BACKGROUND Ulcerative colitis is a chronic relapsing disease usually treated with mesalamine. The need of steroid therapy at diagnosis is generally considered as a poor prognostic factor. AIMS The aim of our study was to assess whether patients treated with corticosteroids at diagnosis have more clinical relapses, disease progression, or an increased risk of colectomy during a 5-year follow-up. METHODS We retrospectively evaluated patients who had received diagnosis of ulcerative colitis with a 5-year follow-up. Relapse was defined as a worsening of symptoms requiring an increase in medical treatment. Progression of disease was defined as a proximal extension of mucosal involvement, comparing the colonoscopy performed 5 years after diagnosis with the first one. The need of corticosteroid treatment at diagnosis was correlated to number of relapses, disease progression, and colectomy rate. RESULTS We included 230 patients, 116 of them (50%) treated with steroids at diagnosis. Multivariate analysis demonstrated that there is a strong correlation between corticosteroid use and number of relapses (p < 0.01), as well as with disease progression (p < 0.05). Seventeen patients (7.4%) underwent colectomy, but the correlation with steroids was not statistically significant. CONCLUSIONS These data provide evidence that the need of corticosteroids at diagnosis is associated with a worse clinical outcome.

中文翻译：

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诊断时的皮质类固醇治疗：溃疡性结肠炎的复发，疾病扩展和结肠切除率分析。

背景技术溃疡性结肠炎是通常用美沙拉敏治疗的慢性复发性疾病。诊断时需要类固醇治疗通常被认为是不良的预后因素。目的本研究的目的是评估在接受5年随访期间，接受皮质类固醇激素治疗的患者在诊断时是否有更多的临床复发，疾病进展或结肠切除术的风险增加。方法我们回顾性评估了诊断为溃疡性结肠炎的患者，并进行了5年的随访。复发定义为需要加重治疗的症状加重。疾病的进展定义为粘膜受累的近端扩展，将诊断后5年进行的结肠镜检查与第一个进行比较。诊断时需要糖皮质激素治疗与复发次数，疾病进展和结肠切除率相关。结果我们纳入了230位患者，其中116位（50％）在诊断时接受了类固醇治疗。多变量分析表明，使用皮质类固醇激素与复发次数（p <0.01）以及疾病进展（p <0.05）之间有很强的相关性。17名患者（7.4％）接受了结肠切除术，但与类固醇的相关性无统计学意义。结论这些数据提供了证据，表明在诊断时需要糖皮质激素与较差的临床预后相关。多变量分析表明，使用皮质类固醇与复发次数（p <0.01）以及疾病进展（p <0.05）之间有很强的相关性。17名患者（7.4％）接受了结肠切除术，但与类固醇的相关性无统计学意义。结论这些数据提供了证据，表明在诊断时需要糖皮质激素与较差的临床预后相关。多变量分析表明，使用皮质类固醇激素与复发次数（p <0.01）以及疾病进展（p <0.05）之间有很强的相关性。17名患者（7.4％）接受了结肠切除术，但与类固醇的相关性无统计学意义。结论这些数据提供了证据，表明在诊断时需要糖皮质激素与较差的临床预后相关。