Intest Res  
Successful remission of ulcerative colitis flare-up during pregnancy with adsorptive granulomonocytapheresis plus tacrolimus
Tomoyoshi Shibuya, Keiichi Haga, Masato Kamei, Koki Okahara, Shoko Ito, Masahito Takahashi, Osamu Nomura, Takashi Murakami, Masae Makino, Tomohiro Kodani, Dai Ishikawa, Naoto Sakamoto, Taro Osada, Tatsuo Ogihara, Sumio Watanabe, Akihito Nagahara
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
Correspondence to: Tomoyoshi Shibuya, Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. Tel: +81-3-5802-1058, Fax: +81-3-3813-8862, E-mail: tomoyosi@juntendo.ac.jp
Received: November 21, 2017; Revised: February 1, 2018; Accepted: February 26, 2018; Published online: April 6, 2018.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Ulcerative colitis (UC) is 1 of the 2 major phenotypes of chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms that impair function and quality of life. Further, IBD often affects women during childbearing age. Indeed, UC activity frequently increases during pregnancy, and the medications used to induce remission may adversely affect the health of the mother and the unborn child. We report successful induction of a remission in a UC case who experienced a flare-up in the first trimester of pregnancy. Upon relapse, she was treated with steroids and adsorptive granulomonocytapheresis (GMA) with the Adacolumn plus tacrolimus. This combination therapy induced a stable remission that was maintained during her entire pregnancy. She gave birth to a healthy child at 36 weeks of pregnancy with no maternal or fetal complications. Our experience indicates that GMA, as a non-drug therapeutic intervention with a favorable safety profile, plus tacrolimus might be a relevant treatment option for patients with active IBD during pregnancy. A future study of a large cohort of pregnant patients should strengthen our findings.
Keywords: Colitis, ulcerative; Pregnancy; Tacrolimus; Granulomonocytapheresis

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