Corticosteroid-dependent eosinophilic oesophagitis: azathioprine and 6-mercaptopurine can induce and maintain long-term remission.

Abstract:

BACKGROUND:Eosinophilic oesophagitis (EO) is a chronic inflammatory disorder of the oesophagus that is rapidly increasing in prevalence. Although systemic and topical corticosteroids are effective in treating EO, some patients develop corticosteroid dependency. Alternative therapeutic approaches that avoid corticosteroids are scarce. AIM:To analyse our experience at inducing and maintaining remission with an immunomodulatory therapy in steroid-dependent EO patients. METHODS:We analysed the clinical and histological response to azathioprine (AZA) and 6-mercaptopurine in three patients with EO (one also with eosinophilic gastroenteritis) and corticosteroid dependency. RESULTS:In all three patients, AZA or 6-mercaptopurine-induced clinical and histological remission that was maintained during the follow-up period (range 3-8 years). Two patients experienced relapses after ceasing AZA therapy. Remission, however, resumed when short-term corticosteroid treatment was followed by AZA. In all the patients, blood eosinophilia disappeared under AZA treatment. Only jumbo biopsies confirmed suspected EO with predominant muscle-layer involvement in one patient. CONCLUSION:In adult patients with corticosteroid-dependent EO, immunomodulatory treatment with purine analogues is a promising therapeutic approach for inducing and maintaining long-term remission without the need for further corticosteroids. Jumbo forcep biopsies might be needed to confirm a diagnosis of muscle-layer predominant EO.

authors

Netzer P,Gschossmann JM,Straumann A,Sendensky A,Weimann R,Schoepfer AM

doi

10.1097/MEG.0b013e32825a6ab4

subject

Has Abstract

pub_date

2007-10-01 00:00:00

pages

865-9

issue

10

eissn

0954-691X

issn

1473-5687

pii

00042737-200710000-00006

journal_volume

19

pub_type

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