LDN and pediatric Crohn's publication

[Guest guest]

A letter to the editor in Inflammatory Bowel Disease, pre-pub electronic edition

(no abstract available, so I just cut and pasted the important part of the

letter):

Low-dose naltrexone for treatment of duodenal Crohn's disease in a pediatric

patient.

A, Alkhouri N, Mayacy S, Kaplan B, Mahajan L.

Department of Pediatric Gastroenterology, Cleveland Clinic Pediatric Institute,

Cleveland, Ohio.

CASE REPORT

A 14-year-old white female was

referred for recurrent episodes of right

upper quadrant pain of 3 years duration.

On examination, she was well-nourished

with no significant & #64257;ndings other than

tenderness in the right upper quadrant.

She underwent comprehensive radiologic

and laboratory investigations during sev-

eral follow-up visits, which did not reveal

any specific etiology for her pain; how-

ever, IBD7 serology was consistent with

Crohn's disease (CD). She underwent an

esophagogastroduodenoscopy (EGD)

which showed erosions with overlying

exudate in the duodenum. Biopsy

revealed & #64257;bropurulent exudate and focal

active duodenitis. Subsequent wireless

capsule endoscopy demonstrated scat-

tered areas of mild erythema and super & #64257;-

cial erosions/mucosal cracking through-

out the duodenum and proximal jejunum.

A diagnosis of duodenal CD was made

based on these endoscopic, histologic,

and serologic & #64257;ndings. Acid suppressive

therapy and empiric treatment for H.

pylori infection did not relieve symp-

toms. Treatment with prednisone and

azathioprine resulted in severe myalgias

and stiffness requiring a wheelchair.

Finally, she was placed on LDN (4.5 mg

daily) and had significant improvement

of her symptoms after 4 weeks of ther-

apy. A repeat EGD done 3 months after

starting naltrexone showed complete mu-

cosal healing with normal biopsies.