Steroids are useful in treating Crohn's disease and ulcerative colitis, but they are often a double-edged sword. They can get the IBD symptoms of pain, diarrhea and bleeding under control quickly and effectively. They work on IBD's over-active immune system to reduce intestinal inflammation and even intestinal narrowing if it's early. But steroids can make fistulas worse, and steroids can interfere with wound healing, if surgery is needed. Some are loaded with side effects

One of the main IBD treatment goals is to get patients off steroids to avoid the long-term side effects of these medicines. As a result, when steroids are used, they are usually intended for just brief use and as a bridge to longer-term medication and / or dietary treatments.

  • Prednisone is the standard oral steroid, the one that most doctors prescribe because it is effective and comes as a pill in different strengths. 
  • Prednisolone is similar to prednisone in its action and strength. It comes as a liquid and is often used when someone can't take pills.
  • Methylprednisolone, better known by its trade name, Solu-Medrol, is the intravenous (IV) form of steroids. This is used when someone can't take anything by mouth or when the steroid is needed right away for rapid use in the blood stream (for example, an emergency or to accompany another medicine).
  • Hydrocortisone is a steroid that can be absorbed through the skin or intestinal tissue, so it is used in suppositories to treat IBD at the very bottom of the intestine, or in enemas or foams to bathe the rectal area which is a little higher up.

All of the steroid medicines listed above are well-absorbed and accumulate in the body. That accumulation can cause serious short and long-term problems.

  • Budesonide is a new steroid that can target different areas of the body without accumulating. It can be delivered to the lungs, the esophagus, the small intestine or the large intestine.  It works on the tissue there. Very little (or none) gets absorbed, so the steroid exits the body, without causing the usual side-effects for most people. 

Unfortunately, it doesn't work for everyone with IBD. Even when it does, it helps patients get better, but it doesn't keep them better (something else has to be used long-term). And some have gotten steroid side effects when they used the medicine long-term.

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