Inflammatory bowel disease glucocorticoids

The glucocorticoids are administered with caution to patients with renal or hepatic disease hypothyroidism, ulcerative colitis, diverticulitis, peptic ulcer disease, inflammatory bowel disease hypertension, osteoporosis, convulsive disorders, or diabetes. The glucocorticoids... 

Glucocorticoid therapy is indicated in selected patients with inflammatory bowel disease, chronic ulcerative colitis as well as Crohn s disease. Agents include prednisolone, hydrocortisone and budes-onide, the latter having a predominantly local effect... 

Glucocorticoids are commonly used in the treatment of patients with moderate to severe active inflammatory bowel disease. Active disease is commonly treated with an initial oral dosage of 40-60 mg/d of prednisone or prednisolone. Higher doses have not been shown to be more efficacious but have significantly greater adverse effects. Once a patient responds to initial therapy (usually within 1-2 weeks), the dosage is tapered to minimize development of adverse effects. In severely ill patients, the drugs are usually administered intravenously. 

For the treatment of inflammatory bowel disease involving the rectum or sigmoid colon, rectally administered glucocorticoids are preferred because of their lower systemic absorption. 

This report highlights the risk of cardiovascular adverse effects with short courses of glucocorticoid therapy in elderly patients with inflammatory bowel disease, even with rather low-dosage regimens. Acute myocardial infarction occurred in an old man with coronary insufficiency and giant cell arteritis after treatment with prednisolone (SEDA-10, 343) but could well have been coincidental. 

In a retrospective study, postoperative infectious complications were evaluated in 159 patients with inflammatory bowel disease undergoing elective surgery (317). Immunosuppression consisted of glucocorticoid monotherapy (n = 56), a glucocorticoid + azathioprine or mercaptopurine (n — 52), and neither a glucocorticoid nor azathioprine or mercaptopurine (n — 51). The adjusted odds ratios for any infection and major infections in patients who took glucocorticoid were 3.69 and 5.54 respectively, and in patients who took azathioprine or mercaptopurine 1.68 and 1.20. Thus, preoperative use of glucocorticoid in patients with inflammatory bowel disease increased the risk of postoperative infectious complications. 

Glucocorticoids See text for listing Heart, kidney, liver, bone marrow Multiple sclerosis, rheumatoid arthritis, SLE, inflammatory bowel disease, hemolytic disorders, others. 

Topical glucocorticoids are used extensively for the treatment of a variety of inflammatory diseases such as rhinitis, inflammatory bowel disease, asthma, and several dermatological diseases. 

There have been three other reports of interstitial nephritis associated with mesalazine in patients with inflammatory bowel disease, two with ulcerative colitis and one with Crohn s disease (83-85). One patient continued to be dialysis-dependent and in two patients withdrawal of the drug and treatment with glucocorticoids resulted in partial improvement in renal function. 

A possible risk of glucocorticoid treatment of ulcerative colitis is the development of toxic megacolon or colonic perforation. A change from ulcerative colitis to Crohn s disease may have been induced by prolonged treatment with glucocorticoids (SEDA-19, 376) (130). This case provides further evidence for the view that ulcerative colitis and Crohn s disease may represent a continuous spectrum of inflammatory bowel disease and raises the possibility that reduced polymorphonuclear leukocyte function caused by glucocorticoids may have provoked the development of granulomata. 

Finally, approximately 2 out of 10 000 Europeans 15 years or older suffer from inflammatory bowel disease, that is, ulcerative cholitis and Crohn s disease. Ulcerative cholitis occurs with a higher incidence than Crohn s disease [143]. The standard treatment for IBD includes glucocorticoids and other immunomodulators, and as many as 30% of Crohn s disease and 25% of ulcerative cholitis patients are glucocorticoid dependent. However, 50% of patients suffering from Crohn s disease and 20% of patients with ulcerative colitis experience bowel resection. IBD treatment failure can occur when either or all of the three mechanisms listed below come into effect ... 

Farrell, R.J. and Kelleher, D. (2003) Glucocorticoid resistance in inflammatory bowel disease. The Journal of Endocrinology, 178 (3), 339-346. 

The client with inflammatory bowel disease is prescribed the glucocorticoid prednisone. Which priority intervention should the nurse implement ... 

Infection risk Patients receiving infliximab are more susceptible to serious infections, including mycobacterial infections [128 ] and pneumonia [129 ]. Concomitant treatment with glucocorticoids was the only independent susceptibility factor for infections in patients with inflammatory bowel disease treated with infliximab [130. ... 

Susceptibility factors Inflammatory bowel disease is a susceptibility factor for abnormal bone metabolism, with a large amount of evidence of increased incidences of osteopenia and osteoporosis in adults. However, only a few studies of bone mineral density have been performed in children and adolescents with inflammatory bowel disease. Bone mineral density in the lumbar spine has been evaluated in 40 children and adolescents with inflammatory bowel disease, mean age 12 years, 26 with ulcerative colitis and 14 with Crohn s disease, in order to identify the associated susceptibility factors [15 ]. There was a low bone mineral density (Z-score worse than —2) in 25% of patients, with equal prevalences in Crohn s disease and ulcerative cohtis. Height for age, basal metabolic index, and cumulative glucocorticoid dose had independent effects, and these effects remained significant after adjustment for disease duration. 

Verkasalo M, Raivio T. Bone turnover and metabolism in paediatric patients with inflammatory bowel disease treated with systemic glucocorticoids. Eur J Endocrinol 2008 159(6) 693-8. 

Synthetic glucocorticoids are indicated for a wide variety of conditions including rheumatoid arthritis, asthma, ankylosing spondylitis, lupus erythematosus, inflammatory bowel disease, dermatitis, allergic reaction, etc. These steroids are available in a variety of formulations allowing for oral, topical, inhalation and intravenous forms. Typical examples of synthetic glucocorticoids include betamethasone, cortisone acetate, deflazacort. 

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