Abstract
Introduction: Lymphonodular hyperplasia (LNH) is a mass of lymphoid tissue that has been described in the terminal ileum, colon and duodenum mainly in children. LNH is commonly found during pediatric endoscopies, and therefore has been considered as a normal or age related finding(1,2). LNH is commonly associated with abdominal pain and hematochezia(3). In one study, cyproheptadine treatment led to resolution of symptoms within 14–21 days. Those who did not respond (5%) were treated with prednisone(3). However, these drugs are associated with significant adverse effects. Methods: We report a series of 6 patients, ages 10–24 years, with severe intractable abdominal pain diagnosed with ileal LNH, proven by upper GI and follow through study and colonscopy with biopsies. All patients had normal blood count, ESR, C reactive protein and albumin Results: Four patients improved on 5ASA preparations (50mg/kg for two months) and two needed budesonide (9mg/day for 6 weeks). No adverse events were noted. None of these patient developed inflammatory bowel disease during follow-up. Conclusion: This is the first report to our knowledge that is using these agents as a possible treatment for patients with LNH and intractable symptoms. These agents have high safety profile and should be considered as a treatment for these patients.
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