| Corticosteroids: use in inflammatory bowel disease |
Corticosteroids are used principally to induce remission in both Crohn’s disease and ulcerative colitis. Depending on the clinical circumstances, they are given parenterally, orally or rectally.
Prednisolone or prednisone can be used orally.
Budesonide, given orally in a controlled ileal release formulation, is used to induce remission in Crohn’s disease. It acts locally on the mucosa of the terminal ileum and right side of the colon. Budesonide passes via the portal venous circulation to the liver where it undergoes extensive first-pass metabolism. Systemic and cosmetic adverse effects are less prominent although there may still be suppression of the hypothalamic-pituitary-adrenal axis.
Rectal formulations are used in inflammatory bowel disease. The choice of which rectal formulation to use is determined by the site of inflammation. For very distal anorectal disease, suppositories may be used. Foam preparations are often better tolerated than enemas but only reach the sigmoid colon. Enemas can reach as far as the splenic flexure.
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