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Author Affiliations: Ege University, Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bornova, Izmir, Turkey (Cakir M, Ozgenc F, Yusekaya HA, Ecevit CO, Yagci RV)
Corresponding Author: Murat Cakir, Ege University, Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bornova, Izmir, Turkey (Tel: 0 532 681 0318; Email: muratcak@hotmail.com)
Background: We aimed to analyze clinical and inflammatory markers of steroid non-response in patients with moderate/severe ulcerative colitis (UC) at the time of diagnosis.
Methods: This study included patients who were graded as having moderate/severe UC and received corticosteroids as first-line therapy. Demographic, clinical and laboratory findings and pediatric ulcerative colitis activity scores (PUCAS) were recorded. Response to corticosteroids was assessed 30 days after the induction and long-term therapy.
Results: Twenty-eight children were diagnosed as having moderate/severe UC. Their mean age ¡À SD was 12.2 ¡À 4 years, and 17% were under 5 years of age. PUCAS at their initial admission was 56.9 ¡À 11.8. UC was observed at the left colon in 9 patients (32.1%), and pancolitis in 19 (67.9%). At the end of the 30th day, UC was completely remitted in 15 patients (53.5%), partially remitted in 2 (7.1%), and no response in 11 (39.2%). Short-term follow-up showed partial remission in 2 patients, and overall remission with steroid in 17 (60.7%). Non-responders were given second-line treatment; steroid dependency was documented in 2 patients (7.1%) and another 2 (7.1%) patients underwent colectomy. Predictors for steroid non-response were analyzed and only PUCAS at the initial admission was found to be associated with non-response to steroids (51.4 ¡À 11.4 vs. 65.4 ¡À 6.8, P<0.05).
Conclusions: Approximately half of the pediatric patients had complete response to steroid therapy in a long period. PUCAS could be used as a potential marker of "failed response" to steroid, but should be supported with a number of prospective randomized controlled studies.
Key words: children; corticosteroid; ulcerative colitis
World J Pediatr 2011;7(1):50-53
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