Overview
Sclerosing mesenteritis is a rare inflammatory condition characterized by fibrosis and sclerosis of the mesentery, often leading to abdominal pain, bowel obstruction, and mesenteric fat atrophy 1.Diagnosis
Imaging (CT, MRI) showing mesenteric thickening and fat stranding is crucial 1.
Histopathology from biopsy confirms the diagnosis with features of inflammation and fibrosis 1.
Elevated inflammatory markers may support the diagnosis but are non-specific 1.Management
First-line treatments: Corticosteroids (e.g., prednisone) are often initiated for symptomatic relief 1.
Adjunctive therapies: Immunosuppressive agents like azathioprine or infliximab may be considered in refractory cases 1.
Symptom management: Pain control and nutritional support are essential 1.Special Populations
Pregnancy: Limited data; management typically involves conservative approaches with close monitoring 1.
Elderly: Treatment strategies should consider comorbidities and functional status, often starting with corticosteroids cautiously 1.
Comorbidities: Presence of other inflammatory conditions may influence treatment choices, favoring immunosuppressive agents 1.Key Recommendations
Initiate corticosteroid therapy for symptomatic patients to manage inflammation and alleviate symptoms (Evidence: Strong 1).
Consider immunosuppressive therapy in cases refractory to corticosteroids to control disease progression (Evidence: Moderate 1).
Regular imaging follow-up is essential to monitor disease activity and treatment response (Evidence: Expert opinion 1).References
1 Worthington MT, Wolf JL, Crockett SD, Pardi DS. AGA Clinical Practice Update on Sclerosing Mesenteritis: Commentary. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2025. link