Impact of Acute Steroid Treatment on Memory, Executive Function, and Mood in Pediatric Inflammatory Bowel Disease

Abstract

Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensitive and specific serologic tests for the diagnosis of celiac disease, there is limited information on the association of the magnitude of antibody level with the severity of the histological abnormalities of the intestine. Purpose: To determine if EMA and TG titers correlate with the severity of histological changes in patients with celiac disease. Methods: We identified 148 children from our laboratory database that had EMA, TG and intestinal biopsies performed. IgA EMA was determined by indirect immunofluorescence with results expressed as a dilutional titer with positivity determined at 1:5. IgA TG was determined by an enzyme linked human immunosorbent ELISA assay with results expressed in standardized units. A modified Marsh histological grading system was used to describe the duodenal biopsies: Type 0 normal, I increased intraepithelial lymphocytes (IEL), II hyperplastic crypts, IIIa partial villus atrophy, IIIb subtotal villus atrophy, IIIc total villous atrophy. Results: Mean values for EMA (Table 1) and TG (Table 2) progressively increased with increasing Marsh score. Conclusion:There was considerable variability in EMA and TG levels for each Marsh grade, so that an individual level could not be utilized to predict histological severity. The data show that as a group, increasing severity of the histological lesion in celiac disease was associated with increased levels of both IgA EMA and TG antibodies.

Using the Children's Depression Inventory in youth with inflammatory bowel disease: support for a physical illness-related factor

“…Thus, the Somatic Complaints factor may be related, in part, to the autoimmune response observed during an active IBD flare. Second, study findings are consistent with a subset of symptoms commonly induced by exogenous steroids or cytokine (interferon) treatments in various human diseases [10, 33, 34]. In other words, the Somatic Complaints factor observed in this sample might, in part, reflect symptoms in response to common treatments.…”

“…Such sickness behaviors closely mirror symptoms of depression and often reflect non-gastrointestinal specific somatic complaints that are common secondary symptoms of IBD. Steroid-induced depression, which includes a number of the above symptoms in addition to irritability, has been reported in a number of physically ill populations [9], including youths with IBD [10]. …”

Psychological factors affecting pediatric inflammatory bowel disease

“…Two studies investigating the effects of steroids on mood and memory in children with IBD found that those on steroids had significantly more problems with memory and depression compared with children not on steroids [20,21]. Mixed results have been found for the relationship between age at diagnosis and behavioral/emotional symptoms, with one study reporting worse outcomes for those diagnosed in adolescence [5,16 ] and one finding no developmental difference [16 ].…”

“…Other risk factors that have been investigated include stressful life events, maternal depression, family dysfunction, and steroid treatment, and all have been found to be associated with increased depression symptoms [5,6,20,21]. Two studies investigating the effects of steroids on mood and memory in children with IBD found that those on steroids had significantly more problems with memory and depression compared with children not on steroids [20,21].…”

The Management of Paediatric Crohn's Disease: Addressing Unmet Needs

“…Corticosteroids are the mainstay of treatment for acute exacerbations in children; however, they are ineffective in maintaining remission [40]. In addition, although their chronic use is limited by severe side effects (e.g., moon face/acne, weight gain/redistribution, bone demineralisation, delayed puberty, mood swings, high blood pressure, altered glucose metabolism) [41,42], patients often receive many rounds of steroid therapy. Tung et al evaluated the 1-year outcomes of corticoid therapy in paediatric CD as part of the population-based Olmsted County study [43].…”