Corticosteroid Treatment at Diagnosis: An Analysis of Relapses, Disease Extension, and Colectomy Rate in Ulcerative Colitis

  • Lorenzo BertaniEmail author
  • Giorgia Bodini
  • Maria Gloria Mumolo
  • Nicola de Bortoli
  • Linda Ceccarelli
  • Leonardo Frazzoni
  • Gherardo Tapete
  • Eleonora Albano
  • Maria Corina Plaz Torres
  • Massimo Bellini
  • Edoardo Savarino
  • Vincenzo Savarino
  • Santino Marchi
  • Francesco Costa
Original Article



Ulcerative colitis is a chronic relapsing disease usually treated with mesalamine. The need of steroid therapy at diagnosis is generally considered as a poor prognostic factor.


The aim of our study was to assess whether patients treated with corticosteroids at diagnosis have more clinical relapses, disease progression, or an increased risk of colectomy during a 5-year follow-up.


We retrospectively evaluated patients who had received diagnosis of ulcerative colitis with a 5-year follow-up. Relapse was defined as a worsening of symptoms requiring an increase in medical treatment. Progression of disease was defined as a proximal extension of mucosal involvement, comparing the colonoscopy performed 5 years after diagnosis with the first one. The need of corticosteroid treatment at diagnosis was correlated to number of relapses, disease progression, and colectomy rate.


We included 230 patients, 116 of them (50%) treated with steroids at diagnosis. Multivariate analysis demonstrated that there is a strong correlation between corticosteroid use and number of relapses (p < 0.01), as well as with disease progression (p < 0.05). Seventeen patients (7.4%) underwent colectomy, but the correlation with steroids was not statistically significant.


These data provide evidence that the need of corticosteroids at diagnosis is associated with a worse clinical outcome.


Ulcerative colitis Disease progression Clinical relapses Corticosteroids 



The authors want to thank Tommaso Cosci for the support in data collection.

Author’s contribution

LB and NdB are involved in data collection and analysis, wrote the manuscript, and approved the final version. GB, GT, EA, and MCPT performed the data collection and analysis and approved the final version. LF contributed to statistical analysis and approved the final version. MGM, LC, MB, ES, VS, SM, and FC wrote the manuscript and approved the final version.


This paper has not required funding in terms of grants, equipment, drugs

Compliance with Ethical Standards

Conflict of interest

Edoardo Savarino received lecture and Consultancy Honoraria from Takeda, Janssen, MSD, Abbvie, Sofar, Malesci, Reckitt Benckiser, Medtronic, not influencing this paper. Francesco Costa received Board Membership honoraria from Takeda, Janssen, Amgen, and lecture fees from Abbvie, Takeda, Zambon, Ferring, Diasorin, Otsuka, MSD; none of these honoraria had influence on this paper. Lorenzo Bertani, Giorgia Bodini, Maria Gloria Mumolo, Nicola de Bortoli, Linda Ceccarelli, Leonardo Frazzoni, Gherardo Tapete, Eleonora Albano, Maria Corina Plaz Torres, Massimo Bellini, Vincenzo Savarino, and Santino Marchi have no conflict of interest to declare.

Ethical approval

This study protocol was conducted in accordance with 1975 Decl aration of Helsinki and was approved by the Ethical Committee of the University Hospital of Pisa (CEAVNO), on May 22, 2019, with the protocol number 29,124. A written informed consent was obtained from each patient included in the study.


