Esophagitis in an Adolescent Patient with Crohn’s Disease after Changing Treatment from Prednisolone to Budesonide

Abstract

Studies have demonstrated that budesonide is effective in the treatment of active Crohn's disease. Due to its extensive hepatic metabolism, budesonide has much lower adverse events compared to prednisolone. Consequently, the low systemic availability restricts its application to Crohn's disease of the terminal ileum and the colon. Esophageal ulceration is a rare complication of Crohn's disease. This article describes the case of a young lady who presented at the age of 16 with active Crohn's disease of the terminal ileum and the colon without dysphagia or pain in the chest. Her disease was successfully treated with prednisolone for almost two years. Because of weight gain, acne, and moon face she was switched to budesonide. A few days later she presented with intractable pain of the esophagus, dysphagia, and inability to eat. Endoscopy demonstrated aphthous ulcerations of the esophagus and the histology was compatible with Crohn's disease. After two weeks of treatment with prednisolone all symptoms resolved and at follow-up gastroscopy ulcers had disappeared.

Crohn’s disease of the esophagus

“…Due to the ileal-release characteristics of this drug, it is not useful in treatment of esophageal Crohn's disease. There is one case report of exacerbation of esophageal Crohn's disease in a patient who was switched from prednisone to budesonide for the treatment of extraesophageal Crohn's disease [26]. Although it has not been studied in this setting, budesonide powder for inhalation may have some efficacy in the treatment of esophageal Crohn's disease if it is swallowed.…”