A short course of corticosteroids prior to surveillance colonoscopy to decrease mucosal inflammation in inflammatory bowel disease patients: Results from a randomized controlled trial |
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Authors: | Judith E Baars L Vogelaar Frank HJ Wolfhagen K Biermann Ernst J Kuipers C Janneke van der Woude |
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Institution: | a Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands;b Department of Internal Medicine and Gastroenterology, Tweesteden Hospital, Tilburg, The Netherlands;c Department of Pathology, Erasmus MC, Rotterdam, The Netherlands;d Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands |
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Abstract: | BackgroundInflammation is a known pitfall of surveillance colonoscopy for inflammatory bowel disease (IBD) as it is difficult to differentiate between inflammation and true dysplasia. This randomized controlled trial assessed the effectiveness of a low dose of corticosteroids prior to surveillance colonoscopy to decrease mucosal inflammation.MethodsIBD-patients scheduled for surveillance colonoscopy between July 2008–January 2010 were eligible to participate. Patients were randomized to either two weeks daily 20 mg prednisone and calcium plus vitamin D prior to surveillance colonoscopy or no treatment. All biopsies were reviewed by an expert gastrointestinal pathologist who was blinded for medication-use. Statistics were performed using chi-square tests, non-parametric tests and binary logistic regression.ResultsSixty patients (M/F 30/30, UC/CD 31/29) participated: 31 (52%) in the treatment arm and 29 (48%) in the control group. In the treatment arm, 247 biopsies were scored against 262 in the control group. In the treatment arm 27 out of 247 biopsies (10.9%) had a score > 1 on the Geboes scale, against 50 out of 262 biopsies (19.1%) in the control group, p = 0.013. In total, 58% of the treatment arm against 66% of the control group had endoscopic or histological mucosal inflammation (p = 0.6). There was a trend for patients in the treatment arm to have less severe inflammation compared with the control group, however this was not significant (p = 0.12).ConclusionsIn our cohort, a short course of corticosteroids decreases the overall histological disease activity in individual biopsies without major side-effects. Moreover, there is a trend for corticosteroids to decrease the maximum severity of both endoscopic and histological disease activity per patient. |
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Keywords: | Inflammatory bowel disease Surveillance colonoscopy Dysplasia Corticosteroids Mucosal inflammation |
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