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Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn's disease: a case report.
J Med Case Rep. 2016 Sep 23; 10(1):264.JM

Abstract

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.

CASE PRESENTATION

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.

CONCLUSION

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.

Authors+Show Affiliations

University of Florida, College of Medicine, 1600 SW Archer Rd, Room 4102, Gainesville, FL, 32611, USA. Sunina.nathoo@bcm.edu.Department of Graduate Medical Education, Nova Southeastern University, Largo Medical Center, 201 14th St SW, Largo, FL, 33770, USA.Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 2000 SW Archer Rd, Gainesville, FL, 32610, USA.Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, 2000 SW Archer Rd, Gainesville, FL, 32610, USA.Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 2000 SW Archer Rd, Gainesville, FL, 32610, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27663846

Citation

Nathoo, Sunina, et al. "Tofacitinib for the Treatment of Tumor Necrosis Factor-α Inhibitor Refractory Esophageal Crohn's Disease: a Case Report." Journal of Medical Case Reports, vol. 10, no. 1, 2016, p. 264.
Nathoo S, Hood WA, Keihanian S, et al. Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn's disease: a case report. J Med Case Rep. 2016;10(1):264.
Nathoo, S., Hood, W. A., Keihanian, S., Collinsworth, A. L., & Glover, S. C. (2016). Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn's disease: a case report. Journal of Medical Case Reports, 10(1), 264.
Nathoo S, et al. Tofacitinib for the Treatment of Tumor Necrosis Factor-α Inhibitor Refractory Esophageal Crohn's Disease: a Case Report. J Med Case Rep. 2016 Sep 23;10(1):264. PubMed PMID: 27663846.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn's disease: a case report. AU - Nathoo,Sunina, AU - Hood,William A, AU - Keihanian,Sara, AU - Collinsworth,Amy L, AU - Glover,Sarah C, Y1 - 2016/09/23/ PY - 2016/05/16/received PY - 2016/08/12/accepted PY - 2016/9/25/entrez PY - 2016/9/25/pubmed PY - 2016/9/25/medline KW - Dysphagia KW - Esophageal Crohn’s disease KW - Inflammatory bowel disease KW - Therapeutics KW - Tofacitinib SP - 264 EP - 264 JF - Journal of medical case reports JO - J Med Case Rep VL - 10 IS - 1 N2 - 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. CASE PRESENTATION: 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. CONCLUSION: 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. SN - 1752-1947 UR - https://www.unboundmedicine.com/medline/citation/27663846/Tofacitinib_for_the_treatment_of_tumor_necrosis_factor_α_inhibitor_refractory_esophageal_Crohn's_disease:_a_case_report_ L2 - https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-016-1036-y DB - PRIME DP - Unbound Medicine ER -
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