title: Therapy with budesonide in patients with refractory sprue.
abstract: BACKGROUND
  Refractory sprue (RS) is a rare malabsorption syndrome, which often requires long-term corticosteroid treatment. Locally acting budesonide could replace systemic corticosteroid therapy and reduce toxicity in patients with RS.
  
  
  OBJECTIVE
  To evaluate the efficacy and toxicity of budesonide in patients with RS.
  
  
  METHODS
  Clinical and histological data from patients with RS who received budesonide were analyzed. RS was defined as villous atrophy and malabsorption in spite of a strict gluten-free diet persisting for >6 months or requiring earlier therapeutic intervention.
  
  
  RESULTS
  We identified 9 patients (1 with autoimmune enteropathy, 4 with RS type I without and 3 with RS type II with signs of early T cell lymphoma and 1 with CD4-positive sprue-like intestinal T cell lymphoma), who received 9 mg/day of budesonide (range 6-12) for 24 months (1-60), and 7 of whom had an initial treatment with 40 mg/day of prednisolone (30-60) for 4 months (1-144). The initial body mass index was 18 (13.1-22.8) and increased similarly under prednisolone [21.5 (14.9-26.7), p < 0.05] and budesonide therapy [21 (18-27.2), p < 0.05]. The stool frequency per day also decreased similarly from 6 (2-8) to 2 (1-3) and 2 (1-5), each p < 0.05, under prednisolone and budesonide therapy, respectively. Two patients with RS type II did not respond and 7, including all 4 with RS type I, were clinically stable with budesonide therapy. Skin fragility in 1 patient was the only adverse effect of budesonide therapy.
  
  
  CONCLUSIONS
  Budesonide may be an effective treatment option in patients with RS type I, which can stabilize the clinical condition similar to prednisolone.
authors.affiliation: Department of Medicine I, Gastroenterology, Rheumatology and Infectious Diseases, Charité - Universitary Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany. severin.daum@charite.de
authors.forename: Severin
authors.initials: S
authors.lastname: Daum
authors.forename: Rainer
authors.initials: R
authors.lastname: Ipczynski
authors.forename: Bernhard
authors.initials: B
authors.lastname: Heine
authors.forename: Jörg-Dieter
authors.initials: JD
authors.lastname: Schulzke
authors.forename: Martin
authors.initials: M
authors.lastname: Zeitz
authors.forename: Reiner
authors.initials: R
authors.lastname: Ullrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D002446:Celiac Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D019819:Budesonide; D011239:Prednisolone