title: The natural history of corticosteroid therapy for ulcerative colitis in children.
abstract: OBJECTIVE
  The aim of this study was to determine the clinical outcome after corticosteroid therapy in children who are newly diagnosed with ulcerative colitis (UC).
  
  
  METHODS
  Data were gathered prospectively from the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry database between January 2002 and March 2005. All children who were newly diagnosed with inflammatory bowel disease younger than the age of 16 years were managed according to the dictates of their respective physicians. Demographic, clinical, and laboratory data were collected at diagnosis, at 30 days, and then quarterly. Patients were classified as corticosteroid responsive, corticosteroid dependent, or refractory, and outcomes were determined at 3 months and at 1 year.
  
  
  RESULTS
  Ninety-seven patients had a diagnosis of UC and a minimum of 1 year of follow-up evaluation; 77 (79%) received corticosteroids (62 within 30 days of diagnosis [early] and 15 between 31 days and 6 months [late]). At diagnosis, 81% of corticosteroid-treated patients (age, 11.3 +/- 3.5 y) had moderate/severe disease, and 81% had pancolitis. For those treated early with corticosteroids, disease activity at 3 months was inactive in 60%, mild in 27%, and moderate/severe in 11%. At 1 year, 31 of 62 (50%) of the early corticosteroid-treated patients were considered corticosteroid responsive and 28 (45%) were corticosteroid dependent. A total of 4 patients receiving corticosteroids (5%) required colectomy in the first year. Immunomodulators were used in 61% of all corticosteroid-treated patients.
  
  
  CONCLUSIONS
  Although short-term clinical response to corticosteroids in children with newly diagnosed UC is excellent, even with the common use of immunomodulators corticosteroid dependence is seen in 45% of patients.
authors.affiliation: Connecticut Children's Medical Center, Hartford, Connecticut, USA. jhyams@ccmckids.org
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: Anthony
authors.initials: A
authors.lastname: Otley
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Mariann
authors.initials: M
authors.lastname: Pfefferkorn
authors.forename: Joel
authors.initials: J
authors.lastname: Rosh
authors.forename: Robert
authors.initials: R
authors.lastname: Rothbaum
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
authors.forename: Adam
authors.initials: A
authors.lastname: Mezoff
authors.forename: Robert
authors.initials: R
authors.lastname: Wyllie
authors.forename: Vasundhara
authors.initials: V
authors.lastname: Tolia
authors.forename: J Fernando
authors.initials: JF
authors.lastname: delRosario
authors.forename: M Susan
authors.initials: MS
authors.lastname: Moyer
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Neal
authors.initials: N
authors.lastname: Leleiko
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones