Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2017; 9(36): 1385-1388
Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1385
Eosinophilic cholangitis treatment with budesonide
Marianne Anastasia De Roza, Chee Hooi Lim
Marianne Anastasia De Roza, Chee Hooi Lim, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169856, Singapore
Author contributions: De Roza MA and Lim CH designed the report and analyzed the data; Lim CH reported and monitored outcomes; De Roza MA wrote the report; Both De Roza MA and Lim CH made critical revisions before final approval of the report.
Conflict-of-interest statement: There is no conflict of interest for all authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marianne Anastasia De Roza, MB.BS, MMED (Int Med), MRCP (UK), Registrar, Department of Gastroenterology and Hepatology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore. marianneanastasia.deroza@mohh.com.sg
Telephone: +65-326-6693
Received: September 21, 2017
Peer-review started: September 22, 2017
First decision: October 17, 2017
Revised: October 21, 2017
Accepted: November 11, 2017
Article in press: November 12, 2017
Published online: December 28, 2017
Processing time: 96 Days and 23.9 Hours
Abstract

Eosinophilic cholangitis is a rare cause of deranged obstructive liver function tests. It has been described as a great mimicker for malignant biliary strictures and bile duct obstruction. There are only case reports available on treatment experience for eosinophilic cholangitis. A large proportion of patients present with biliary strictures for which they have undergone surgery or endoscopic treatment and a small proportion was given systemic corticosteroid. We share our treatment experience using budesonide which has fewer systemic side effects to prednisolone and avoids invasive management.

Keywords: Eosinophilic cholangitis; Budesonide; Biliary stricture; Eosinophilia; Obstructive liver function test

Core tip: Eosinophilic cholangitis is a rare cause of obstructive liver function tests and secondary sclerosing cholangitis. Peripheral eosinophilia is the most useful laboratory hint for the diagnosis thus avoiding invasive endoscopic or surgical treatment. It is normally treated with a prolonged duration of corticosteroids, risking the development of corticosteroid adverse effects. We describe our successful experience with budesonide, an alternative treatment option which has a higher first pass effect resulting in fewer systemic side effects.