Off-label Anwendung einer budesonidhaltigen Suspension für die Behandlung einer lymphozytären Ösophagitis

BACKGROUND: Lymphocytic esophagitis (LyE) is a rare chronic inflammatory disease of the esophagus, which shares clinical characteristics with the eosinophilic esophagitis. The most important part of its treatment is proton pump inhibitors (PPIs). Referring to locally acting steroids, evidence-based treatment strategies are missing.

CASE REPORT: A 62-year-old patient presented for evaluation of his chronic dysphagia with previously diagnosed multiple oesophageal stenoses. Endoscopy revealed diffusely distributed esophageal rings and furrows and the diagnosis of LyE was established after immunohistochemical analysis of multiple mucosal biopsies. We initiated therapy with budesonide in the form of capsules (Entocort 3 × 3 mg Hartkapseln® once daily). During the course of the treatment, we initiated the off-label use of suspensions (Budenobronch® 0.5 mg twice daily) routinely used in the treatment of patients with asthma or COPD to increase the patient΄s acceptance of this therapy which was diminished because of his dysphagia. Under this therapy, clinical and later histological remission was achieved.

CONCLUSION: Our case report is meant to describe an empirical therapeutic concept, which led to clinical and histological remission of chronic LyE.