Gastric Neoplasia during Anti-TNF Therapy for Crohn’s Disease: Casual Event?
2015
The increase risk of cancer development in patients with inflammatory intestinal
disease (IBD) has already studied for decades. The anti-TNF therapy has changed
the treatment strategy of IBD. By using on a larger scale and for a longer time,
the anti-TNF raised concern over its potential adverse events. A male Crohn’s disease (CD) patient, 55 years old, diagnosed
for nine years, treated with infliximab for 6 years. In 2011, he underwent
a nupper endoscopy (UE) which showed flat erosive gastritis with moderate intensity
in antrum, gastric polyps and gastric erosion. Pathological examination revealed
a chronic gastritis in erosive activity and search for Helicobacter pylori resulted
positive. In May 2014, the patient was asymptomatic, when it held UE, which showed
suggestive lesion of early gastric cancer, measuring 1.5 cm and search for Helicobacter
pylori negative. Histopathological exams confirmed the adenocarcinoma. The patient
underwent to a laparoscopic surgery (total gastrectomy with lymphadenectomy and
reconstruction Roux-en-Y). Risk factors for the development of gastric cancer in
general population are already well defined. However studying a possible association
among CD and the different therapeutic modalities used in the treatment of this
disease with gastric cancer appearance is important to set specific assessment strategies,
prevention and follow-up. While there is no consensus on a proper monitoring for
gastric cancer prevention in these patients, individualized conduct, taking into
account individual characteristics, family record and other risk factors, should
be adopted to avoid unfavorable outcomes in CD patients.
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