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• W3019051775 abstract "When considering a patient with Crohn’s disease eemed “steroid-dependent” one must understand the erminology, itself.1 By describing her as “steroid-depenent” we must first recognize that she was “steroidesponsive” but has been unable to taper prednisone.2 his is in contrast to a “steroid-refractory” patient dened as failing to respond to treatment with prednisone ssuming adequate doses (up to 1 mg/kg) within a -week time-frame. The terminology is more than a emantic issue as we should base our therapeutic options n evidence that examines this specific issue. “Steroidependency” is the rule, rather than the exception, for rohn’s disease patients requiring steroid therapy.3 Paient series from both Denmark4 and Olmsted County, innesota2 have detailed that, while approximately 80% f patients respond to treatment with prednisone over 4 eeks, by the end of a year the majority of the responders ill be unable to taper off, or remain ill on steroids. imilarly, in maintenance trials for patients who have chieved remissions on steroids, nearly 75%–80% will elapse within a year as steroids are tapered or withrawn.5,6 Therefore, “steroid-dependency” usually aplies to patients who cannot taper or rapidly flare (usually ithin 6 months) after steroid-withdrawal. A second consideration before reviewing therapeutic ptions is whether there are individual or disease-related actors that are contributing to the steroid-dependence Table 1).7 For instance, is the patient taking nonsteroial anti-inflammatory agents that are contributing to the rohn’s disease activity or does she smoke cigarettes, as mokers have consistently been noted to have more reractory disease.8 In either case the contributing factors hould be modified or eliminated. Other factors that may imic disease activity and be masked by the steroid reatment at super-physiologic doses (e.g., 7 mg/ ay) include intercurrent infections (e.g., C. difficile or ossibly cytomegalovirus or Epstein–Barr virus infecions in an immunocompromised host) or co-existing rritable bowel syndrome that, at times, is steroid-reponsive. Additionally, the primary symptom should be e-assessed to determine whether there are noninflammaory components such as diarrhea caused by malabsorpion in a postoperative setting or a chronic pain synrome. Therefore, the patient should be re-evaluated to rule ut infections and to be certain that the symptoms are, ndeed, inflammatory rather than caused by visceral hyersensitivity or malabsorption. Investigations should nclude a complete blood count (CBC); sedimentation ate and/or possibly C-reactive protein; and stool examnation for fecal leukocytes or stool lactoferrin, enteric athogens, and C. difficile toxin. This is also an opportune ime to re-assess the disease activity and location via adiographic studies (to determine whether there are xed-stenoses, evidence of small bowel stasis potentiat-" @default.
• W3019051775 created "2020-05-01" @default.
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• W3019051775 date "2003-01-01" @default.
• W3019051775 modified "2023-09-26" @default.
• W3019051775 title "onsiderations in the Management of Steroid-dependent rohn’s Disease" @default.
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