Intest Res.  2014 Jan;12(1):66-69. 10.5217/ir.2014.12.1.66.

Refractory Duodenal Crohn's Disease Successfully Treated with Infliximab

• Kim YL
• Park YS
• Park EK
• Park DR
• Choi GS
• Ahn SB
• Kim SH
• Jo YJ

• KMID: 2174340
• DOI: http://doi.org/10.5217/ir.2014.12.1.66

Abstract

Crohn's disease (CD) may involve any part of the gastrointestinal tract, from the mouth to the anus. Approximately >90% of cases occur in the small bowel and colon. Upper gastrointestinal involvement, especially duodenal manifestation, is relatively rare. Therefore, adequate medical treatment for duodenal CD has not yet been established. We report a case of CD with duodenal involvement. A 46-year-old man with Crohn's ileocolitis presented to our hospital with right upper quadrant pain. An endoscopy showed a deep excavated ulcer with deformity at the duodenal bulb, and he was initially treated with azathioprine (1 mg/kg), Pentasa (3.0 g/day), and a proton pump inhibitor for 1 year. However, the deep ulcer did not heal. Therefore, infliximab infusion therapy was initiated, and the duodenal lesion completely resolved on follow-up esophagogastroduodenoscopy. We report a case of duodenal CD that completely resolved following infliximab infusion, with a review of the literature.

Keyword

Crohn's disease; Duodenum; Infliximab

MeSH Terms

Anal Canal
Azathioprine
Colon
Congenital Abnormalities
Crohn Disease*
Duodenum
Endoscopy
Endoscopy, Digestive System
Follow-Up Studies
Gastrointestinal Tract
Humans
Infliximab
Mesalamine
Middle Aged
Mouth
Proton Pumps
Ulcer
Azathioprine
Mesalamine
Proton Pumps

Figure

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  Fig. 1 Endoscopic and histopathologic findings of the distal ileum. (A) Endoscopic findings of the distal ileum. A cobble stone appearance on the ileal side of the ileocolostomy site. (B) Non-caseating granuloma seen on biopsy (H&E stain, ×200).

• 

  Fig. 2 Endoscopic findings of the duodenum. (A) At initial diagnosis, an active ulcer with bulb deformity is found. (B) After 1 year of proton pump inhibitor treatment, an aggravating deep ulcer with partial stenosis is seen at the superior duodenal angle. (C) After the eight injections of infliximab, complete resolution of the duodenal ulcer is seen with good passage to the second part of duodenum.

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  Fig. 3 Abdominal CT findings. Computed tomography shows aggravated abnormal wall thickening at the anastomosis site in the small bowel.

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