Tofacitinib for the treatment of tumor necrosis factor-α inhibitor refractory esophageal Crohn’s disease: a case report

BACKGROUND: Esophageal Crohn’s disease is reported as a rare manifestation, although its prevalence may be underestimated because upper endoscopies are not routinely performed in asymptomatic adults. Tofacitinib, an oral janus kinase inhibitor, is a new biologic that has shown promise in the treatment of ulcerative colitis and may be effective in the treatment of Crohn’s disease according to phase 2 trials. We report the first case of esophageal Crohn’s disease successfully treated with tofacitinib in a patient with worsening symptoms despite maintenance therapy with a tumor necrosis factor-α inhibitor. CASE PRESENTATION: A 67-year-old Caucasian woman presented with new dysphagia and had findings of esophageal Crohn’s disease on endoscopy. The dosage of her current biologic therapy—adalimumab—was increased in frequency, without improvement. Our patient was started on tofacitinib and demonstrated an improvement in symptoms, with a repeat endoscopy showing resolution of the previous lesions. CONCLUSION: Esophageal Crohn’s disease is likely underdiagnosed but is an important consideration in a patient with new symptoms of dysphagia and known Crohn’s disease. Tofacitinib, while a novel agent, could have a role in the treatment of esophageal Crohn’s disease that does not improve with intensification of the current biologic therapy. It provides a different mechanism in patients who become refractory to maintenance therapy.