Conventional therapy of ulcerative colitis: Corticosteroids

Corticosteroids are efficacious in patients with active ulcerative colitis, and this, together with their generally low cost, has ensured that they remain an attractive therapeutic option for inducing remission. However, side effects and complications are common, leading to the idea that they are a “necessary evil.” In this chapter, the evidence base for efficacy of various formulations, including oral and topical second-generation corticosteroids, are discussed and complications outlined. Optimal use of corticosteroids (maximizing benefits and minimizing side effects) involves not only the appropriate choice of formulation in specific scenarios, but also sensible management of withdrawal, corticosteroid resistance, and corticosteroid dependence, and institution of strategies to reduce the risks of side effects and complications. The judicious use of corticosteroids should be an integral part of care for all clinicians managing patients with ulcerative colitis.