Alcalde Vargas Alfonso, Justiniano José Manuel Herrera, Carnerero Eduardo Leo, Salado Claudio Trigo, Domingo Ignacio Gutiérrez, Galán José Luis Márquez
Departamento de Gastroenterología, Hospital Universitario Virgen del Rocío, Seville, Spain.
Gastroenterol Hepatol. 2011 Jan;34(1):24-8. doi: 10.1016/j.gastrohep.2010.09.004. Epub 2010 Dec 17.
Severe lower gastrointestinal (GI) bleeding is an infrequent complication in Crohn's disease. We report the cases of three patients with Crohn's disease, localized in distinct areas, who developed severe enterorrhagia requiring multiple transfusions. All three patients responded favorably to infliximab administration, which resolved the life-threatening hemorrhages and avoided emergency surgical resection, which had seemed inevitable. Based on this clinical experience and a review of the literature comparing infliximab with other pharmacological options, we believe that this drug should be the treatment of choice in patients with Crohn's disease who develop severe lower gastrointestinal bleeding. This strategy can, in some cases, avoid surgery if the bleeding stops due to rapid healing of the deep mucosal lesions causing the hemorrhagic episode.
严重下消化道出血是克罗恩病中一种罕见的并发症。我们报告了3例克罗恩病患者的病例,病变位于不同部位,均发生了严重肠出血,需要多次输血。所有3例患者对英夫利昔单抗治疗反应良好,该治疗解决了危及生命的出血问题,避免了原本看似不可避免的急诊手术切除。基于这一临床经验以及对英夫利昔单抗与其他药物选择进行比较的文献回顾,我们认为该药应成为发生严重下消化道出血的克罗恩病患者的首选治疗药物。在某些情况下,如果导致出血发作的深部黏膜病变迅速愈合使出血停止,这种治疗策略可避免手术。