Tofacitinib for the Treatment of Tumor Necrosis Factor-α Inhibitor Refractory Esophageal Crohn's Disease

A Case Report

Sunina Nathoo; William A. Hood; Sara Keihanian; Amy L. Collinsworth; Sarah C. Glover

Disclosures

J Med Case Reports. 2016;10(264) 

In This Article

Background

Esophageal manifestations of Crohn's disease (CD) include erosion, ulceration, stricture, and fistula formation. Patients can present with odynophagia and/or dysphagia, but more serious manifestations including bronchoesophageal fistula have been reported.[1] Involvement of the esophagus in CD is rare and it is the least commonly affected segment in CD.[1] Additionally, the lack of standard upper endoscopy in asymptomatic adult patients with CD could also contribute to its low incidence.[2] Therefore, the prevalence of esophageal Crohn's disease could be underestimated; it is currently reported as being 1–6.8 % in the literature.[1–4] In contrast, there is a higher incidence of esophageal CD reported in the pediatric population because screening upper endoscopy is performed at the time of diagnosis given the high degree of proximal active disease, although patients are typically asymptomatic.[2] However, new studies suggest that upper gastrointestinal involvement is seen equally in the adult and pediatric populations.[5] There is a lack of consensus in the definition of involvement and, until recently, on treatment.[4,5] However, recent guidelines suggest treatment with immunomodulators, and tumor necrosis factor-α (TNF-α) inhibitors if the disease is more refractory; both options have been described in several case series with success.[2,6,7] We report the first case of esophageal CD successfully treated with tofacitinib, an oral janus kinase (JAK) inhibitor, in a patient with known CD. To the best of our knowledge, this is the first reported case of its use in esophageal CD. We also review the presentation, diagnosis, and treatment of esophageal CD.

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