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Published on: January 5, 2017
Review article: systemic and topical steroids in inflammatory bowel disease
1Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg, Germany. juergen.schoelmerich@klinik.uni-r.de
Alimentary Pharmacology & Therapeutics
|September 9, 2004
Summary
Steroids are used for inflammatory bowel diseases, but newer options like budesonide and immunosuppressants offer better alternatives. Long-term steroid use is discouraged for ulcerative colitis and Crohn
Area of Science:
- Gastroenterology and Pharmacology
Background:
- Steroids remain a common treatment for inflammatory bowel diseases (IBD).
- Pharmacokinetic studies indicate no significant abnormalities in steroid metabolism in IBD patients.
- Development of topical and 'nonsystemic' oral steroids aims to reduce systemic side effects.
Purpose of the Study:
- To evaluate the current role and alternatives to steroid therapy in inflammatory bowel diseases.
- To assess the efficacy of different steroid formulations and long-term treatment strategies.
Main Methods:
- Review of pharmacological studies on steroid pharmacokinetics in IBD.
- Analysis of treatment guidelines and population-based studies for ulcerative colitis and Crohn's disease.
- Evaluation of alternative therapies including 5-aminosalicylates, budesonide, and immunosuppressants.
Main Results:
- Rectal foam steroids achieve low bioavailability, minimizing systemic complications.
- 5-aminosalicylates are effective for most ulcerative colitis cases, reducing the need for steroids.
- Budesonide is suitable for active Crohn's disease but not for long-term remission maintenance; immunosuppressants are preferred alternatives.
Conclusions:
- Long-term steroid treatment has no place in ulcerative colitis management.
- Steroid use in Crohn's disease should be limited, with immunosuppression being a superior long-term strategy.
- Alternative treatments offer safer and more effective management for many IBD patients.
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