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Budesonide in the Treatment of Refractory Celiac Disease

Brar, Pardeep, M.D.1; Lee, Susie, M.D.1; Lewis, Suzanne, M.D.1; Egbuna, Ikenna, M.D.1; Bhagat, Govind, M.D.2; Green, Peter H.R., M.D.1

American Journal of Gastroenterology: October 2007 - Volume 102 - Issue 10 - p 2265–2269
ORIGINAL CONTRIBUTION: COLON/SMALL BOWEL
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OBJECTIVE Corticosteroids are used in patients with refractory celiac disease. In order to minimize their systemic side effects, we assessed the role of a locally active sustained release corticosteroid with minimal systemic bioavailability in patients with refractory celiac disease in an open labeled noncontrolled study.

METHODS Patients who received budesonide for refractory celiac disease were classified according to whether they were primarily or secondarily unresponsive to the diet, and whether they had a polyclonal (type I) or clonal (type II) expansion of intraepithelial lymphocytes. The response to budesonide was assessed globally and by reduction in bowel movements.

RESULTS Patients (N = 29, 72% female) received budesonide for a mean of 6.7 ± 8.5 months, 5 patients (18%) had type II disease (clonal T-cell population); 76% responded to the medication, 55% completely. Response occurred when budesonide was used alone or with oral corticosteroids and/or azathioprine. There was an objective improvement in the number of bowel movements in those that responded. Response occurred in those with either primary or secondary refractory disease and in those with type II disease, irrespective of the presence of microscopic colitis (N = 7). There was no improvement in the duodenal biopsy over the study period and there were no side effects of budesonide.

CONCLUSIONS Budesonide may be of value in the management of refractory celiac disease.

Departments of 1Medicine and 2Surgical Pathology, Columbia University College of Physicians and Surgeons, New York

Reprint requests and correspondence: Peter H.R. Green, M.D., Harkness Pavilion, Suite 956, 180 Fort Washington Ave., New York, NY 10032.

CONFLICT OF INTEREST Guarantor of the article: Peter H.R. Green, M.D.

Specific author contributions: Dr. Peter H.R. Green is responsible for the entire contents. Dr. Pardeep Brar and Dr. Ikenna Egbuna are the fellows who analyzed and compiled the data. Dr. Susie Lee, Dr. Suzanne Lewis, and Dr. Peter H.R. Green looked after the patients, while Dr. Govind Bhagat is the pathologist involved in the study.

Financial support: None.

Potential competing interests: None.

Received October 25, 2006; accepted April 17, 2007.

© The American College of Gastroenterology 2007. All Rights Reserved.
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