The Influence of Corticotrophin and Adrenal Steroids on the Course of Ulcerative Colitis: A Comparison with the Presteroid Era

Abstract

Summary The course of 238 patients with moderate to severe ulcerative colitis treated with corticotrophin or adrenal steroids, or both, during 1952 to 1958, is analyzed and compared with the course of 245 patients treated during the presteroid era. The total number of serious complications has been reduced. The reduction in the number of perforations, pericolic abscesses, perirectal infections, arthritic complications, and cases of pyoderma gangrenosum and pneumonia can be correlated with hormonal therapy. An increase in the number of cases of toxic dilation, osteoporosis, thrombophlebitis, nephrolithiasis, psychic complications, and massive upper gastrointestinal bleeding can also be correlated with the use of these agents. The evidence that ACTH and adrenal steroids have influenced the proportion of patients requiring definitive surgery for ulcerative colitis during the period of follow up is inconclusive. The indications for surgical intervention have been altered in the steroid era so that many more .eleotivc or relatively elective procedures and less emergency operations are performed. Coincidentally more extensive colonic surgery is done as a primary procedure. The over-all mortality rate has decreased from 21 to 12 per cent. Of the 29 deaths concerned, 5 were directly attributable to ulcerative colitis, 8 had complications caused or accentuated by hormonal therapy, 6 seriously ill patients died in the postoperative period, including 1 whose death was attributable to adrenal insufficiency, 4 died of complications after secondary operations, 1 died of carcinoma of the colon, and 5 died of unrelated diseases. At the time of follow up, 37 per cent of the patients from each group were completely well, but less of the steroid treated patients had been symptomatic in the interim. Only 6 per cent of the steroid treated patients required maintenance medication.