Ulcerative Colitis Blog

The use of a class of steroids known as “corticosteroids,” is common for the induction of disease remission in IBD. This form of steroid is different from the anabolic type of steroids which receive media attention regarding use among athletes. Corticosteroids have a variety of anti-inflammatory effects which make them useful in the short-term to aid in achieving control of disease. Corticosteroids are produced in topical, oral, and intravenous formulations which can be administered depending on the severity and locations of a patient's disease.

Topical Corticosteroids
UC which is limited to the very bottom portion of the rectum is called ulcerative proctitis or proctosigmoiditis. Patients with mild-moderate forms of ulcerative proctitis limited to the rectum or distal portion of the colon may be candidates for topical corticosteroid therapy. Topical corticosteroids come in enema solution and foam preparations. During periods of active disease, enemas are typically administered at night. Patients should be instructed to use the washroom prior using enema preparations in an attempt to empty the rectum. Ideally, enemas should be retained on the rectum as long as possible (hours to overnight). Many patients note that the foam preparations are easier to retain due to the consistency of the medication. As disease activity subsides, the enemas can be spaced out and tapered. The corticosteroids applied topically are systemically absorbed to some degree, and can result in side effects similar to those of oral steroids. For this reason, they are not recommended for long-term use and topical 5-ASA preparations may supplant them.

Systemic Corticosteroids
For disease that involves more extensive portions of the colon (beyond the left side of the colon) or is of greater severity, oral and/or intravenous corticosteroids may aid in inducing remission of disease. Oral prednisone is commonly prescribed at diagnosis and during flares of disease to quickly abolish the cycle of inflammation. At maximum doses (typically 40mg daily), patients responsive to corticosteroids will note abrupt improvement in symptoms over a period of days to weeks. Once a patient feels well again (1-2 formed bowel movements per day, no blood, no urgency, no nighttime symptoms), the steroids can be gradually tapered. In instances where the colitis is severe, patients may fail to respond to oral steroids. For these forms of severe, acute disease, hospitalization with intravenous corticosteroids is recommended. The vast majority of patients receiving intravenous therapy will note an improvement in symptoms within 5-7 days; a transition is then made to oral steroids with eventual taper.

Side Effects
While corticosteroids have a variety of useful anti-inflammatory properties, the duration of their use is limited by toxicities which are time and dose dependent. As such, corticosteroids are indicated for a limited time (weeks to 3 months) to obtain disease control and then should be safely tapered; their use for maintenance of disease remission is not recommended. Many side effects are dose-dependent and reversible with the exception of osteoporosis, osteonecrosis, and cataracts which are irreversible.

1) High blood pressure - Corticosteroids cause sodium (salt) and water retention which results in swelling and can elevate blood pressure.

2) High blood glucose - Hyperglycemia (a high blood sugar) can occur with steroids. Signs and symptoms of high blood glucose include excessive thirst and urination as well as fatigue. Careful monitoring of blood glucose levels is necessary for diabetics with IBD who require steroid treatment. Other patients exhibiting signs and symptoms of hyperglycemia should have a blood glucose checked.

3) Low potassium levels - Low blood potassium levels can be associated with corticosteroid use and are manifested by musculoskeletal cramps, weakness, nausea, and vomiting

4) Osteoporosis - Long-term corticosteroid use (>3 months) impairs calcium metabolism and can weaken bone mineralization. Patient’s receiving corticosteroids for > 3 months should have a bone density scan performed to assess for changes in bone mineralization.

5) Osteonecrosis - Osteonecrosis is a form of irreversible bone injury resulting from loss of blood flow to bony tissue. It most commonly affects the hip, shoulder joints, leg and foot joints.

6)Cataracts - Cataracts are associated with long-term corticosteroids use. Patient’s utilizing recurrent courses of steroids should have routine eye exams.

7) Fluid retention - As noted above, corticosteroids result in salt and water retention which makes patient’s swell. Many people will note fullness in the cheeks as well as fluid around the ankles.

8) Skin changes - Corticosteroids may thin skin or result in striae, the technical name for stretch marks.

9) Increased appetite - Many patients note a dramatic increase in their appetite after starting steroids.

10) Irritability/Insomnia - High doses of corticosteroids often make people feel jittery or hyperactive. Sleep disturbances may be noted.