The natural history of corticosteroid therapy for ulcerative colitis in children.
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.
Hyams
Jeffrey
J
Connecticut Children's Medical Center, Hartford, Connecticut, USA. jhyams@ccmckids.org
Markowitz
James
J
Lerer
Trudy
T
Griffiths
Anne
A
Mack
David
D
Bousvaros
Athos
A
Otley
Anthony
A
Evans
Jonathan
J
Pfefferkorn
Mariann
M
Rosh
Joel
J
Rothbaum
Robert
R
Kugathasan
Subra
S
Mezoff
Adam
A
Wyllie
Robert
R
Tolia
Vasundhara
V
delRosario
J Fernando
JF
Moyer
M Susan
MS
Oliva-Hemker
Maria
M
Leleiko
Neal
N
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
D000305:Adrenal Cortex Hormones