From the FDA Drug Label
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From the Research
Treatment of chronic mesenteric infiltration should prioritize an endovascular approach as the first line of therapy, considering its lower periprocedural mortality and morbidity rates, as evidenced by the study published in 2013 1. The primary treatment strategy depends on identifying the specific etiology, which may include malignancy, inflammatory conditions, or fibrosis.
- For malignant infiltration, systemic chemotherapy regimens specific to the primary cancer are indicated, often combined with targeted therapies.
- In cases of inflammatory causes like mesenteric panniculitis, corticosteroids such as prednisone (starting at 40-60mg daily with gradual taper) are first-line therapy, with immunomodulators like azathioprine (2-3mg/kg/day) or methotrexate (15-25mg weekly) added for steroid-sparing effects.
- Tamoxifen (10-20mg twice daily) may be beneficial due to its anti-fibrotic properties, particularly in idiopathic sclerosing mesenteritis. Pain management is essential, typically beginning with NSAIDs and progressing to neuropathic agents like gabapentin (300-1200mg three times daily) or pregabalin (75-300mg twice daily) if needed.
- Nutritional support is crucial, often requiring consultation with dietitians to address malabsorption and weight loss. Surgical intervention is generally reserved for complications such as bowel obstruction, perforation, or ischemia. Regular monitoring with CT imaging every 3-6 months is recommended to assess treatment response and disease progression, as supported by the study published in 2011 2. The treatment approach should be individualized based on disease severity, patient comorbidities, and quality of life considerations, with a focus on minimizing morbidity, mortality, and improving quality of life, as highlighted in the study published in 2010 3.