Infliximab and pediatric stricturing Crohn's disease : a possible alternative to surgery ? Experience of seven cases

Introduction : Infliximab (IFX) is one of the treatments of choice for the different phenotypes of pediatric Crohn's disease (CD). Although it was initially feared that anti-TNFa treatment might cause bowel stenosis, recent studies have validated the efficacy of IFX as an anti-stricturing agent. Aim : To assess the efficacy of IFX treatment for pediatric stricturing CD. Patients and methods : Data were obtained on pediatric patients treated at our tertiary level Pediatrics Department (years 2000- 2010). Indications for IFX therapy included persistent disease activity (PCDAI > 20) unresponsive to corticosteroids and thiopurines. All patients treated with IFX underwent upper and lower intestinal endoscopy, abdominal ultrasound and magnetic resonance enterography. Case series : Among 44 pediatric CD patients, 21 were treated with IFX. Seven of these cases had luminal strictures and in 6 patients the inflammatory strictures disappeared after treatment with IFX. One child with ileal fibrotic stenosis (MR) required a surgical resection. Conclusion : Our data support the efficacy of IFX in pediatric CD, including the stricturing phenotype. (Acta gastroenterol. belg., 2012, 75, 58-60).