title: Steroid response in moderate to severe pediatric ulcerative colitis: a single center's experience.
abstract: BACKGROUND
  we aimed to analyze clinical and inflammatory markers of steroid non-response in patients with moderate/severe ulcerative colitis (UC) at the time of diagnosis.
  
  
  METHODS
  this study included patients who were graded as having moderate/severe UC and received corticosteroids as first-line therapy. Demographic, clinical and laboratory findings and pediatric ulcerative colitis activity scores (PUCAS) were recorded. Response to corticosteroids was assessed 30 days after the induction and long-term therapy.
  
  
  RESULTS
  twenty-eight children were diagnosed as having moderate/severe UC. Their mean age ± SD was 1 2.2 ± 4 years, and 17% were under 5 years of age. PUCAS at their initial admission was 56.9 ± 11.8. UC was observed at the left colon in 9 patients (32.1%), and pancolitis in 19 (67.9%). At the end of the 30th day, UC was completely remitted in 15 patients (53.5%), partially remitted in 2 (7.1%), and no response in 11 (39.2%). Short-term follow-up showed partial remission in 2 patients, and overall remission with steroid in 17 (60.7%). Non-responders were given second-line treatment; steroid dependency was documented in 2 patients (7.1%) and another 2 (7.1%) patients underwent colectomy. Predictors for steroid non-response were analyzed and only PUCAS at the initial admission was found to be associated with non-response to steroids (51.4 ± 11.4 vs. 65.4 ± 6.8, P<0.05).
  
  
  CONCLUSIONS
  approximately half of the pediatric patients had complete response to steroid therapy in a long period. PUCAS could be used as a potential marker of "failed response" to steroid, but should be supported with a number of prospective randomized controlled studies.
authors.affiliation: Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ege University, Bornova, Izmir, Turkey. muratcak@hotmail.com
authors.forename: Murat
authors.initials: M
authors.lastname: Cakir
authors.forename: Funda
authors.initials: F
authors.lastname: Ozgenc
authors.forename: Hasan Ali
authors.initials: HA
authors.lastname: Yusekkaya
authors.forename: Cigdem Omur
authors.initials: CO
authors.lastname: Ecevit
authors.forename: Rasit Vural
authors.initials: RV
authors.lastname: Yagci
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids