What is the relationship between Prednisone (corticosteroid) and gastritis?

From the Guidelines

Prednisone can cause or worsen gastritis, particularly in patients taking nonsteroidal anti-inflammatory drugs or anticoagulants, and therefore, prophylactic measures such as histamine 2 blockers or proton pump inhibitors should be considered during steroid therapy. According to the study published in the Journal of the National Comprehensive Cancer Network in 2019 1, patients receiving long-term systemic corticosteroids, such as prednisone, are at risk of developing gastritis, among other complications. To minimize this risk, it is recommended to take prednisone with food or milk to reduce stomach irritation. Additionally, patients at higher risk of developing gastritis may benefit from prophylactic measures such as histamine 2 blockers or proton pump inhibitors. Some key points to consider include:

• Patients taking prednisone should be monitored for signs of gastritis, such as black stools, vomiting blood, or severe abdominal pain, which require immediate medical attention.
• A proton pump inhibitor like omeprazole (20-40mg daily) or an H2 blocker such as famotidine (20mg twice daily) may be prescribed for stomach protection.
• Patients with a history of ulcers or gastritis should inform their doctor before starting prednisone therapy to take appropriate preventive measures.
• Prednisone should not be stopped suddenly, and patients should always follow their prescribed tapering schedule to avoid any potential complications. The study 1 emphasizes the importance of considering prophylactic measures to reduce the risk of gastritis and other complications associated with long-term corticosteroid use.

From the FDA Drug Label

Steroids should be used with caution in active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since they may increase the risk of a perforation Gastric irritation may be reduced if taken before, during, or immediately after meals or with food or milk. administration of antacids between meals to help prevent peptic ulcers.

The relationship between Prednisone (corticosteroid) and gastritis is that Prednisone may increase the risk of gastritis or peptic ulcers, especially in patients with a history of active or latent peptic ulcers. To minimize this risk, it is recommended to take Prednisone with food or milk, and antacids may be administered between meals to help prevent peptic ulcers 2, 2. Caution should be used when prescribing Prednisone to patients with gastrointestinal conditions.

From the Research

Relationship between Prednisone and Gastritis

The relationship between prednisone (a corticosteroid) and gastritis is complex and involves the potential for corticosteroids to increase the risk of gastric ulcers, particularly when used in high doses or for prolonged periods 3.

Gastric Ulcer Prophylaxis

• Gastric ulcer prophylaxis with proton pump inhibitors (PPIs) is commonly prescribed when administering high-dose glucocorticoids (> 30 mg/day of prednisone equivalent) or during prolonged treatment (> 15 days) 3.
• The use of PPIs as prophylaxis is due to their safety profile compared to the potential severe consequences of developing a gastric ulcer 3.
• However, PPIs have numerous adverse effects, making it essential to question the risk-benefit balance when prescribing them 3.

Risks Associated with PPIs

• Prolonged use of gastric acidity inhibitors, including PPIs, has been suggested as a risk factor for severe gastrointestinal infections 4.
• PPIs can increase the risk of acute gastroenteritis and community-acquired pneumonia in children 4.
• The use of PPIs can also lead to an increased risk of gastric pre-malignant lesions, although the evidence is inconsistent 5.

Interaction with Other Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of gastrointestinal toxicity, and the addition of a PPI can decrease the development of NSAID-associated ulcers and recurrent NSAID-related ulcer complications 6.
• Patients taking low-dose aspirin who have risk factors for GI complications should receive medical co-therapy, such as a PPI 6.

Long-term Use of PPIs

• Long-term use of PPIs can lead to structural and functional changes within the gastric mucosa, including fundic gland polyps, enterochromaffin-like cell hyperplasia, and hypergastrinaemia 7.
• The clinical importance of these changes is currently uncertain, and further studies are needed to investigate the mechanisms of the increased risk of infections in patients treated with PPIs 7.