From the Research
The treatment for sclerosing mesenteritis should prioritize a combination of corticosteroids and tamoxifen, as this regimen has shown the most promising results in reducing inflammation and preventing fibrosis, thereby improving patient outcomes in terms of morbidity, mortality, and quality of life. When considering treatment options, it's essential to weigh the benefits and risks of each approach, focusing on the most recent and highest-quality evidence available. The use of corticosteroids, such as prednisone, is a common first-line treatment to control inflammation, with dosages typically starting at 40-60 mg daily and gradually tapering as the patient responds 1. Additionally, tamoxifen, with its anti-fibrotic properties, is frequently used in combination with steroids, often at doses of 10-20 mg twice daily, as evidenced by its effectiveness in improving symptoms in patients with sclerosing mesenteritis 1. Other treatment options, including immunosuppressive agents like azathioprine, cyclophosphamide, or methotrexate, may be considered for steroid-sparing effects or in refractory cases, but the combination of corticosteroids and tamoxifen remains the most supported approach by recent studies 1. Colchicine may also be beneficial in reducing fibrosis, and for pain management, NSAIDs or opioid analgesics may be necessary, depending on the severity of symptoms 2, 3. Surgery is generally reserved for complications such as bowel obstruction or perforation, emphasizing the importance of monitoring symptoms and imaging to assess response to treatment 4. Given the rarity of sclerosing mesenteritis and its potential to mimic malignancy, confirming diagnosis through imaging and sometimes biopsy before initiating treatment is crucial, with treatment duration often being long-term, lasting months to years 1, 4. Ultimately, the treatment approach should be individualized based on symptom severity, disease progression, and patient tolerance to medications, prioritizing the combination of corticosteroids and tamoxifen as the cornerstone of therapy for sclerosing mesenteritis. Key considerations in managing sclerosing mesenteritis include:
- Confirming diagnosis to rule out malignancy
- Initiating treatment with corticosteroids and tamoxifen for inflammation and fibrosis reduction
- Monitoring symptoms and imaging regularly to assess treatment response
- Reserving surgery for complications
- Individualizing treatment based on patient-specific factors.