A population-based study of the frequency of corticosteroid resistance and dependence in pediatric patients with Crohn's disease and ulcerative colitis.
BACKGROUND
The goal of this study was to examine the 1-year outcome after the first course of systemic corticosteroids in an inception cohort of pediatric patients with inflammatory bowel disease.


METHODS
All Olmsted County (Minnesota) residents diagnosed with Crohn's disease (n = 50) or ulcerative colitis (n = 36) before 19 years of age from 1940 to 2001 were identified. Outcomes at 30 days and 1 year after the initial course of corticosteroids were recorded.


RESULTS
Twenty-six patients with Crohn's disease (65%) and 14 with ulcerative colitis (44%) were treated with corticosteroids before age 19. Thirty-day outcomes for corticosteroid-treated Crohn's disease were complete remission in 16 (62%), partial remission in 7 (27%), and no response in 3 (12%), with 2 of these patients requiring surgery. Thirty-day outcomes for treated ulcerative colitis were complete remission in 7 (50%), partial remission in 4 (29%), and no response in 3 (21%). One-year outcomes for Crohn's disease were prolonged response in 11 (42%) and corticosteroid dependence in 8 (31%), whereas 7 (27%) were postsurgical. One-year outcomes for ulcerative colitis were prolonged response in 8 (57%) and corticosteroid dependence in 2 (14%), whereas 4 (29%) were postsurgical.


CONCLUSIONS
Most pediatric patients with inflammatory bowel disease initially responded to corticosteroids. However, after 1 year, 58% of pediatric patients with Crohn's disease and 43% of pediatric patients with ulcerative colitis either were steroid dependent or required surgery. This finding emphasizes the need for early steroid-sparing medications in pediatric inflammatory bowel disease.
Tung
Jeanne
J
Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Loftus
Edward V
EV
Freese
Deborah K
DK
El-Youssef
Mounif
M
Zinsmeister
Alan R
AR
Melton
L Joseph
LJ
Harmsen
W Scott
WS
Sandborn
William J
WJ
Faubion
William A
WA
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones