The necessity of perioperative corticosteroid supplementation therapy in patients with ulcerative colitis undergoing ostomy closure

Abstract

Perioperative corticosteroid supplementation therapy is considered as the standard of care for patients with steroids＜12 months before surgery. However, there is no biochemical or clinical evidence to support this therapy. The aim of this study was to evaluate the necessity of not perioperative corticosteroid supplementation therapy in patients with ulcerative colitis undergoing ostomy closure. A total of 43 patients with ulcerative colitis who underwent sur-gery at our institution between July 2015 and June 2018 were included. The median total steroid dose was 8,000mg (1,000～35,000mg), and median steroid free duration was 43 days (2～166 days). Early morning cortisol levels ＜18μg/dL was found in 41 (95.3%) patients. A peak cortisol response of the High Dose Adrenocorticotropic Hor-mone (ACTH) stimulation test ＜18μg/dL was found in 7 (17.1%) patients. This 7 patients received further evalu-ation and were denied secondary adrenal insufficiency. There were no patients who had acute adrenal insufficiency or adrenal crisis after stoma closure. In the case of steroid-treated patients with ulcerative colitis who underwent 2-staged surgery, it was suggested that perioperative corticosteroid supplementation therapy may not be necessary if off steroids at the time of ostomy closure.