The use of corticosteroids to treat patients with inflammatory bowel disease [IBD] has been the bedrock of IBD therapeutics since the pioneering work of Truelove and Witts in the UK in the 1950s and subsequent large cohort studies in the USA and Europe. Nevertheless, although effective for induction of remission, these agents do not maintain remission and are associated with a long list of recognised side effects, including a risk of increased mortality. With the arrival of an increasing number of therapies for patients with IBD, the question arises as to whether we are using these agents appropriately in contemporary practice. This review discusses the historical background to steroid usage in IBD, and also provides a brief review of the literature on side effects of corticosteroid treatment as relevant to IBD patients. Data on licensed medications are presented with specific reference to the achievement of corticosteroid-free remission. We review available international data on the incidence of corticosteroid exposure and excess, and discuss some of the observations we and others have made concerning health care and patient-level factors associated with the risk of corticosteroid exposure, including identification of ‘at-risk’ populations.

中文翻译：

---

皮质类固醇在炎症性肠病中的历史作用和当代使用。

自 1950 年代英国 Truelove 和 Witts 的开创性工作以及随后在美国和欧洲进行的大型队列研究以来，使用皮质类固醇治疗炎症性肠病 [IBD] 患者一直是 IBD 治疗的基石。然而，尽管这些药物对诱导缓解有效，但不能维持缓解并且与一长串公认的副作用相关，包括增加死亡率的风险。随着针对 IBD 患者的治疗方法越来越多，出现了一个问题，即我们是否在当代实践中适当地使用了这些药物。本综述讨论了 IBD 中类固醇使用的历史背景，并简要回顾了与 IBD 患者相关的皮质类固醇治疗副作用的文献。关于获得许可的药物的数据在特定参考实现无皮质类固醇缓解的情况下提供。我们回顾了有关皮质类固醇暴露和过量发生率的现有国际数据，并讨论了我们和其他人就与皮质类固醇暴露风险相关的医疗保健和患者层面因素所做的一些观察，包括识别“高危”人群.