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Inflammatory Bowel Disease pp 73–92Cite as

State of the Art Medical Treatment of the Adult Patient with IBD: Modern Use of Corticosteroids

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Abstract

Conventional corticosteroids, such as prednisone, should be used as a therapy to induce remission in patients with mild to moderately active ulcerative colitis with inadequate response or intolerance to 5-ASA, or in patients presenting with moderate to severe UC. Patients with ulcerative proctitis may benefit from combined treatment with rectal enema formulations of beclomethasone dipropionate and 5-ASA. Rectal formulations of topical budesonide might be a promising treatment in patients with left-side colitis. Corticosteroids are not effective in maintaining remission in ulcerative colitis. Intravenous corticosteroids are indicated in patients not responding to oral corticosteroids or in those with severe activity of disease. Crohn’s disease Controlled ileal-release formulations of topical budesonide should be used in patients with mild to moderate ileocecal Crohn’s disease. Conventional corticosteroids are recommended in patients with moderate to severe CD regardless of disease location or in those with ileocecal CD with no response to budesonide. Corticosteroids are not recommended in patients presenting with perianal fistulas. Systemic corticosteroids are not effective as maintenance therapy of CD. Budesonide 6 mg daily is effective and safe in maintaining medically induced remission in CD but the duration of remission is limited only up to 6 months while on therapy. Intravenous corticosteroids are indicated in patients not responding to oral ­corticosteroids or in those with severe activity of disease.

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Authors and Affiliations

  1. Division of Gastroenterology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Gary R. Lichtenstein

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  1. Wojciech Blonski
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  2. David Kotlyar
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  3. Gary R. Lichtenstein
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Correspondence to Gary R. Lichtenstein .

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  1. MC 4076, Sect. Of GE, Hepatol. & Nutr., Department of Medicine, University of Chicago Medical Center, S. Maryland Ave. 5841, Chicago, 60637, Illinois, USA

    Russell D. Cohen

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Blonski, W., Kotlyar, D., Lichtenstein, G.R. (2011). State of the Art Medical Treatment of the Adult Patient with IBD: Modern Use of Corticosteroids. In: Cohen, R. (eds) Inflammatory Bowel Disease. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-433-3_6

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  • DOI: https://doi.org/10.1007/978-1-60327-433-3_6

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