Drugs in focus: Budesonide and its role in paediatric gastrointestinal disorders

Budesonide is a glucocorticoid with strong topical anti-inflammatory properties and minimal systemic effects due to extensive first-pass hepatic metabolism. It is designed for targeted delivery within the gastrointestinal (GI) tract and is available in oral and rectal formulations. Budesonide is indicated for various GI disorders, including Crohn's disease (CD, ulcerative colitis (UC) and eosinophilic oesophagitis (EoE), with specific formulations approved for different disease locations and severities. This narrative review evaluates the pharmacological profile, clinical applications and guideline recommendations surrounding the use of budesonide in both paediatric and adult GI disorders. Evidence from randomised controlled trials and real-world studies supports the efficacy of budesonide in inducing remission in mild to moderate ileocaecal CD. It is recommended by ESPGHAN/ECCO [European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Crohn's and Colitis Organisation] guidelines as a therapeutic alternative in selected paediatric patients when exclusive enteral nutrition is not feasible. In UC, budesonide-multimatrix tablets and rectal foam formulations may be effective for distal and left-sided disease, though they are generally less effective than systemic corticosteroids or 5-aminosalicylic acid and are reserved for patients with contraindications to standard therapies. In EoE, topical swallowed budesonide has shown promising results in inducing clinical and histological remission, with increasing data supporting its use in children. Although budesonide is associated with fewer systemic adverse effects, long-term use may still pose risks such as growth suppression and hypothalamic-pituitary adrenal axis suppression, necessitating careful monitoring. Budesonide offers a valuable treatment option when used in alignment with disease phenotype, formulation properties and patient-specific considerations.