Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease

Abstract

Background and Aim Steroids have long been used in inducing remission of inflammatory bowel disease (IBD). Chronic use, defined as therapy greater than 3 months, has been implicated in complications including increased hospital length of stay (LOS), infections, and even death. In our retrospective study, we aim to identify the complications of chronic steroid use in patients with IBD. Methods The fourth quarter of 2015–2019 National Inpatient Sample (NIS) was used in this study. International Classification of Diseases (ICD‐10) codes were used to identify patients with a diagnosis of IBD and chronic steroid use. Adverse outcomes of chronic steroid use in IBD patients were analyzed, such as osteoporosis, opportunistic infections, mortality rate, and LOS. Cohorts were weighted using an algorithm provided by the NIS allowing for accurate national estimates. Results A total of 283 970 patients had a diagnosis of IBD. Of those, 18 030 patients had concurrent chronic steroid use. Racial disparities existed, with 77.4% White, 12.7% Black, and 6.0% Hispanic. Patients with a history of IBD and chronic steroid use were found to have higher odds of developing osteoporosis, opportunistic infections, and acute thromboembolic events but did not have higher odds of mortality. Conclusion There is much controversy about whether IBD patients should be on chronic steroids for maintenance therapy and this study highlights the importance of this decision as patients on chronic steroid use had higher odds of developing adverse effects. These results stress the importance of monitoring patients on steroids and avoiding chronic use.

Inflammatory bowel disease and risk of more than 1500 comorbidities: A disease-wide pre- and post-diagnostic phenomic association study

“…For several diseases observed in excess following an IBD diagnosis, it remains to be understood if these are consequences of severe disease or the treatment thereof. We observed a significantly increased risk in the post-diagnostic period of osteopenia and osteoporosis with pathological fracture, which is a well-documented adverse effect of long-term steroid exposure 28 . Advances in IBD therapies over the last decades with more steroid sparing management in severe IBD management may change this picture over time.…”

Candida tropicalis Affects Candida albicans Virulence by Limiting Its Capacity to Adhere to the Host Intestinal Surface, Leading to Decreased Susceptibility to Colitis in Mice

“…CD is a chronic disease that cannot be fully cured; the main clinical therapies are focused on slowing down CD progression using anti-inflammatory approaches such as biological therapies and steroids [3,4].…”