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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2018; 72(3): 251–256. doi:10.14735/amgh2018251.

Experience in the treatment of severe bleeding in Crohn’s disease with anti-TNF therapy

Jan Ulbrych1, Klára Šlapalová1, Alena Ondrejková1, Jana Drábková2, Jiří Vaníček2, Bohuslav Kianička  1

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Massive bleeding into the gastrointestinal tract (enterorrhagia) is a rare and life-threatening complication of Crohn’s disease (CD) and occurs in up to 4% of patients. The most common cause of enterorrhagia is a deep ulceration caused by inflammation of a part of the gastrointestinal tract. Risk factors for enterorrhagia have not yet been identified. Determination of the source of the bleeding and the extent of the inflammatory disorder are vital for successful treatment. Based on the results of examinations, a decision on the optimal treatment can be made. In this work, we describe two CD cases who were hospitalized at our workplace in 2016–2017. The first case was a patient who required hospitalization because of CD relapse in the colon area. The patient did not respond to conventional therapy and did not enter remission. Despite treatment, enterorrhagia propagated. The second case was a patient with massive enterorrhagia that appeared as the primary manifestation of CD relapse in the terminal ileum and colon. Conventional therapy did not lead to cessation of bleeding or remission. Instead, enterorhagia propagated. Using these selected case studies, we aim to demonstrate the efficacy of anti-TNF therapy in preventing gastrointestinal bleeding in CD patients. We note that anti-TNF therapy has the advantage of rapid onset in cases where conventional therapy has failed or in cases where other therapeutic methods such as mini-invasive procedures or surgical treatment cannot be used due to the high risk of “short-bowel syndrome”.


Crohn’s disease, anti-TNF, enterorrhagia, infliximab

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