Preoperative steroid-related complications in Japanese pediatric patients with ulcerative colitis.
OBJECTIVE
This study was designed to clarify a limit for steroid therapy in patients with ulcerative colitis through analyzing the preoperative major steroid-related complications and to define when alternative therapies, including surgery, should be performed in pediatric ulcerative colitis patients.


METHODS
The medical records of 28 pediatric and 57 adult patients with ulcerative colitis who underwent total proctocolectomy and ileal J-pouch-anal anastomosis were reviewed. The relationship between the preoperative dose of glucocorticoids and major steroid-related complications, as well as the surgery variables, was evaluated.


RESULTS
Significantly higher incidences of growth retardation, osteoporosis, glaucoma, and cataracts were noted in pediatric patients than in adult patients. In pediatric patients, major steroid-related complications occurred at a significantly lower preoperative total dosage of glucocorticoids/body weight (mg/kg) or preoperative total dosage of glucocorticoids/body surface area (mg/m2) than in adult patients. A similar surgical procedure was performed in both pediatric and adult patients. The presence of major steroid-related complications can lower a patient's long-term quality of life.


CONCLUSIONS
Evidence-based guidelines for the recommended dose of glucocorticoids according to body weight or body surface area are needed. To allow patients to feel well and maintain a good quality of life, early introduction of alternative treatments, including surgery, should be considered.
Uchida
Keiichi
K
Second Department of Surgery, Mie University School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan.
Araki
Toshimitsu
T
Toiyama
Yuji
Y
Yoshiyama
Shigeyuki
S
Inoue
Mikihiro
M
Ikeuchi
Hiroki
H
Yanagi
Hidenori
H
Miki
Chikao
C
Yamamura
Takehira
T
Kusunoki
Masato
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000139:chemically induced* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D005183:Failure to Thrive / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000139:chemically induced* / Q000453:epidemiology; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000453:epidemiology; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors
D005938:Glucocorticoids