Balancing IBD relief and steroid risks.

IBD Management: How Nurses Can Improve Steroid Use

Avery Sinclair monogram
Avery Sinclair in Health & Wellness October 2026 • 4 min read.

"Discover how a Kent IBD Nurse-led initiative is transforming steroid use for IBD patients, enhancing bone protection, and promoting better patient outcomes."


Inflammatory Bowel Disease (IBD), encompassing conditions like Crohn's disease and ulcerative colitis, demands careful management to alleviate symptoms and sustain remission. Steroids have long been a cornerstone of IBD treatment, effectively reducing inflammation and bringing relief to patients. However, their long-term use is fraught with risks, including adverse reactions and a failure to modify the underlying disease progression.

Recognizing the need for safer and more effective steroid use, a collaborative effort in the UK led to the development of the Steroid Assessment Tool (SAT). This web-based tool empowers clinicians to monitor and optimize steroid usage within their practice. An audit conducted by IBD nurses in Kent provides valuable insights into the impact of this tool and its potential to transform patient care.

This article delves into the findings of the Kent IBD Nurse Experience with the Steroid Assessment Tool, exploring how this initiative is improving steroid management, enhancing bone protection, and promoting better outcomes for individuals living with IBD. We'll uncover the key insights from the audit and discuss their implications for clinical practice.

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Short-Term Steroid Use

For moderate-to-severe IBD flares, the supplied recommendation is prednisolone 40 mg once each morning, tapered over 6–8 weeks. It says steroids should not be used for maintenance, and the American Gastroenterological Association likewise notes that steroids can induce remission but do not maintain it. The AGA advises limiting corticosteroid use to less than two months because long-term use carries significant risks.

Reexamining Steroids in IBD Trials

A systematic review discussed in the October 2024 issue of Inflammatory Bowel Diseases examined corticosteroid use during both induction and maintenance in placebo-controlled randomized trials involving adults with moderate-to-severe IBD. The review was presented by da Silva et al. Its focus reflects continued scrutiny of steroid use across different treatment phases.

What is the Impact of Steroid Assessment Tool?

Balancing IBD relief and steroid risks.

The Kent IBD Steroid Audit, involving 500 patients, revealed that a significant 40% had received oral corticosteroids in the past year. This highlights the prevalent use of steroids in managing IBD symptoms. However, the audit also uncovered areas of concern regarding steroid excess. A notable 28% of Kent IBD patients had experienced steroid excess, with 6% receiving six or more courses of steroids within 12 months. This figure is significantly higher than the national average of 13.8%, underscoring the need for improved monitoring and management practices.

One of the critical findings of the audit was the inconsistency in bone protection among hospital trusts. This suggests that many IBD patients on steroids are not receiving adequate bone protection, leaving them vulnerable to complications like osteoporosis and fractures. There could be several reasons for this gap:

  • Patients hording steroids
  • Lack of awareness among patients regarding the need for bone protection
  • Failure of physicians to prescribe bone protection agents alongside steroids
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New Guidance on Reducing Exposure

A November 2025 narrative review updates the evolving use of corticosteroids in IBD, focusing on appropriate use, route of administration, and duration. A November 2025 international expert consensus is described as the first to provide recommendations for appropriate corticosteroid use in randomized IBD trials. It emphasizes minimizing exposure through expedited tapering and shorter fixed-dose periods that more closely resemble clinical care.

Quality Improvement and Steroid Use

An analysis of data from 2,385 UK patients found lower steroid use at centers participating in a quality improvement program. Steroid exposure was 23.8% at intervention centers versus 31.0% elsewhere, and excess use was 11.5% versus 17.1%; both differences had P < .001. These results show an association between participation in the program and lower use, rather than establishing that the program alone caused the difference.

Comparisons Without a Treatment Ranking

A multicentre audit reported that 30% of 1,176 patients with IBD had received steroids in the prior 12 months. A practical comparison published in October 2025 covers Entocort (budesonide) alongside prednisone, mesalamine, azathioprine, infliximab, and other IBD drugs. The supplied summary does not provide comparative efficacy or safety results, so it does not support ranking those options.

To address these issues, the Kent IBD team has formalized an IBD pathway that incorporates correct steroid dosages and monitoring protocols. This ensures that patients receive appropriate steroid treatment while minimizing the risk of adverse effects. Furthermore, the pathway emphasizes the importance of bone protection, promoting awareness among both patients and healthcare professionals.

Improving IBD Patient Outcomes

The Kent IBD Nurse Experience with the Steroid Assessment Tool demonstrates the crucial role nurses can play in optimizing IBD management. By actively monitoring steroid use, promoting bone protection, and educating patients, nurses can significantly improve patient outcomes. This initiative serves as a model for other healthcare systems seeking to enhance their IBD care and minimize the risks associated with long-term steroid therapy.

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More Personalized IBD Care

The second edition of “Current trends and future management of IBD, volume II” describes a growing shift toward personalized, mechanistically informed, patient-centered care. It identifies integration of mechanistic insights into clinical decision-making as a central theme. The same editorial summary appears in the PMC and Frontiers listings.

Risks of Chronic Steroid Use

A 2022 study highlights controversy about chronic steroids as maintenance therapy and reports higher odds of adverse effects among patients on chronic steroids. Its summary stresses monitoring patients who take steroids and avoiding chronic use. A second source reports that one in eight patients with ulcerative colitis and one in four with Crohn’s disease in the United Kingdom experience chronic steroid use lasting more than six months, despite the increased morbidity associated with prolonged use compared with immunomodulators and biologics.

