Studies have demonstrated that
budesonide is effective in the treatment of active
Crohn's disease. Due to its extensive hepatic metabolism,
budesonide has much lower adverse events compared to
prednisolone. Consequently, the low systemic availability restricts its application to
Crohn's disease of the terminal ileum and the colon. Esophageal ulceration is a rare complication of
Crohn's disease. This article describes the case of a young lady who presented at the age of 16 with active
Crohn's disease of the terminal ileum and the colon without
dysphagia or
pain in the chest.
Her disease was successfully treated with
prednisolone for almost two years. Because of
weight gain,
acne, and moon face she was switched to
budesonide. A few days later she presented with
intractable pain of the esophagus,
dysphagia, and inability to eat. Endoscopy demonstrated aphthous ulcerations of the esophagus and the histology was compatible with
Crohn's disease. After two weeks of treatment with
prednisolone all symptoms resolved and at follow-up gastroscopy
ulcers had disappeared.