From the Research
Tamoxifen, in combination with prednisone, is the recommended first-line pharmacotherapy for patients with pronounced symptoms or complicated sclerosing mesenteritis, with a typical dose of 10 mg twice daily. Sclerosing mesenteritis is a rare inflammatory condition affecting the mesentery, characterized by chronic inflammation, fat necrosis, and fibrosis. The condition typically presents in the fifth or sixth decade of life, with patients having a history of abdominal surgery and/or autoimmune disease being at higher risk 1. Common signs and symptoms include abdominal pain, weight loss, diarrhea, and palpable abdominal mass on examination.
Diagnosis and Treatment
The diagnosis of sclerosing mesenteritis has shifted away from biopsy to computed tomography imaging of the abdomen due to the invasive nature of biopsy 1. However, certain conditions can mimic sclerosing mesenteritis on imaging, and a biopsy may be warranted for definitive diagnosis if clinical suspicion is equivocal. Asymptomatic patients do not require treatment, but for patients with pronounced symptoms or complicated sclerosing mesenteritis, the combination of tamoxifen and prednisone is the first-line pharmacotherapy 1.
Tamoxifen and Prednisone Combination
The use of tamoxifen in combination with prednisone has shown effectiveness in treating sclerosing mesenteritis, with 60% of patients improving with this regimen 2. Tamoxifen works by inhibiting fibroblast proliferation and collagen production, which helps reduce the fibrotic process central to sclerosing mesenteritis. The treatment duration typically ranges from 3-12 months, with some patients requiring longer therapy depending on their response.
Monitoring and Follow-up
Regular monitoring is essential to assess treatment response and potential side effects, including hot flashes, vaginal discharge, and increased risk of thromboembolic events. Treatment response should be assessed through symptom improvement and follow-up imaging to evaluate the reduction in mesenteric inflammation and fibrosis. Rarely, surgery may be necessary in cases of persistent bowel obstruction refractory to medical management 1.
Key Points
- Sclerosing mesenteritis is a rare inflammatory condition affecting the mesentery.
- Tamoxifen, in combination with prednisone, is the recommended first-line pharmacotherapy for patients with pronounced symptoms or complicated sclerosing mesenteritis.
- The treatment duration typically ranges from 3-12 months, with some patients requiring longer therapy depending on their response.
- Regular monitoring is essential to assess treatment response and potential side effects.