Department of Internal Medicine, Ospedale dell'Angelo, Venezia, Italy.
Gastroenterology Unit, San Giuseppe Hospital, Milano, Italy.
Dig Liver Dis. 2017 Oct;49(10):1092-1097. doi: 10.1016/j.dld.2017.07.005. Epub 2017 Jul 22.
To evaluate how Italian gastroenterologists use corticosteroids in clinical practice for the treatment of Crohn's disease (CD) and ulcerative colitis (UC).
All members of the Italian Group for Inflammatory Bowel Disease (IG-IBD) were invited to fill in a web-based questionnaire.
131/448 (29.2%) members completed the survey. In mild-to-moderate UC and CD relapses, low-bioavailability steroids (LBS) are first-line therapy for 37% and 42% of clinicians, respectively. In case of failure, immediate step-up to biologics or immunosuppressants is considered by 23% and 29%. Regarding conventional corticosteroids (CCS), a fixed starting dose is prescribed by 50%, and a weight-based dose by 22%. Tapering is started after 7-10days by 41% and after 14days by 32%. The preferred tapering schedule is 5mg/week. In case of CCS failure, 47% switch to parenteral steroids before considering shifting to different drug classes. In case of symptoms recurrence during tapering, 14% re-increase the dose and try tapering again. Before prescribing steroids, 72% do not prescribe any specific evaluation whereas during treatment some evaluation is performed by 85%. Vitamin D and calcium supplements are routinely prescribed along with steroids by 38%.
Several discrepancies and some deviation from the available guidelines were recorded among Italian gastroenterologists regarding corticosteroids use in IBD patients.
评估意大利胃肠病学家在克罗恩病（CD）和溃疡性结肠炎（UC）的临床实践中如何使用皮质类固醇。
邀请意大利炎症性肠病组（IG-IBD）的所有成员填写在线问卷。
131/448（29.2%）名成员完成了调查。在轻度至中度 UC 和 CD 复发中，低生物利用度类固醇（LBS）分别是 37%和 42%的临床医生的一线治疗药物。如果失败，23%和 29%的医生会考虑立即升级为生物制剂或免疫抑制剂。对于传统皮质类固醇（CCS），50%的医生会开出固定起始剂量，22%的医生会开出基于体重的剂量。41%的医生会在 7-10 天后开始减量，32%的医生会在 14 天后开始减量。首选的减量方案是每周 5mg。如果 CCS 治疗失败，47%的医生会在考虑转换为不同药物类别之前转为使用静脉皮质类固醇。在减量过程中出现症状复发的情况下，14%的医生会增加剂量并再次尝试减量。在开皮质类固醇之前，72%的医生不开具任何特定的评估，而在治疗过程中，85%的医生会进行一些评估。38%的医生会常规开维生素 D 和钙补充剂与皮质类固醇一起使用。
意大利胃肠病学家在 IBD 患者中使用皮质类固醇方面存在一些差异和与现有指南的偏离。
