Reply

Abstract

We read, with interest, the letter by Huang et al. regarding the closure of ileal pouch-vaginal fistulas with infliximab in 2 patients with a history of ulcerative colitis. We agree with the authors that infliximab in this setting appears to be a useful therapeutic modality. Since our original publication detailing our experience with infliximab in 7 patients with a history of ulcerative colitis where we changed the diagnosis to Crohn’s disease and treated them with infliximab, we have gained additional experience.1Ricart E. Panaccione R. Loftus E.V. Tremaine W.J. Sandborn W.J. Successful management of Crohn’s disease of the ileoanal pouch with infliximab.Gastroenterology. 1999; 117: 429-432Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar We have now treated 29 patients for this indication of whom 69% had perianal or pouch-vaginal fistulizing disease as a major treatment indication.2Colombel J.F. Ricart E. Loftus E.V. Tremaine W.J. Young-Fadok T. Dozois E.J. Wolff B.G. Devine R. Pemberton J.H. Sandborn W.J. Management of Crohn’s disease (CD) of the ileoanal pouch with infliximab.Gastroenterology. 2003; 124: A519Abstract Full Text PDF Google Scholar A majority of the patients in our extended experience had complete or partial short-term benefit, and half of the patients had long-term response, although most patients with long-term response required maintenance therapy with infliximab. We continue to believe that these patients are best characterized as having Crohn’s disease (based on findings of complicated fistulizing disease and/or pre-pouch ileitis), although we acknowledge that this is a point that requires further study and discussion. To our knowledge, there is not published experience with the use of infliximab in patients who have chronic pouchitis. A trial of infliximab for this indication deserves future study as well.