Glucocorticoids in pediatric inflammatory bowel disease

Abstract

Children with moderate to severe inflammatory bowel disease (IBD) are treated with systemic glucocorticoids (GCs). The majority of the patients respond to the given treatment; however, steroid resistance and dependency are significant clinical problems. Also therapy-related side effects limit the use of GCs in the control of active inflammation. This review summarizes recent knowledge of GC treatment in pediatric patients with IBD.

The impact of anti‐TNFα therapy on colectomy rates and corticosteroid treatment among 3001 paediatric and adolescent patients with ulcerative colitis—a nationwide study from 1995 to 2015

“…In patients who respond to anti‐TNFα therapy it is clinically important to consider whether the use of corticosteroid can be reduced or terminated. In paediatric and adolescent patients it is especially important to minimise the use of corticosteroids as corticosteroids may suppress growth even at low doses . Our result on the use of corticosteroid in paediatric and adolescent patients treated with anti‐TNFα therapy is not directly comparable to other studies.…”

“…The guidelines recommend a step‐up approach encompassing 5‐aminosalicylates (5‐ASA), corticosteroids, immunomodulators, anti‐TNFα therapy, and colectomy in patients not responding to the medical treatment . However, an early introduction of anti‐TNFα therapy is also discussed as a corticosteroid sparring therapy paying special attention and consideration to the growth and development of the child . Our first results have indicated a decline in the colectomy risk after the introduction of anti‐TNFα .…”

Enteral Nutrition in Crohn’s Disease: An Underused Therapy

“…They have been shown to induce remission in most patients when administered for a period of 4–6 weeks [42]. There have been several studies demonstrating equivalent efficacy of EEN in inducing remission in active CD.…”

“…Corticosteroids are limited in their use by risk of infection, osteoporosis, hypertension, growth retardation, poor mucosal healing, and early relapses on cessation of therapy [8]. This is especially problematic in paediatric patients who may experience significant growth retardation and osteoporosis with steroid therapy [9–12].…”

Managing inflammatory bowel disease in adolescent patients

“…Corticosteroids have long been considered the principal therapy for active CD, and continue to be widely used in some centers. Although CS may improve symptoms, there is increasing recognition that they lead to relatively low rates of mucosal healing, and have unacceptable side effect profiles, especially for adolescents 5,55. Although budesonide has substantially fewer systemic side effects than oral prednisone, it has also less efficacy, and it appears to have optimal benefits only for terminal ileal CD 55…”