Case Report
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World J Gastroenterol. Sep 28, 2012; 18(36): 5135-5137
Published online Sep 28, 2012. doi: 10.3748/wjg.v18.i36.5135
Use of anti tumor necrosis factor-alpha monoclonal antibody for ulcerative jejunoileitis
Gulseren Seven, Adel Assaad, Thomas Biehl, Richard A Kozarek
Gulseren Seven, Richard A Kozarek, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Adel Assaad, Department of Pathology, Virginia Mason Medical Center, Seattle, WA 98101, United States
Thomas Biehl, Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: Seven G and Kozarek RA designed and performed research; Seven G and Kozarek RA wrote and edited the paper; Assaad A and Biehl T contributed acquisition and interpretation of data and writing.
Correspondence to: Richard A Kozarek, MD, Digestive Disease Institute, Virginia Mason Medical Center, 1100 9th Ave., PO Box 900, Mail Stop C3-GAS, Seattle, WA 98101, United States. gasrak@vmmc.org
Telephone: +1-206-2232310 Fax: +1-206-3410061
Received: March 14, 2012
Revised: April 13, 2012
Accepted: April 20, 2012
Published online: September 28, 2012
Abstract

Ulcerative jejunoileitis is an uncommon clinical syndrome consisting of abdominal pain, weight loss associated with diarrhea, and multiple inflammatory ulcerations and strictures of the small bowel. Ulcerative jejunoileitis can complicate established celiac disease or develop in patients de novo. Increased levels of tumor necrosis factor-alpha (TNF-α) in the small intestine of patients with untreated celiac disease are associated with a role in the immune pathogenesis of this disorder. No specific therapy has been shown to change the course of ulcerative jejunoileitis. We report a case of severe ulcerative jejunoileitis previously unresponsive to traditional therapies, including high dose corticosteroids and cyclosporine. The patient had a dramatic resolution of symptoms and a complete normalization of endoscopic findings after anti-TNF-α monoclonal antibody, infliximab (Remicade®).

Keywords: Ulcerative jejunoileitis; Biologic therapy; Tumor necrosis factor-alpha; Infliximab