Hepatotoxicity of herbal remedies.

Abstract

Background Eosinophilic esophagitis (EoE) is a clinicopathological disease characterised by oesophageal eosinophilia and gastrointestinal symptoms. It is caused by immunologic reactions to ingested and inhaled allergens. The diagnosis is considered if at least 15 eosinophils are detected per high-powered field in mucosal biopsies. Purpose To describe and evaluate the efficacy of oral viscous budesonide for EoE in paediatric patients. Materials and methods Patient, 11 years old, diagnosed with EoE, persistent atopic asthma and pollen rhinoconjunctivitis, with multiple food allergies. He initiated a restricted-foods diet and drug treatment with Montelukast 10 mcg/24 h, Fluticasone 50 mcg twice daily and on-demand salbutamol inhalation, which failed, although there was some clinical improvement. Therefore, treatment with budesonide suspension was initiated 0.5 mcg twice daily, 1 h after meals. Budesonide suspension is a viscous liquid consisting of budesonide nebulizer suspension (Pulmicort respules 0.50mg/ml) mixed with sodium benzoate sodium, saccharin, and glycerine with constant stirring until blended. Finally add the strawberry essence and incorporate xanthan gum on top without mixing and add water to 240 ml. The final concentration is 0.25 mg/ml. Results In our present medical case, the patient presented eosinophilic enteritis and esophagitis, despite having been treated with omeprazole, antihistamines, and dietary advice. Between April 2013 and May 2013, he had been receiving, budesonide 500 mcg/12 hourly and dietary treatment. He had a significant improvement. After the treatment the endoscopy was completely normalised. Unfortunately, 3 months later after stopping the oral steroids the patient reported recurrence of symptoms. Conclusions As with most eosinophilic diseases, oral steroids improve oesophageal eosinophilic and symptoms in patients with EoE. Treatment with budesonide induced full remission in the patient. Unfortunately, the therapeutic effect of oral steroids on the disease is abolished following cessation of treatment. Therefore, patients may have to continue on therapeutic treatment levels for an indefinite amount of time No conflict of interest.