Gastroenterology

Gastroenterology

Volume 121, Issue 2, August 2001, Pages 255-260
Gastroenterology

Alimentary Tract
The natural history of corticosteroid therapy for inflammatory bowel disease: A population-based study,☆☆,

https://doi.org/10.1053/gast.2001.26279Get rights and content

Abstract

Background & Aims: The aim of this study was to determine the 1-year outcome after the first course of corticosteroids in an inception cohort of patients with inflammatory bowel disease.Methods: All patients in Olmsted County, Minnesota, diagnosed with Crohn's disease (n = 173) or ulcerative colitis (n = 185) from 1970 to 1993 who were treated with systemic corticosteroids were identified (4 denied research authorization).Immediate outcome (30 days) and 1-year outcome after the first course of corticosteroids were determined.Results: Seventy-four (43%) patients with Crohn's disease and 63 (34%) with ulcerative colitis were treated with corticosteroids.Immediate outcomes for Crohn's disease were complete remission in 43 (58%), partial remission in 19 (26%), and no response in 12 (16%).Immediate outcomes for ulcerative colitis were complete remission in 34 (54%), partial remission in 19 (30%), and no response in 10 (16%).One-year outcomes for Crohn's disease were prolonged response in 24 (32%), corticosteroid dependence in 21 (28%), operation in 28 (38%), and lost to follow-up in 1 (1%).One-year outcomes for ulcerative colitis were prolonged response in 31 (49%), corticosteroid dependence in 14 (22%), and operation in 18 (29%).Conclusions: Most patients with Crohn's disease and ulcerative colitis initially respond to corticosteroids.At 1 year, 32% of patients with Crohn's disease and 48% with ulcerative colitis are corticosteroid free without operation.

GASTROENTEROLOGY 2001;121:255-260

Section snippets

Design of the study

The study was a population-based inception cohort study.It has been reported previously that 173 patients were diagnosed with CD and 185 patients were diagnosed with UC in Olmsted County, Minnesota, between the years of 1970 and 1993.7, 8 These patients had been identified using the resources of the Rochester Epidemiology Project, a linked medical diagnostic index that exploits the unique healthcare delivery system of Olmsted County and allows for true population-based studies of disease.9 Four

Patients

Seventy-four of 171 patients with CD (43%; 95% CI, 36%–41%) and 63 of 183 patients with UC (34%; 95% CI, 28%–42%) received CS therapy.The demographic characteristics for these patients, including sex, age at diagnosis, disease duration at first CS therapy, site of disease, concomitant therapy, and history of intestinal resection before first CS therapy, are shown in Table 1.

. Baseline characteristics of patients

VariableUC (n = 63)CD (n = 74)
Men34 (54%)34 (46%)
Age at diagnosis (yr)a33.1 (14.9–77.9)

Discussion

Several important conclusions can be drawn from this population-based inception cohort study of the natural history of IBD after CS therapy.First, only 43% of patients with CD and 34% of patients with UC ever required CS therapy.Second, only 16% of patients with CD and 16% of patients with UC failed to respond to CS therapy.Finally, CS dependence and surgery occurred commonly in patients with either CD or UC who required CS therapy, even among those who initially responded to treatment.These

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Address requests for reprints to: Edward V.Loftus, Jr., M.D., or William J.Sandborn, M.D., Division of Gastroenterology and Hepatology, Mayo Clinic, 2001st Street, S.W., Rochester, Minnesota 55905.e-mail: [email protected] or [email protected]; fax: (507) 266-0335.

☆☆

Supported in part by a research grant from AstraZeneca Pharmaceuticals, Wayne, Pennsylvania, and by grant AR30582 from the National Institutes of Health.

Drs.Loftus and Sandborn have served as consultants for AstraZeneca Pharmaceuticals.

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