Different treatments for Crohn's disease complicated with severe acute lower Gastrointestinal bleeding: Infliximab therapy is critical and cannot be ignored

Shuoyi Yao¹Zheyu Wang¹Mingyan Xie²Shengnan Wu³Yingjuan Feng⁴Xiaoming Liu¹Fen Wang^1*

• ¹Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China
• ²The First People's Hospital of Changde City, Changde, China
• ³Yueyang Central Hospital, Yueyang, China
• ⁴University of South China, Hengyang, China

Objective: Acute severe lower gastrointestinal bleeding (SLGIB) is one of the life-threatening complications of Crohn’s disease (CD), whose therapy is constantly being optimized. We aim to evaluate therapeutic efficacy and economic benefits of different treatments for acute SLGIB in CD. Method: A multi-center retrospective cohort study in Hunan Province, China was conducted by collecting CD patients with acute SLGIB, analyzing the clinical (hemostatic effect, hemoglobin improvement, rebleeding risk, anti-inflammation influence, and complications) and economic (length and cost of hospital stay) characteristics of infliximab, surgery and traditional hemostatic therapy. Results: All the 3 groups got no obvious signs of bleeding within 1 week. The negative conversion rates of c reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in infliximab therapy group were significantly higher than those in the other 2 groups (adjusted-P<0.05 for both CRP and ESR), while the increase in hemoglobin didn’t differ significantly among the three groups (P=0.298). The incidence of post-treatment complications was significantly higher in the surgery (resection) group than in the other 2 groups (adjusted-P<0.05). Cumulative re-bleeding risk was the lowest in infliximab therapy group (P=0.001 vs. surgery group and P=0.032 vs. traditional therapy group). The multi-variable COX regression also revealed surgery (HR=7.270, 95%CI [1.574, 33.592], P=0.011) and traditional therapy (HR=4.395, 95%CI [1.011, 19.113], P=0.048) were independently related to higher re-bleeding risk when compared to infliximab therapy. The length and cost of hospital stay of infliximab therapy group were significantly lower than surgery group (adjusted-P<0.05) and similar to traditional group (adjusted-P>0.05). Conclusion: Compared with surgery and traditional therapy (such as somatostatin or octreotide), infliximab therapy could also control acute SLGIB in CD and reach similar hemoglobin improvement with additional anti-inflammatory effect and lower re-bleeding risk. Meanwhile, it is more economical than surgery.