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


OBJECTIVE
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.


CONCLUSIONS
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.
Netzer
Peter
P
Department of Gastroenterology, University of Berne, Berne, Switzerland. netzer@gzl.ch
Gschossmann
Juergen M
JM
Straumann
Alex
A
Sendensky
Alexander
A
Weimann
Rosemarie
R
Schoepfer
Alain M
AM
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use*; D004802:Eosinophilia / Q000188:drug therapy* / Q000473:pathology; D004941:Esophagitis / Q000188:drug therapy* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine; D011241:Prednisone