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

• Published in: JGH open Vol. 6; no. 12; pp. 910 - 914
• Main Authors: Farraj, Kristen L, Pellegrini, James R, Munshi, Rezwan F, Russe‐Russe, Jose, Kaliounji, Aboud, Tiwana, Muhammad S, Srivastava, Pranay, Subramani, Krishnayer
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.12.2022; John Wiley & Sons, Inc; Wiley
• Subjects: Bone diseases; Comorbidity; corticosteroids; Crohns disease; Diabetes; Emotional disorders; Fractures; Gender; Heart attacks; Hospitals; Hypertension; Infections; Inflammatory bowel disease; Length of stay; Metabolic syndrome; Mood disorders; Mortality; Original; Osteoporosis; Pancreatitis; Patients; Quality of life; Sepsis; steroid; steroid celiac disease; Steroids; Thrombosis; Transient ischemic attack; ulcerative colitis; Ulcers; United Kingdom > UK; United States > US; Europe; ulcerative colitis; corticosteroids; inflammatory bowel disease; steroid celiac disease; steroid
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12841

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. Steroids have long been used in inducing remission of inflammatory bowel disease (IBD), but there is controversy about whether IBD patients should be on chronic steroids for maintenance therapy. In this retrospective study, we aim to identify the complications of chronic steroid use in patients with IBD. Our results highlight the importance of monitoring patients on steroids and avoiding chronic use as patients on chronic steroid use had higher odds of developing adverse effects, such as osteoporosis, opportunistic infections, and acute thromboembolic events.