Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab
Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Association for the Study of Intestinal Diseases
2017-10-01
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| Series: | Intestinal Research |
| Subjects: | |
| Online Access: | https://doi.org/10.5217/ir.2017.15.4.535 |
| _version_ | 1818955857129373696 |
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| author | Shinji Okabayashi Taku Kobayashi Tomohisa Sujino Ryo Ozaki Satoko Umeda Takahiko Toyonaga Eiko Saito Masaru Nakano Maria Carla Tablante Shojiroh Morinaga Toshifumi Hibi |
| author_facet | Shinji Okabayashi Taku Kobayashi Tomohisa Sujino Ryo Ozaki Satoko Umeda Takahiko Toyonaga Eiko Saito Masaru Nakano Maria Carla Tablante Shojiroh Morinaga Toshifumi Hibi |
| author_sort | Shinji Okabayashi |
| collection | DOAJ |
| description | Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that was refractory to steroids. A 20-year-old man was diagnosed with UC of typical pancolitis without ileal involvement and started treatment with pH-dependent mesalazine and oral prednisolone. Although his symptoms transiently resolved, the condition flared when the steroid dose was tapered down. Computed tomography revealed marked thickening of the ileal wall, and capsule endoscopy and balloon-assisted enteroscopy found diffuse mucosal inflammation with ulcers in the ileum. On the contrary, the inflammation in the colon and rectum was improving. Since the response to the second steroid course was inadequate, treatment with adalimumab and 6-mercaptopurine was initiated and finally achieved clinical and endoscopic remission. The investigation of small intestinal lesions is necessary in patients with UC whose clinical deterioration cannot be explained by colonic lesions. |
| first_indexed | 2024-12-20T10:44:43Z |
| format | Article |
| id | doaj.art-36911b8dd8cc4c3ebbd0345dbea02a31 |
| institution | Directory Open Access Journal |
| issn | 1598-9100 |
| language | English |
| last_indexed | 2024-12-20T10:44:43Z |
| publishDate | 2017-10-01 |
| publisher | Korean Association for the Study of Intestinal Diseases |
| record_format | Article |
| series | Intestinal Research |
| spelling | doaj.art-36911b8dd8cc4c3ebbd0345dbea02a312022-12-21T19:43:27ZengKorean Association for the Study of Intestinal DiseasesIntestinal Research1598-91002017-10-0115453553910.5217/ir.2017.15.4.535ir.2017.15.4.535Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumabShinji Okabayashi0Taku Kobayashi1Tomohisa Sujino2Ryo Ozaki3Satoko Umeda4Takahiko Toyonaga5Eiko Saito6Masaru Nakano7Maria Carla Tablante8Shojiroh Morinaga9Toshifumi Hibi10Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Department of Diagnostic Pathology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that was refractory to steroids. A 20-year-old man was diagnosed with UC of typical pancolitis without ileal involvement and started treatment with pH-dependent mesalazine and oral prednisolone. Although his symptoms transiently resolved, the condition flared when the steroid dose was tapered down. Computed tomography revealed marked thickening of the ileal wall, and capsule endoscopy and balloon-assisted enteroscopy found diffuse mucosal inflammation with ulcers in the ileum. On the contrary, the inflammation in the colon and rectum was improving. Since the response to the second steroid course was inadequate, treatment with adalimumab and 6-mercaptopurine was initiated and finally achieved clinical and endoscopic remission. The investigation of small intestinal lesions is necessary in patients with UC whose clinical deterioration cannot be explained by colonic lesions.https://doi.org/10.5217/ir.2017.15.4.535Ulcerative colitisEnteritisInflammatory bowel diseaseCapsule endoscopyBalloon-assisted enteroscopy |
| spellingShingle | Shinji Okabayashi Taku Kobayashi Tomohisa Sujino Ryo Ozaki Satoko Umeda Takahiko Toyonaga Eiko Saito Masaru Nakano Maria Carla Tablante Shojiroh Morinaga Toshifumi Hibi Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab Intestinal Research Ulcerative colitis Enteritis Inflammatory bowel disease Capsule endoscopy Balloon-assisted enteroscopy |
| title | Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab |
| title_full | Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab |
| title_fullStr | Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab |
| title_full_unstemmed | Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab |
| title_short | Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab |
| title_sort | steroid refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab |
| topic | Ulcerative colitis Enteritis Inflammatory bowel disease Capsule endoscopy Balloon-assisted enteroscopy |
| url | https://doi.org/10.5217/ir.2017.15.4.535 |
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