Steroids in inflammatory bowel disease: a clinical review

Corticosteroids are strong, non-selective, anti-inflammatory agents used to treat many inflammatory disorders, autoimmune conditions and haematological cancers. They inhibit synthesis and transcription of pro-inflammatory proteins, which down-regulates the production of nuclear factor kappa-B and inflammatory cytokines such as interleukin (IL)-1, IL-6 and tumour necrosis factor (TNF)-alpha. In addition, anti-inflammatory mediators are up-regulated by corticosteroids.

This review aims to evaluate the role of corticosteroids in inflammatory bowel disease (IBD) within clinical practice. The review will focus on both ulcerative colitis (UC) and Crohn's disease (CD) in summarising key recommendations to choosing the correct steroid depending on disease severity. Adverse effects and steroid dependence are covered to ensure early recognition, education and management.

In the 1950s, Truelove and Witts (1955) showed that oral cortisone could be used to induce remission in patients with UC. In the 1970s Summers et al (1979) reported oral prednisolone starting at 60 mg once daily was effective in inducing remission in patients with active CD. Corticosteroids are effective and rapidly active and are therefore deemed the initial therapeutic option for patients with moderately-to-severely active inflammatory bowel disease. First-generation corticosteroids include hydrocortisone, prednisolone and methylprednisolone. They are used in moderate-to-severe disease, where rapid and systemic anti-inflammation is required. Second-generation corticosteroids include budesonide, budesonide multimatrix and beclomethasone diproprionate. These are reserved for mild-to-moderate disease, where local or specific anti-inflammation is required.