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-TNFα 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.