For further information please download the full patient publication from Crohn’s and Colitis UK

A range of corticosteroids are used in IBD. They include:

• prednisolone, prednisone, hydrocortisone and methylprednisolone. These are sometimes known as the ‘conventional corticosteroids’.

• budesonide (Entocort or Budenofalk). This is a newer type of steroid which has a local anti-inflammatory effect at the end of the small bowel (ileum).

• beclometasone dipropionate (BDP) (Clipper).

Steroids such as prednisolone, prednisone, and hydrocortisone are used to treat acute attacks of UC or Crohn’s. They are generally very effective at bringing symptoms under control – as many as eight out of 10 people respond to treatment with steroids.

These steroids can be given by injection, as tablets, or topically. When injected or taken by mouth, they can reduce inflammation throughout the whole body. So they can be used to reduce inflammation in the eyes, skin and joints, if affected, as well as in the gut.

Although steroids are naturally present in the body, the high doses needed to control inflammation can have unwanted side effects. Most people will experience at least some of these side effects, which can be off-putting. However, steroids can be very effective at controlling flare-ups and many of these side effects usually disappear when the dose is reduced or stopped.

The challenge is to get the greatest possible benefit with the fewest side effects and it is best to discuss this carefully with your IBD specialist.

Side effects can include:

• an increase in appetite which can lead to weight gain
• rounding or ‘mooning’ of the face, growth of facial hair
• development or worsening of acne
• an increase in blood sugar level and salt retention – so legs may swell
• mood changes and problems with sleeping and/or concentrating
• a reduced ability to cope with infections
• more rarely, pain in the chest or upper abdomen.

Longer term side effects may include:

• thinning of the bones, muscles and skin
• a tendency to bruise easily
• diabetes due to increased blood sugar levels
• after longstanding treatment with steroids, problems with natural cortisol production
• more rarely, glaucoma or cataracts.

Coming off steroids

Although they are very effective at bringing symptoms under control, steroids cannot prevent flare-ups and often have rather strong side effects, so are not used for maintenance treatment.

So, once you begin to feel well, your doctor will start to reduce your steroid dose. This has to be done gradually, especially if you have been on steroid treatment for more than a few weeks.

This is because corticosteroids are very similar to the naturally occurring hormone, cortisol, and when you take steroids as medicine your adrenal glands reduce or stop cortisol production. This is known as adrenal suppression. If you suddenly stop your steroid treatment, it may take some time before the adrenal glands start producing cortisol normally again. This could leave you with much lower levels of cortisol in your body, which can mean that your body does not respond so well to stressful situations, causing nausea, fatigue and light-headedness.

Unfortunately, sometimes the symptoms return when you reduce the dose. If this keeps happening, immunosuppressant drugs may be added to help you come off steroids completely.

© Crohn’s and Colitis UK 2015