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Successful treatment for ulcerative proctitis with rectal tacrolimus in an 8-year-old girl with intolerance to mesalamine

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Abstract

Ulcerative colitis (UC) is defined as a chronic inflammatory condition causing continuous mucosal inflammation of the colon without granulomas on biopsy. It affects the rectum, and, to a variable extent, the colon in continuity and is characterized by a relapsing and remitting course. Oral 5-aminosalicylic acid (5-ASA) regimens are recommended as first-line induction therapy for mild to moderately active pediatric UC and for maintenance of remission regardless of other initial treatments. In large clinical trials in adults, mesalamine intolerance was found in 2–5 % of the patients. We present a case of an 8-year-old female patient with intolerance to mesalamine and proctitis resistant to conventional therapy who responded to rectal tacrolimus treatment. The patient started with a dose of 2 mg/day at night with an excellent response. She reported feeling better than any of the previously prescribed treatments and without feeling the discomfort of previously administered enemas. After four weeks of treatment, the dose was reduced to 2 mg/week with no relapses. Tacrolimus suppositories were very well tolerated, and no adverse effects have been reported. Although only very little data has been published, rectal tacrolimus seems to be safe and of efficacy in ulcerative proctitis resistant to standard therapy.

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References

  1. Dignass A, Eliakim R, Magro F, Maaser C, Chowers Y, Geboes K, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis. 2012;6(10):965–90.

    Article  PubMed  Google Scholar 

  2. Sauer CG, Kugathasan S. Pediatric inflammatory bowel disease: highlighting pediatric differences in IBD. Gastroenterol Clin N Am. 2009;38:611–28.

    Article  Google Scholar 

  3. Levine A, de Bie C, Turner D, Cucchiara S, Sladek M, Murphy, Escher J, the EUROKIDS Porto IBD Working Group of ESPGHAN. Atypical disease phenotypes in pediatric ulcerative colitis: 5-year analyses of the EUROKIDS registry. Inflamm Bowel Dis. 2013;19:370–7.

    Article  PubMed  Google Scholar 

  4. Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011;17(6):1314–21.

    Article  PubMed  Google Scholar 

  5. Turner D, Levine A, Escher JC, Griffiths AM, Russell RK, Dignass A, European Crohn’s and Colitis Organization; European Society for Paediatric Gastroenterology, Hepatology, and Nutrition, et al. Management of pediatric ulcerative colitis: joint ECCO and ESPGHAN evidence-based consensus guidelines. J Pediatr Gastroenterol Nutr. 2012;55(3):340–61.

    Article  CAS  PubMed  Google Scholar 

  6. Oustamanolakis P, Koutroubakis IE. New desensitization regimen with mesalamine granules in a patient with ulcerative colitis and mesalamine intolerance. Inflamm Bowel Dis. 2011;17(2):E8–9.

    Article  PubMed  Google Scholar 

  7. Turner D, Otley AR, Mack D, Hyams J, de Bruijne J, Uusoue K, et al. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007;133(2):423–32.

    Article  PubMed  Google Scholar 

  8. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317(26):1625–9.

    Article  CAS  PubMed  Google Scholar 

  9. Navas-López VM, Blasco Alonso J, Serrano Nieto MJ, Girón Fernández-Crehuet F, Argos Rodriguez MD, Sierra Salinas C, Sierra Salinas C. Oral tacrolimus for pediatric steroid-resistant ulcerative colitis. J Crohns Colitis. 2014;8(1):64–9.

    Article  PubMed  Google Scholar 

  10. García Muñoz C, Cañamares Orbis I, Méndez Esteban ME, Casis Herce B. Tacrolimus enema for the treatment of Inflammatory Bowel Disease. Farm Hosp. 2012;36(6):544–5.

    PubMed  Google Scholar 

  11. Lawrance IC. Novel topical therapies for distal colitis. World J Gastrointest Pharmacol Ther. 2010;1(5):87–93.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Lawrance IC. Topical agents for idiopathic distal colitis and proctitis. J Gastroenterol Hepatol. 2011;26(1):36–43.

    Article  CAS  PubMed  Google Scholar 

  13. Lawrance IC, Copeland TS. Rectal tacrolimus in the treatment of resistant ulcerative proctitis. Aliment Pharmacol Ther. 2008;28:1214–20.

    Article  CAS  PubMed  Google Scholar 

  14. van Dieren JM, van Bodegraven AA, Kuipers EJ, et al. Local application of tacrolimus in distal colitis: feasible and safe. Inflamm Bowel Dis. 2009;15:193–8.

    Article  PubMed  Google Scholar 

  15. Herrlinger KR, Koc H, Winter S, Teml A, Stange EF, Fellermann K, et al. ABCB1 single-nucleotide polymorphisms determine tacrolimus response in patients with ulcerative colitis. Clin Pharmacol Ther. 2011;89(3):422–8.

    Article  CAS  PubMed  Google Scholar 

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Disclosures

Conflict of Interest: Dr. Navas-López VM, Blasco Alonso J, Girón Fernández-Crehuet F, Serrano Nieto MJ, Gallego Gutierrez S, Luque Pérez S and Sierra Salinas C declare that they have no conflict of interest.

Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent: Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Pediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil, Avda. Arroyo de los ángeles s/n, 29011, Málaga, Spain

    Víctor Manuel Navas-López, Javier Blasco-Alonso, Francisco Girón Fernández-Crehuet, Maria Juliana Serrano Nieto, Silvia Gallego-Gutiérrez, Silvia Luque Pérez & Carlos Sierra Salinas

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  1. Víctor Manuel Navas-López
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  2. Javier Blasco-Alonso
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  3. Francisco Girón Fernández-Crehuet
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  4. Maria Juliana Serrano Nieto
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  5. Silvia Gallego-Gutiérrez
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  6. Silvia Luque Pérez
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  7. Carlos Sierra Salinas
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Correspondence to Víctor Manuel Navas-López.

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Navas-López, V.M., Blasco-Alonso, J., Girón Fernández-Crehuet, F. et al. Successful treatment for ulcerative proctitis with rectal tacrolimus in an 8-year-old girl with intolerance to mesalamine. Clin J Gastroenterol 7, 320–323 (2014). https://doi.org/10.1007/s12328-014-0506-2

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  • DOI: https://doi.org/10.1007/s12328-014-0506-2

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