Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn's disease: a case report.
BACKGROUND
Esophageal Crohn's disease is reported as a rare manifestation, although its prevalence may be underestimated because upper endoscopies are not routinely performed in asymptomatic adults. Tofacitinib, an oral janus kinase inhibitor, is a new biologic that has shown promise in the treatment of ulcerative colitis and may be effective in the treatment of Crohn's disease according to phase 2 trials. We report the first case of esophageal Crohn's disease successfully treated with tofacitinib in a patient with worsening symptoms despite maintenance therapy with a tumor necrosis factor-α inhibitor.


METHODS
A 67-year-old Caucasian woman presented with new dysphagia and had findings of esophageal Crohn's disease on endoscopy. The dosage of her current biologic therapy-adalimumab-was increased in frequency, without improvement. Our patient was started on tofacitinib and demonstrated an improvement in symptoms, with a repeat endoscopy showing resolution of the previous lesions.


CONCLUSIONS
Esophageal Crohn's disease is likely underdiagnosed but is an important consideration in a patient with new symptoms of dysphagia and known Crohn's disease. Tofacitinib, while a novel agent, could have a role in the treatment of esophageal Crohn's disease that does not improve with intensification of the current biologic therapy. It provides a different mechanism in patients who become refractory to maintenance therapy.
University of Florida, College of Medicine, 1600 SW Archer Rd, Room 4102, Gainesville, FL, 32611, USA. Sunina.nathoo@bcm.edu.
Sunina
S
Nathoo
Department of Graduate Medical Education, Nova Southeastern University, Largo Medical Center, 201 14th St SW, Largo, FL, 33770, USA.
William A
WA
Hood
Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 2000 SW Archer Rd, Gainesville, FL, 32610, USA.
Sara
S
Keihanian
Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, 2000 SW Archer Rd, Gainesville, FL, 32610, USA.
Amy L
AL
Collinsworth
Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 2000 SW Archer Rd, Gainesville, FL, 32610, USA.
Sarah C
SC
Glover
Dysphagia; Esophageal Crohn’s disease; Inflammatory bowel disease; Therapeutics; Tofacitinib
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