What are the pros and cons of steroid therapy for ulcerative colitis in young people (in their 20s)?

Randi

Ulcerative colitis is a chronic inflammatory disorder involving the colon (large intestine), beginning in the rectum and continuing for a variable distance further up into the colon. Some patients have disease limited to the rectum, and in others it involves the entire colon. It may occur at any age, but it peaks in the 20s and 30s. The cause is unknown. Symptoms usually include bleeding from the rectum and some level of diarrhea. Some people have only occasional attacks, and a small percentage have severe disease and require emergency treatment.

The treatment of ulcerative colitis can be difficult. Mild attacks are treated with drugs like sulfasalazine, either given by a rectal suppository or in pill form. More severe attacks are often treated with corticosteroids such as prednisone. These steroids are powerful antiinflammatory agents that should not be confused with the anabolic steroids used by body builders. Prednisone may be given in a pill, by a suppository or intravenously, depending on how sick you are.

Prednisone provides excellent relief of symptoms in most patients, and in general it is more successful than sulfasalazine-like drugs. Unfortunately, steroids are associated with side effects such as diabetes, acne, high blood pressure, and bone loss conditions -- the latter including aseptic necrosis of the hip, a problem that may require hip replacement. Most of these side effects occur when steroids are used for long periods. However, all patients taking steroids should have regular visits to the doctor for blood tests to check their glucose and potassium levels, blood pressure monitoring, and general health assessment. These visits can vary from weekly to monthly or longer depending on the severity of disease.

There are ways to reduce the need for steroids by giving other drugs in combination with it. Such drugs as azathioprine (Imuran) or some cytotoxic drugs that are used in chemotherapy are often helpful in the disease and may allow the prednisone dose to be lowered. These drugs also require careful and frequent blood tests and doctor visits and are usually used in severe disease. Rectal steroids may give fewer side effects. And some experts suggest that taking the steroids every other day instead of daily may cut down on side effects; however, this usually limits their effectiveness in ulcerative colitis.

In any case, you should not change the dosage or timing of your medicine without consulting your doctor. Ulcerative colitis requires management by a gastroenterologist with expertise in this disease. The treatment plan must be tailored to each patient -- and most people end up with successful outcomes. Please see your doctor and ask to be referred to a specialist if you are not already seeing one. For further advice, you may wish to consult the Crohns/Colitis Foundation.