Navigating IBD: Understanding Corticosteroid Use and Its Impact
"A closer look at corticosteroid usage and its associated complications in inflammatory bowel disease (IBD) patients, offering insights for better management."
Inflammatory Bowel Disease (IBD), encompassing Crohn's disease and ulcerative colitis, presents a significant challenge for millions worldwide. While there is no cure, various medications aim to control inflammation and alleviate symptoms. Corticosteroids, powerful anti-inflammatory drugs, have long been a cornerstone of IBD treatment, particularly during flare-ups. However, their use is not without potential drawbacks.
A recent study published in PLOS ONE sheds light on the patterns of corticosteroid use and the associated complications within a large cohort of IBD patients in the United States. While the original study contained some inaccuracies that have since been corrected, the core findings remain relevant and provide valuable insights for both patients and healthcare providers.
This article delves into the key findings of the corrected study, highlighting the prevalence of corticosteroid use among IBD patients, the potential complications that can arise, and the ongoing efforts to optimize treatment strategies for improved long-term outcomes. It aims to empower IBD patients with a better understanding of their treatment options and the importance of informed decision-making.
IBD Prevalence and Steroid Use
The CDC reports that inflammatory bowel disease (IBD) prevalence is rising in the United States overall. IBD comprises lifelong intestinal diseases, with ulcerative colitis and Crohn's disease identified as its main types. NCHS reports that the prevalence of Crohn's disease, ulcerative colitis, and overall IBD increased with age; women had higher prevalence of ulcerative colitis and overall IBD, while White non-Hispanic adults had the highest prevalence across these conditions. Corticosteroids can induce remission and serve as bridging therapy, but the cited audit notes that they are not recommended for maintenance treatment because of long-term side effects.
From Disease History to Cortisone
Ulcerative colitis was the first subtype of IBD to be characterized as a distinct entity, so the early history of IBD is largely the history of ulcerative colitis. The historical review also emphasizes that this does not mean ulcerative colitis appeared before Crohn's disease. Corticosteroids have been used to treat active IBD for nearly 50 years as of the 2001 review. In 1955, Truelove and Witts reported that oral cortisone beginning at 100 mg daily effectively induced remission in patients with active ulcerative colitis.
Corticosteroids in IBD: A Double-Edged Sword
Corticosteroids, such as prednisone and budesonide, are synthetic drugs that mimic the effects of cortisol, a natural hormone produced by the adrenal glands. They work by suppressing the immune system, reducing inflammation, and alleviating symptoms such as abdominal pain, diarrhea, and rectal bleeding. Due to their rapid action and effectiveness, corticosteroids are often prescribed to induce remission during IBD flare-ups.
- Increased Risk of Infections: Corticosteroids suppress the immune system, making patients more susceptible to bacterial, viral, and fungal infections.
- Bone Loss: Long-term use can lead to osteoporosis, increasing the risk of fractures.
- Weight Gain and Fluid Retention: Corticosteroids can disrupt metabolism, leading to weight gain, swelling, and elevated blood pressure.
- Mood Changes: Irritability, anxiety, depression, and even psychosis can occur as side effects of corticosteroid use.
- Elevated Blood Sugar: Corticosteroids can increase blood sugar levels, potentially leading to or worsening diabetes.
- Cataracts and Glaucoma: Prolonged use can increase the risk of developing these eye conditions.
Current Concerns About Corticosteroid Use
Recent literature continues to identify excessive corticosteroid use as a quality-of-care concern in IBD, although one analysis notes that official evidence on overuse remains scarce and insufficiently emphasized. A 2025 narrative review describes corticosteroids as among the most frequently prescribed medications for IBD and highlights risks of overuse and misuse. The review also maintains that corticosteroids have a critical role in selected cases for induction of remission. A separate study reports that patients' concern about corticosteroid-related risks can be significantly higher than physicians' concern, despite similar awareness of specific effects such as weight gain and osteoporosis.
Limits of the Available Evidence
The cited PLOS One study identifies a key limitation: its results may be inaccurate because the researchers could not account for care received outside the Veterans Health Administration. This limitation means that the study may not capture the full range of treatment or healthcare use among the patients examined. Therefore, conclusions drawn from its dataset should be interpreted in light of potentially incomplete care records.
Systemic Exposure and Treatment Role
IBD includes ulcerative colitis and Crohn's disease, and its etiology is described as multifactorial, involving altered immune cells and chronic activation of an inflammatory cascade against environmental factors that remain unknown. Oral systemic corticosteroids have been used for more than 50 years to induce remission in active IBD. Because systemic corticosteroids are associated with a wide array of adverse events, targeted-delivery compounds with low systemic bioavailability were developed as an alternative strategy. A 2025 review likewise distinguishes the appropriate induction role of corticosteroids from the risks of overuse and misuse.
The Path Forward: Optimizing IBD Management
Managing IBD effectively requires a multifaceted approach that goes beyond simply relying on corticosteroids. Newer treatment options, such as biologics and small molecule inhibitors, offer targeted therapies that can control inflammation with potentially fewer side effects. These medications are often used as steroid-sparing agents, helping patients reduce or eliminate their reliance on corticosteroids. Regular monitoring, proactive management of complications, and open communication between patients and healthcare providers are essential for achieving optimal outcomes in IBD.
Guiding Safer Corticosteroid Use
The 2025 narrative review focuses on appropriate corticosteroid use in IBD, including the route of administration and duration of treatment. Its stated purpose is to update understanding of the evolving use of corticosteroids in IBD. A separate systematic review and meta-analysis evaluates the prevalence of glucocorticoid-induced adrenal insufficiency in IBD patients after glucocorticoid use. That work also uses a Delphi panel to develop evidence-based expert opinions on evaluating and managing this complication.
Balancing Efficacy and Adverse Events
International consensus work notes that oral systemic corticosteroids have been used to induce remission in active IBD for over 50 years. Their wide array of adverse events prompted the development of steroid compounds with targeted delivery and low systemic bioavailability. The same consensus effort addresses appropriate corticosteroid use in IBD clinical trials and seeks to improve consistency between trial practice and clinical care. These issues reflect the broader challenge of preserving corticosteroids' therapeutic role while limiting systemic exposure.