Symptomatic Gallbladder Sludge and its Relationship to Subsequent Biliary Events.

formed the only prospective study of a treatment for mesenteric panniculitis with thalidomide.3 Patients in that study showed a clinical response to thalidomide. However, use of thalidomide to treat mesenteric panniculitis is costly and the drug is associated with multiple side effects. Other commonly used treatments for mesenteric panniculitis include the use of corticosteroids, immunosuppressant agents, and hormonal therapy such as tamoxifen.4 These have the potential for causing serious and life-threatening side effects. LDN seems to have promise for the treatment for Crohn’s disease and several other autoimmune and inflammatory conditions such as multiple sclerosis.1,2,5 This dose of naltrexone is safe with minimal side effects and no immunosuppressant properties. A rat model study showed that a low dose of naltrexone stimulates endogenous opioid growth factor (OGF) and receptor release.6 This increases tissue concentrations of endogenous (Met)-enkephalin (OGF) and endorphins.7 In turn, these lower doses of naltrexone may block the synthesis of tumor necrosis alpha, an important mediator of chronic inflammation. Use of objective measurements of disease severity and quality of life (MPSAS and FANLTC) changes the current management paradigm in this disease, where retrospective anecdotal reports have dictated the current medical therapy. LDN is safe and well tolerated in patients with symptomatic mesenteric panniculitis. In this study, 2 of the 3 patients had symptomatic improvement with treatment. Further studies are in progress. Grigory Roginsky, MD* Aimee Alexoff, BSwz Eli D. Ehrenpreis, MD, FACGzy *Department of Medicine zCenter for the Study of Complex Diseases NorthShore University HealthSystem Evanston yDepartment of Gastroenterology NorthShore University HealthSystem Skokie wDepartment of Biology, Loyola University Chicago, Chicago, IL