Crohn's disease exacerbated by ghost pills of upadacitinib.

The patient, a woman in her 40 s, was diagnosed with Crohn's disease (CD) of the small and large intestine, for which she had been treated for 30 years. The disease activity was difficult to control with infliximab. She underwent multiple surgical procedures, including partial resection of the small intestine and colostomy. She was subsequently introduced to several biologic agents, including adalimumab, ustekinumab, and vedolizumab: All failed to maintain long-term endoscopic and clinical remission. She was introduced to upadacitinib (UPA), but her disease worsened because of the so-called ghost pill phenomenon, by which pills are ejected directly into a pouch through the colostomy because of her short bowel after surgery, which prevented therapeutic efficacy. When using an extended-release agent such as UPA in patients with CD, the patient's gastrointestinal condition must be considered. Moreover, appropriate information must be shared with other health care professionals.