Intralesion Triamcinolon Injection Therapy on Esophageal Stricture as Side Effect of Long Term Use Biphosphonate
Abstract: Systemic Lupus
Erythematous (SLE) is a chronic inflammatory disease that affect almost any
organ system. Patient with SLE is at risk of osteoporosis. Biphosphonate is one
of osteoporosis treatments. However, esophageal stricture (ES) caused by
continuous esophageal inflammation as a result of long-term use Biphosphonate
can occur. Intralesion Triamcinolone Injection (ITI) becomes one of ES therapy
by inhibiting inflammatory response to injury and decrease subsequent collagen
formation. ITI inhibits transcription of matrix protein genes, including
fibronectin and procollagen. It also reduces the synthesis of α2-macroglobulin, an inhibitor of collagenase
activity. A 43 year old woman was diagnosed with SLE. She was treated with
Risedronic Acid (bisphosphonate class) 35 mg once a week. After 8 months, she
started complaining difficulty to swallow. Symptom was getting worse 6 months
later. One-third distal ES with inflammation process was found with endoscopy.
ITI 150 mg was given in inflammation area. She was scheduled to follow up after
7 days for re-endoscopy. Endoscopy
showed that inflammation process had been improved. Six months later, she had
again complained difficulty to swallow and we found that she still consumed
Risedonic Acid. ITI 150 mg was given because inflammation and ES was found with
endoscopy. After 7 days, endoscopy
showed that there was no ES and inflammation process had been improved. She was
advised to stop Risedronic Acid consumption.
Keywords: Intralesion
Triamcinolone injection; esophageal stricture; systemic lupus erythematous
(SLE); Biphosphonate
Author: Arles, Yoanda Silvia
Journal Code: jpkedokterangg170399
