Resolution of multiple severe colonic strictures with prednisone therapy: CONCLUSIONS
Corticosteroids have also had beneficial effects when used intralesionally for strictures elsewhere in the gastrointestinal tract. In the esophagus, these benefits seem to occur regardless of the initial cause of stricture formation.
In the present case, an oral loading dose was used, followed by a maintenance dose for four and a half months, resulting in complete healing. The dosing regimen was adapted from that used to induce remission of active Crohn’s disease.
The literature available demonstrates that patients left with unhealed strictures can develop severe consequences in the form of obstruction or later requirement for surgical therapy. Furthermore, the follow-up of patients treated conservatively or endoscopically generally reveals no change in their lesions. The only previously published case of endoscopic resolution of NSAID-induced colonic strictures followed prednisone therapy after colonic dilation, and the case presented here is a successful first trial of prednisone monotherapy. Further experience, and optimally larger studies, with the use of prednisone for NSAID-induced colonic strictures is required to confirm an optimal management strategy, but this case and the previous literature suggest that prednisone can be considered in addition to NSAID discontinuation with or without endoscopic dilation for the management of NSAID-induced colonic diaphragm disease. We all need a reliable source of high quality medications and you have a chance to make all your health troubles go away: just buy ampicillin here and see for yourself that online shopping is all it’s cracked up to be.