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A population-based study of the frequency of corticosteroid resistance and dependence in pediatric patients with Crohn's disease and ulcerative colitis

Authors

  • Jeanne Tung MD,

    1. Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, Minn.
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  • Edward V. Loftus Jr MD,

    1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn.
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  • Deborah K. Freese MD,

    1. Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, Minn.
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  • Mounif El-Youssef MD,

    1. Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, Minn.
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  • Alan R. Zinsmeister PhD,

    1. Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn.
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  • L. Joseph Melton III MD,

    1. Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn.
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  • W. Scott Harmsen MS,

    1. Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn.
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  • William J. Sandborn MD,

    1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn.
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  • William A. Faubion Jr MD

    Corresponding author
    1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn.
    • Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester MN 55905
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  • Presented in part at the 106th Annual Meeting of the American Gastroenterological Association, Chicago, Ill, May 14-19, 2005. Published in abstract form in Gastroenterology. 2005;128 (Suppl 2):A327.

Abstract

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.

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