Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab

Shinji Okabayashi, Taku Kobayashi, Tomohisa Sujino, Ryo Ozaki, Satoko Umeda, Takahiko Toyonaga, Eiko Saito, Masaru Nakano, Maria Carla Tablante, Shojiroh Morinaga, Toshifumi Hibi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)535-539
Number of pages5
JournalIntestinal Research
Volume15
Issue number4
DOIs
Publication statusPublished - 2017 Jan 1
Externally publishedYes

Keywords

  • Balloon-assisted enteroscopy
  • Capsule endoscopy
  • Enteritis
  • Inflammatory bowel disease
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    Okabayashi, S., Kobayashi, T., Sujino, T., Ozaki, R., Umeda, S., Toyonaga, T., Saito, E., Nakano, M., Tablante, M. C., Morinaga, S., & Hibi, T. (2017). Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab. Intestinal Research, 15(4), 535-539. https://doi.org/10.5217/ir.2017.15.4.535