Working Toward Steroid-Free Remission

A real-world cohort paper says patterns of steroid use in IBD remain poorly characterized and notes that exposure is associated with adverse effects and often indicates suboptimally controlled disease. Another source describes corticosteroids as effective for acute symptom improvement but not recommended for maintenance because of limited long-term efficacy and significant adverse effects. It identifies steroid-free remission as a long-term medical goal and notes the use of biologics such as infliximab, an anti-tumor necrosis factor alpha drug.

What the reports add to the picture of steroid monitoring

Taken together, the reports describe steroid prescribing as something that can be assessed both by exposure and by whether repeated courses meet criteria for excess. They also show that prescriptions alone do not settle whether each course was avoidable: some cases were independently reviewed for that question.[1] [2]

The reports connect prolonged steroid use with a range of possible adverse effects, while distinguishing steroids’ role in inducing remission from their lack of effectiveness as maintenance agents. That context helps explain why audits focus on repeated or extended exposure, rather than treating any steroid prescription as equivalent.[2] [3]

How the comparisons and data limits shape the figures

A separate SAT evaluation reported bone-protection prescribing alongside corticosteroid treatment in a small share of patients; an Italian comparison reported a higher share receiving calcium and vitamin D with steroids. These figures provide context for the article’s concern about variation, but they are not results from the Kent audit.[4]

Other UK reporting also describes steroid dependency or excess, with a higher prevalence in ulcerative colitis than in Crohn’s disease. A separate self-medication report shows that steroid exposure can include use without a medical prescription, so prescription records may not capture every route of use.[5] [6]

The available registry records are not described as a complete account of steroid prescribing, and figures in the current report cannot be directly compared with reports from before April 2022. Those qualifications limit how confidently differences between reporting periods can be interpreted.[7]

A report comparing international use says the 2019 UK rate was higher than rates in other studies, while noting that the UK study included more patients. This is a broad comparison across studies, not a like-for-like estimate of the Kent initiative’s effect.[4]

What remains unresolved about assessment and follow-up

  • How closely do routine oral-steroid indicators reflect total exposure when registry records may not represent all prescribing and some people report self-medication?[1] [6] [7]
  • When cases are reviewed for avoidability, how often do reviewers agree on whether a prescription could have been avoided, and what factors explain that judgement?[2]

Terms used in steroid monitoring

Steroid excess
A guideline-defined pattern of repeated or prolonged steroid use.[1]
Prolonged steroid use
Continuous steroid therapy lasting beyond the specified duration.[3]

Sources

  1. Establishing key performance indicators for inflammatory bowel disease in the UK (pmc.ncbi.nlm.nih.gov)
  2. A multi-centre audit of excess steroid use in 1176 patients with inflammatory bowel disease. (pubmed.ncbi.nlm.nih.gov)
  3. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults (doi.org)
  4. doi.org (doi.org)
  5. Declining Corticosteroid Use for Inflammatory Bowel Disease Across Alberta: A Population-Based Cohort Study (pmc.ncbi.nlm.nih.gov)
  6. Self-medication with steroids in inflammatory bowel disease. (pubmed.ncbi.nlm.nih.gov)
  7. ibdregistry.org.uk (ibdregistry.org.uk)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What exactly is Inflammatory Bowel Disease (IBD), and why are steroids used in its management?

Inflammatory Bowel Disease, or IBD, is a group of conditions, including Crohn's disease and ulcerative colitis. These diseases require careful management to reduce symptoms and maintain remission. Steroids are frequently used in IBD treatment to reduce inflammation and alleviate symptoms. However, long-term steroid use can lead to adverse effects and may not address the underlying disease progression.

2

What is the Steroid Assessment Tool (SAT), and how does it aim to improve steroid use in IBD management?

The Steroid Assessment Tool (SAT) is a web-based tool developed to help clinicians monitor and improve steroid use in their practice. The tool helps healthcare professionals to ensure safer and more effective steroid use. An audit in Kent highlights the tool's potential to transform patient care by ensuring appropriate steroid dosages and monitoring protocols, while minimizing the risk of adverse effects.

3

What were the key findings of the Kent IBD Steroid Audit regarding steroid use and bone protection?

The Kent IBD Steroid Audit of 500 patients revealed that a considerable 40% had received oral corticosteroids in the past year, indicating a high reliance on steroids for managing IBD symptoms. The audit also showed that 28% of patients had experienced steroid excess, with 6% receiving six or more courses of steroids within 12 months, which is higher than the national average. Additionally, the audit highlighted inconsistencies in bone protection among hospital trusts, suggesting that many IBD patients on steroids are not receiving adequate bone protection, making them vulnerable to complications like osteoporosis and fractures.

4

Why is there inconsistent bone protection for IBD patients on steroids, and what are the potential consequences?

Inconsistent bone protection for IBD patients on steroids can lead to complications such as osteoporosis and fractures. Reasons for this inconsistency include patients hoarding steroids, a lack of awareness among patients about the need for bone protection, and the failure of physicians to prescribe bone protection agents alongside steroids. Addressing these issues is crucial to safeguarding patients' bone health during steroid treatment.

5

What role do nurses play in improving IBD patient outcomes, particularly in the context of steroid management and bone protection?

Nurses play a crucial role in enhancing IBD management by actively monitoring steroid use, promoting bone protection, and educating patients. By identifying and addressing issues related to steroid excess and inadequate bone protection, nurses can significantly improve patient outcomes. The Kent IBD Nurse Experience with the Steroid Assessment Tool serves as a model for other healthcare systems seeking to improve their IBD care and minimize the risks associated with long-term steroid therapy.

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