Steroid dependency and steroid resistance in inflammatory bowel disease

Standard treatment with glucocorticosteroids continues to be the first-line treatment for active inflammatory bowel disease. However, at least one-thi rd of patients develop steroid dependency, meaning that they require steroi d treatment at least three times a year in order to maintain remission. One -fifth of patients become steroid resistant, meaning that it is impossible to keep them in remission on the recommended doses of steroids. This sectio n presents a typical case of steroid dependence and another case demonstrat ing an important aspect involved in the clinical treatment of these disease s: that other diseases can resemble inflammatory bowel disease and lead to a diagnosis of steroid resistance. Budesonide was used in the treatment of these cases due it its favorable side-effect profile; its indications are a lso addressed, particularly in relation to steroid dependency. Also discuss ed are the role of immunosuppressants, 6-mercaptopurine, azathioprine and c yclosporin. These are considered in detail and it is concluded that they ar e the first drugs to use in cases of steroid dependency and steroid resista nce. Finally, the indications for surgery in such circumstances are detaile d, as well as the different types of operations available and the advantage s and disadvantages of each one. (C) 2001 Prous Science. All rights reserve d.