  1. 1.
    de Souza HS, Fiocchi C. Immunopathogenesis of IBD: current state of the art. Nat Rev Gastroenterol Hepatol. 2016;13:13–27.CrossRefGoogle Scholar
  2. 2.
    Ye Y, Pang Z, Chen W, Ju S, Zhou C. The epidemiology and risk factors of inflammatory bowel disease. Int J Clin Exp Med. 2015;8:22529–22542.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54. (quiz e30).CrossRefGoogle Scholar
  4. 4.
    Ghosh S, Mitchell R. Impact of inflammatory bowel disease on quality of life: results of the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA) patient survey. J Crohn’s Colitis. 2007;1:10–20.CrossRefGoogle Scholar
  5. 5.
    Bitton A, Buie D, Enns R, et al. Treatment of hospitalized adult patients with severe ulcerative colitis: Toronto consensus statements. Am J Gastroenterol. 2012;107:179–194. (author reply 195).CrossRefGoogle Scholar
  6. 6.
    Harbord M, Eliakim R, Bettenworth D, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohn’s Colitis. 2017;11:769–784.CrossRefGoogle Scholar
  7. 7.
    Faubion WA Jr., Loftus EV Jr., Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121:255–260.CrossRefGoogle Scholar
  8. 8.
    Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J (Clin Res Ed). 1955;2:1041–1048.CrossRefGoogle Scholar
  9. 9.
    Powell-Tuck J, Bown RL, Lennard-Jones JE. A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis. Scand J Gastroenterol. 1978;13:833–837.CrossRefGoogle Scholar
  10. 10.
    Ford AC, Bernstein CN, Khan KJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106:590–599. (quiz 600).CrossRefGoogle Scholar
  11. 11.
    Creed TJ, Probert CS. Review article: steroid resistance in inflammatory bowel disease—mechanisms and therapeutic strategies. Aliment Pharmacol Ther. 2007;25:111–122.CrossRefGoogle Scholar
  12. 12.
    Li M, Gao X, Guo CC, Wu KC, Zhang X, Hu PJ. OCTN and CARD15 gene polymorphism in Chinese patients with inflammatory bowel disease. World J Gastroenterol. 2008;14:4923–4927.CrossRefGoogle Scholar
  13. 13.
    Mumolo MG, Bertani L, Ceccarelli L, et al. From bench to bedside: Fecal calprotectin in inflammatory bowel diseases clinical setting. World J Gastroenterol. 2018;24:3681–3694.CrossRefGoogle Scholar
  14. 14.
    Kostas A, Siakavellas SI, Kosmidis C, et al. Fecal calprotectin measurement is a marker of short-term clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease. World J Gastroenterol. 2017;23:7387–7396.CrossRefGoogle Scholar
  15. 15.
    Monstad I, Hovde O, Solberg IC, Moum BA. Clinical course and prognosis in ulcerative colitis: results from population-based and observational studies. Ann Gastroenterol Q Publ Hellenic Soc Gastroenterol. 2014;27:95–104.Google Scholar
  16. 16.
    Lee HJ, Jung ES, Lee JH, et al. Long-term clinical outcomes and factors predictive of relapse after 5-aminosalicylate or sulfasalazine therapy in patients with mild-to-moderate ulcerative colitis. Hepatogastroenterology. 2012;59:1415–1420.CrossRefGoogle Scholar
  17. 17.
    Jeon HH, Lee HJ, Jang HW, et al. Clinical outcomes and predictive factors in oral corticosteroid-refractory active ulcerative colitis. World J Gastroenterol. 2013;19:265–273.CrossRefGoogle Scholar
  18. 18.
    Stallmach A, Nickel L, Lehmann T, et al. Parameters of a severe disease course in ulcerative colitis. World J Gastroenterol. 2014;20:12574–12580.CrossRefGoogle Scholar
  19. 19.
    Solberg IC, Lygren I, Jahnsen J, et al. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand J Gastroenterol. 2009;44:431–440.CrossRefGoogle Scholar
  20. 20.
    Safroneeva E, Vavricka S, Fournier N, et al. Systematic analysis of factors associated with progression and regression of ulcerative colitis in 918 patients. Aliment Pharmacol Ther. 2015;42:540–548.CrossRefGoogle Scholar
