Treating Crohn's Disease Without Medication
Minimize Crohn’s Flares With Corticosteroids
Corticosteroids are often prescribed to help with Crohn's flares. Learn how to use the drug safely to minimize the risk of serious side effects.
By Mikel Theobald
Medically Reviewed by Pat F. Bass III, MD, MPH
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When it comes to managing inflammatory bowel disease (IBD), corticosteroids have proven themselves to be an effective remedy for minimizing inflammation.
Many people who take corticosteroids find they experience relief within a few days.
“Corticosteroids also may be used with an immune system suppressor; the corticosteroids can induce remission, while the immune system suppressors can help maintain remission,” said Maxwell Chait, MD, Gastroenterologist at Columbia Doctors Medical Group in Hartsdale, N.Y.
But as helpful as corticosteroids can be for treating flares, steroid side effects can be severe if the drugs are taken for too long or too frequently.
Due to the potential for serious side effects such as stunted growth in children, high blood pressure, diabetes, osteoporosis, bone fractures, increased susceptibility to infections, and more, corticosteroids are usually prescribed in the lowest dosage possible for the shortest amount of time, typically no longer than three or four months, said Dr. Chait.
“Doctors generally use corticosteroids only for moderate-to-severe Crohn’s disease that doesn’t respond to other treatments.”
RELATED: Depression Linked to Crohn's Disease Flare-Ups
Corticosteroids for Crohn's: What’s Right for You?
Prednisone is the most commonly prescribed oral steroid, said Andrew B. Forest, PharmD, pharmacy clinical coordinator at Mercy Medical Center in Baltimore, Md. It is typically prescribed in a 10- to 14-day regimen for a moderate-to-severe flare of Crohn’s symptoms. In rare instances, should you need to be hospitalized and unable to tolerate oral medications, you might be given steroids through an IV.
Budesonide (Entocort) is a second-generation oral corticosteroid that targets the digestive tract and generally has fewer systemic side effects than other corticosteroids. This drug isn’t absorbed by your body at the same rate as prednisone, so less steroid enters the bloodstream, explained Chait. “It has been shown useful in the treatment of mild-to-moderate Crohn’s disease and for maintenance of remission in Crohn’s disease,” he added.
“Budesonide may only be used over a shorter period of time than other corticosteroids,” noted Forest, “for 8 to 16 weeks, then tapering off over two to four weeks.”
The area of your digestive tract affected by Crohn’s may play into the decision of which corticosteroid your doctor prescribes to treat your symptoms and how they are administered. “Budesonide is released in the ileum (final section of the small intestine) and right colon, and therefore has a topical effect against disease in that area,” said Chait. “Steroid enemas also can be used for disease of the lower colon and rectum in order to treat symptoms. Hydrocortisone and budesonide liquid and foam enemas are being marketed for these reasons.”
The Risks: Steroid Side Effects
Corticosteroid side effects range from mild annoyances to serious medical conditions.
Weight gain, puffiness in the face, excessive facial hair, night sweats, insomnia, mood changes (more common with higher doses), and hyperactivity are some of the temporary discomforts you might experience when taking corticosteroids. Osteoporosis, diabetes, high blood pressure, cataracts, glaucoma, heart failure, and an increased susceptibility to infections are some of the more severe potential side effects.
People who have pre-existing diseases have a higher risk for heart failure, diabetes, and worsening osteoporosis, Forest added.
The worst side effects occur when using corticosteroids for long periods of time -- years instead of weeks or months, explained Forest. To reduce your risk of serious steroid side effects, make sure your doctor knows your history of corticosteroid use. This is especially important if you have more than one doctor since corticosteroids can be prescribed for many conditions other than Crohn’s. Always tell each of your health care providers about every medication you’re taking, including dosing information.
Video: How should we manage and follow the low risk IBD patient with mild disease?
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