Steroids

Steroids include several different drugs which come in several different formulations. These drugs  include budesonide, hydrocortisone and  prednisolone amongst others. They are usually given intravenously (usually hydrocortisone), in patients who are acutely unwell and require admission, orally or rectally. Steroids are used for the short term treatment of patients with relapse of inflammatory bowel disease, however they are not effective as a long term treatment or for prevention of future relapse since their long-term side- effects are very significant and they tend to be less effective over time.

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Generally steroids are synthetic drugs (those made in a laboratory or factory) which resemble the steroids which the body makes as hormones to combat stress and regulate, appetite, immune response and  salt & water balance. The steroids used for inflammatory bowel disease are rather different from those used illegally by athletes and body-builders to enhance performance. Steroids given for bowel disease have a range of effects on different parts of the immune system as well as cytokine pathways, white cell function and co-ordination of immune response. They may also affect appetite, bone and connective tissue metabolism, mood and salt and water balance. Many of these effects account for some of the side-effects people experience when taking steroids (weight gain, fluid retention, thinning skin, moodiness anxiety and depression and rarely psychosis, bruising and diabetes).

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Hydrocortisone, usually give intravenously, and prednisolone when administered orally tend to have a greater risk of systemic side-effects for a given therapeutic dose compared to budesonide. This is because whilst 90% of hydrocortisone and prednisolone pass from the gut through the liver and out into the wider circulation, 90% of budesonide is metabolised when it first reaches the liver.