Successful use of montelukast in eosinophilic gastroenteritis: a case report and a literature review

Abstract

Background Eosinophilic gastrointestinal disorders, also known as eosinophilic gastroenteritis, are rare inflammatory conditions characterized by eosinophilic infiltration of different parts of the gastrointestinal tract, along with peripheral eosinophilia in most cases. Other known causes for gut eosinophilic infiltration must be excluded to confirm the diagnosis of eosinophilic gastroenteritis. Symptoms of the disorder depend on the affected gastrointestinal tract segment and depth of involvement. Treatment includes systemic glucocorticoids and/or dietary therapy with an empiric elimination diet. Second line therapies include the leukotriene receptor antagonist montelukast, and other anti-allergy drugs such as mast cell stabilizers (including cromolyn and the H1-antihistamine ketotifen), suplatast tosilate which is a selective Th-2 cytokines (IL-4 and IL-5) inhibitor, and the monoclonal anti-IgE antibody omalizumab. We report a case of eosinophilic gastroenteritis who was successfully treated and achieved remission with montelukast as an initial monotherapy. Upon extensive literature review, this represents the second reported adult case of eosinophilic gastroenteritis who responds to montelukast alone as a first line therapy. Case presentation A 49-year-old female presented with recurrent abdominal pain, vomiting, diarrhea and unexplained eosinophilia. She was diagnosed with eosinophilic gastroenteritis and was successfully treated with montelukast monotherapy. After 7 days of therapy, the patient responded well and had complete resolution of her gastrointestinal symptoms and peripheral eosinophilia. Patient remained in remission on follow-up after 12 months. We reviewed the literature for leukotriene antagonist use in the treatment of eosinophilic gastroenteritis and included the cases treated with the leukotriene antagonist montelukast as an initial therapy or as a second line therapy for refractory disease. Conclusion Montelukast may be an effective treatment for eosinophilic gastroenteritis, either alone or in combination with systemic steroids or ketotifen. Our patient is the second reported adult case of eosinophilic gastroenteritis who responded to montelukast alone as a first line therapy. Further studies and clinical trials are required to confirm efficacy compared to standard therapy.

A rare case of eosinophilic gastrointestinal disorders with short bowel syndrome after strangulated bowel obstruction

“…Fundamentally, the treatment strategy for secondary EGIDs is to treat the primary disease; however, it was difficult to improve the digestive symptoms using only nutritional therapy in our case. Several studies have reported montelukast sodium as an effective treatment for EGIDs [11,12]. Montelukast is a selective and competitive of the cysteinyl leukotriene receptor.…”

“…Montelukast sodium has become the focus of attention in the treatment of EGIDs. One study described the successful use of montelukast as a steroid-sparing agent in 63% adults patients [11], however its effectiveness as a treatment for EGIDs in children remains to be evaluated. In our case, sufficient effectiveness was not observed.…”

March of the Eosinophils: A Case of Eosinophilic Gastroenteritis, Immune Thrombocytopenia, and Iron Deficiency Anemia

“…If prednisone cannot be tolerated due to side effects, budesonide remains a viable alternative as it has a lower systemic side effect profile [ 1 ]. Other agents like azathioprine, cromolyn sodium, ketotifen, montelukast, and biologics like mepolizumab have been explored as adjuncts for the refractory disease but cannot be firmly recommended as first-line therapies due to conflicting data and lack of large-scale studies [ 1 , 14 ].…”

Eosinophilic Duodenal Ulcer Exacerbation after <i>Helicobacter pylori</i> Eradication in a 14-Year-Old Boy

“…The effectiveness of montelukast, a leukotriene receptor antagonist, for EGIDs with duodenal lesions was shown in a double-blind, randomized, placebo-controlled crossover study (Friesen et al 2004). In addition, there are several case reports in which montelukast monotherapy was effective as a first line treatment (Neustrom and Friesen 1999;El-Alali et al 2021). Montelukast is a medication associated with few adverse events and may be considered for use before corticosteroids, especially in cases with duodenal lesions.…”