Treatment Outcomes From Pentoxifylline in Sclerosing Mesenteritis

Abstract

Introduction: Sclerosing mesenteritis (SM) is a rare, chronic fibrosing and inflammatory disorder affecting the small bowel mesentery. Pentoxifylline has anti-inflammatory properties that could potentially benefit this disease. There is limited data on the efficacy of pentoxifylline for other fibroinflammatory disorders. We performed a retrospective chart review of patients with SM who were treated with pentoxifylline. Methods: ICD-9 codes were used to identify patients with SM, and free text search for pentoxifylline was used. Clinical data was abstracted from the electronic medical record and patients were called for followup. Data analysis was performed using JMP version 9.0.1. Results: Eleven patients were identified with median age of 64 years (range 39-75), and 36% were female. At presentation, abdominal pain was present in 10/11 (91%), abdominal distention or bloating was present in 8/11 (73%), and 7/11 (64%) had nausea or vomiting. Eighty-two percent (9/11) had a biopsy-proven SM, while the other 2 patients had characteristic CT findings without biopsy. Imaging findings at diagnosis included mesenteric mass in 6/11 (55%), mesenteritis without mass in 5/11 (45%), and lymphadenopathy in 4/11 (36%). Eight patients were prescribed tamoxifen prior to pentoxifylline; all 8 discontinued use (2 due to thromboembolism, 1 due to intolerance, 5 due to no response). The most common pentoxifylline dose was 400 mg 3 times a day (50% of patients), median duration was 4 months (range 1-30). Long-term follow-up data was available in 7 patients. Five patients were on prednisone while taking pentoxifylline. Two out of 7 patients (28.57%) experienced complete clinical improvement, 2/7 (28.57%) partial improvement, 3/7 (42.86%) no response. One patient had complete resolution of inflammatory changes on abdominal MRI. Two patients experienced nausea secondary to pentoxifylline, 1 of them requiring discontinuation. One patient died from refractory intestinal obstruction. Follicular large-cell lymphoma was diagnosed in 1 patient at follow-up. Conclusion: Pentoxifylline appears to be a reasonable treatment option for patients with SM that did not respond to tamoxifen. It appears to be well-tolerated, with only 1 patient stopping due to side effects. However, larger studies are necessary to better estimate the benefits and side effect profile of pentoxifylline in SM.