restorative proctocolectomy with IPAA (10 patients with Ulcerative Colitis, UC; 4 patients with Crohn's Disease, CD). 4 patients have a definitive ileostomy. 6/10 (60%) patients with IPAA (5 UC, and 1CD, 3 males, average age: 42.1 years, range: 28–56) developed chronic refractory pouchitis and were been treated with infliximab (IFX) (5 mg/kg, 0–2-6 weeks and every 8 weeks). The efficacy of IFX had been evaluated with Pouchitis Disease Activity Index (PDAI). Endoscopic response evaluated before and after treatment. Mucosal healing mucosal healing had been defined as absence of ulcerations of mucosa. Complications during IFX therapy have been reported.

Results

6 patients treated with infliximab therapy (IFX) for CRP. Clinical and endoscopic remission, complications related will be reported in the poster table. Significative difference for median PDAI is present after IFX (p = 0.003). Mucosal healing is present in 50% of patients. Complications included only one infection in one patient: Herpes Genitalis.

Conclusion

In our study 60% patients with IPAA developed chronic refractory pouchitis. Significative differences have been observed with PDAI before and after IFX therapy in patients with chronic refractory pouchitis. Mucosal Healing was present in 50% of patients. We observed only one infection in one patient.

However, additional largest studies are needed to evaluate anti-TNFalfa therapy in patients with chronic refractory pouchitis.