From the Guidelines
Treatment for chronic mesentericitis is primarily focused on reducing inflammation and managing symptoms, with corticosteroids such as prednisone being a common first-line treatment. The goal of treatment is to improve quality of life and reduce morbidity and mortality associated with the condition.
Treatment Options
- Corticosteroids: Prednisone is often used at a starting dose of 40-60mg daily, with gradual tapering over several months to minimize side effects and reduce inflammation 1.
- Immunosuppressive medications: Azathioprine, methotrexate, or mycophenolate mofetil may be added for steroid-sparing effects or in cases where patients do not respond to corticosteroids alone 1.
- Tamoxifen: This medication has been shown to reduce fibrosis in some patients and may be considered as an adjunctive treatment 1.
- Pain management: NSAIDs like ibuprofen or naproxen can help manage pain associated with chronic mesentericitis 1.
- Supportive care: Nutritional support and treatment of complications such as bowel obstruction or vascular compromise are crucial aspects of managing chronic mesentericitis.
Approach to Treatment
The approach to treating chronic mesentericitis involves suppressing the inflammatory process to prevent mesenteric thickening and fibrosis, which can lead to complications like pain, bowel obstruction, and vascular issues. Treatment duration varies based on the patient's response, with some requiring long-term maintenance therapy.
Considerations
While the provided evidence primarily discusses diverticulitis, the principles of reducing inflammation and managing symptoms can be applied to chronic mesentericitis. However, it's essential to consider the underlying cause of the condition and tailor treatment accordingly. In cases associated with IgG4-related disease, rituximab may be beneficial 1. Surgery is generally reserved for complications or diagnostic purposes.
Given the lack of direct evidence on chronic mesentericitis in the provided studies, the recommendation is based on the most recent and highest quality study available, which focuses on diverticulitis treatment 1. The treatment approach prioritizes reducing inflammation and managing symptoms to improve quality of life and reduce morbidity and mortality associated with chronic mesentericitis.
From the Research
Treatment Options for Chronic Mesenteritis
- Medical therapy alone has been used in the treatment of chronic mesenteritis, with some patients responding to this approach 2
- Surgery alone or in combination with medical therapy has also been used, with varying degrees of success 2
- Tamoxifen in combination with prednisone has been shown to be effective in some patients, with 60% of patients improving with this treatment 2
- Conservative management with prednisone has also been reported to be effective in some cases, allowing patients to avoid surgery 3
Medications Used in Treatment
- Tamoxifen and prednisone combination treatment has been shown to be effective in some patients with chronic mesenteritis 2
- Prednisone has been used as a single agent in the conservative management of chronic mesenteritis 3
- Mesalamine, a 5-aminosalicylic acid compound, is commonly used in the treatment of ulcerative colitis, but its use in chronic mesenteritis is not well established 4, 5, 6
Important Considerations
- The optimal treatment approach for chronic mesenteritis is not well established and may vary depending on the individual patient's circumstances 2
- Long-term follow-up is needed to substantiate the effectiveness of different treatment approaches 2
- Patients with chronic mesenteritis should be closely monitored for complications and treated promptly if they occur 2