The natural history of first course of corticosteroid therapy for 235 patients with inflammatory bowel disease

Objective To assess the response to the first course of corticosteroids in inflammatory bowel disease patients and their outcomes.Methods 890 patients in our hospital,diagnosed with inflammatory bowel disease from Jan.2002 to Dec.2010 who were treated with the first course of corticosteroids were identified.Immediate outcome(30 days) and 1-year outcome after the first course of corticosteroids were determined retrospectively.Results A total of 890 IBD patients(401 UC,489 CD) were observed retrospectively.81(81/401,20.2%) cases in UC group and 154(154/489,31.5%) cases in CD group were treated with oral or intravenous corticosteroids.Immediate outcomes(30 days) for ulcerative colitis were complete remission in 57(57/81,70.4%),partial remission in 22(22/81,27.2%),and no response in 2(2/81,2.5%).Immediate outcomes for Crohn's disease were complete remission in 94(94/154,61.0%),partial remission in 45(45/154,29.2%),and no response in 15(15/154,9.7%).1-year outcomes for ulcerative colitis were prolonged response in 53(53/79,67.1%),corticosteroid dependence in 26(26/79,32.9%).1-year outcomes for Crohn's disease were prolonged response in 102(102/151,67.5%),corticosteroid dependence in 26(26/151,17.2%) and operation in 23(23/151,15.2%).Logistic regression analysis of each potential risk factor for immediate and 1-year outcomes showed 1-year outcomes associated with the combination of azathioprine and 6-mercaptopurine in Crohn's disease(P=0.03).Conclusion Most patients with inflammatory bowel disease initially respond to corticosteroids.Ulcerative colitis patients responded better than Crohn's disease cases.At 1-year,32.9% of patients with ulcerative colitis and 17.2% Crohn's disease were corticosteroid dependence,and 15.2% Crohn's disease required surgical resection.