  21. 21.
    Kim B, Park SJ, Hong SP, Kim TI, Kim WH, Cheon JH. Proximal disease extension and related predicting factors in ulcerative proctitis. Scand J Gastroenterol. 2014;49:177–183.CrossRefGoogle Scholar
  22. 22.
    Targownik LE, Nugent Z, Singh H, Bernstein CN. Prevalence of and outcomes associated with corticosteroid prescription in inflammatory bowel disease. Inflamm Bowel Dis. 2014;20:622–630.CrossRefGoogle Scholar
  23. 23.
    Langholz E, Munkholm P, Davidsen M, Nielsen OH, Binder V. Changes in extent of ulcerative colitis: a study on the course and prognostic factors. Scand J Gastroenterol. 1996;31:260–266.CrossRefGoogle Scholar
  24. 24.
    Ayres RC, Gillen CD, Walmsley RS, Allan RN. Progression of ulcerative proctosigmoiditis: incidence and factors influencing progression. Eur J Gastroenterol Hepatol. 1996;8:555–558.CrossRefGoogle Scholar
  25. 25.
    Burisch J, Ungaro R, Vind I, et al. Proximal disease extension in patients with limited ulcerative colitis: a danish population-based inception cohort. J Crohn’s Colitis. 2017;11:1200–1204.CrossRefGoogle Scholar
  26. 26.
    Burisch J, Katsanos KH, Christodoulou DK, et al. Natural disease course of ulcerative colitis during the first five years of follow-up in a European population-based inception cohort—an Epi-IBD study. J Crohn’s Colitis. 2018;13:198–208.CrossRefGoogle Scholar
  27. 27.
    Jeuring SF, Bours PH, Zeegers MP, et al. Disease outcome of ulcerative colitis in an era of changing treatment strategies: results from the dutch population-based IBDSL cohort. J Crohn’s Colitis. 2015;9:837–845.CrossRefGoogle Scholar
  28. 28.
    Ronnblom A, Holmstrom T, Tanghoj H, Karlbom U, Thorn M, Sjoberg D. Low colectomy rate five years after diagnosis of ulcerative colitis. Results from a prospective population-based cohort in Sweden (ICURE) diagnosed during 2005–2009. Scand J Gastroenterol. 2016;51:1339–1344.CrossRefGoogle Scholar
  29. 29.
    Hoie O, Wolters FL, Riis L, et al. Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years. Gastroenterology. 2007;132:507–515.CrossRefGoogle Scholar
  30. 30.
    Rai T, Choudhury BN, Kedia S, et al. Short-term clinical response to corticosteroids can predict long-term natural history of ulcerative colitis: prospective study experience. Dig Dis Sci. 2017;62:1025–1034. Scholar
  31. 31.
    Subramanian V, Banerjee A, Beharry N, Farthing MJ, Pollok RC. Determining the proximal extent of ulcerative colitis: white cell scan correlates well with histological assessment. Aliment Pharmacol Ther. 2007;25:441–446.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Lorenzo Bertani
    • 1
    • 3
    Email author
  • Giorgia Bodini
    • 2
  • Maria Gloria Mumolo
    • 3
  • Nicola de Bortoli
    • 1
  • Linda Ceccarelli
    • 3
  • Leonardo Frazzoni
    • 4
  • Gherardo Tapete
    • 1
  • Eleonora Albano
    • 1
  • Maria Corina Plaz Torres
    • 2
  • Massimo Bellini
    • 1
  • Edoardo Savarino
    • 5
  • Vincenzo Savarino
    • 2
  • Santino Marchi
    • 1
  • Francesco Costa
    • 3
  1. 1.Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
  2. 2.Gastroenterology Unit, Department of Internal MedicineUniversity of GenoaGenoaItaly
  3. 3.IBD Unit, Department of General Surgery and GastroenterologyPisa University HospitalPisaItaly
  4. 4.Department of Medical and Surgical Sciences, Sant’Orsola-Malpighi HospitalUniversity of BolognaBolognaItaly
  5. 5.Gastroenterology Unit, Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly

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