Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2316-2321
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2316
Effectiveness of vedolizumab treatment in two different anti-tumor necrosis factor alpha refractory pouchitis: A case report
Ozlem Ozer Cakir
Ozlem Ozer Cakir, Department of Gastroenterology and Hepatology, Alanya Alaaddin Keykubat University, School of Medicine, Antalya 07425, Turkey
Author contributions: All of the contributions were made by the author.
Informed consent statement: Patient consent and IRB approval were obtained.
Conflict-of-interest statement: The author declares that there are no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ozlem Ozer Cakir, MD, Assistant Professor, Doctor, Department of Gastroenterology and Hepatology, Alanya Alaaddin Keykubat University, School of Medicine, Kestel yerleşkesi, Antalya 07425, Turkey. tansozlem@yahoo.com
Telephone: +90-532-1754014
Received: April 24, 2019
Peer-review started: May 8, 2019
First decision: May 31, 2019
Revised: June 18, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 26, 2019
Processing time: 124 Days and 6.2 Hours
Abstract
BACKGROUND

Refractory pouchitis is a common cause of pouch failure, which may require surgical excision of the pouch or permanent diversion. We aimed to show the effect of vedolizumab on treatment of the patient with refractory pouchitis.

CASE SUMMARY

A 32-year-old male with pancolonic ulcerative colitis since the age of 25 with primary failure of infliximab and mesalamine and intolerance of azathioprine, underwent a total proctocolectomy with ileal pouch-anal anastomosis in 2012. He developed chronic diarrhea in 2014, which was watery, 30 per day and accompanied with blood and mucus affecting his quality of life.

CONCLUSION

Vedolizumab is safe and effective in the management of anti-tumor necrosis factor alpha refractory pouchitis.

Keywords: Anti-tumor necrosis factor alpha; Refractory pouchitis; Vedolizumab; Ulcerative colitis

Core tip: Vedolizumab, a humanized immunoglobulin G1 monoclonal antibody to α4β7 integrin, has been shown to moderate gut lymphocyte trafficking with an efficacy in treatment of both Crohn’s disease and ulcerative colitis. In our patient who had two different anti-tumor necrosis factor refractory pouchitis, the gut-specific immune modulation mediated by vedolizumab treatment resulted in good responses. This case is important because vedolizumab is the novel therapy for refractory pouchitis. However, further large and prospective studies are needed for efficacy and the underlying mechanisms of efficacy of vedolizumab in treatment of refractory pouchitis.