From the Guidelines
Corticosteroids are not recommended for the management of gastrointestinal (GI) bleeding, as they may worsen the condition by impairing mucosal healing and increasing the risk of peptic ulceration. The use of corticosteroids, such as chronic use of steroids, is actually considered a risk factor for GI bleeding, especially in patients on antithrombotic therapy 1.
Management of GI Bleeding
The first-line treatments for acute GI bleeding include:
- Proton pump inhibitors (PPIs) such as pantoprazole or omeprazole to reduce the risk of GI bleeding, particularly from gastroduodenal lesions 1
- Endoscopic interventions like band ligation, sclerotherapy, or thermal coagulation to directly treat the bleeding source
- Volume resuscitation with crystalloids or blood products
- Correction of coagulopathy
- Discontinuation of anticoagulants or antiplatelets
Special Considerations
For patients with variceal bleeding, octreotide and vasopressin may be used to reduce splanchnic blood flow. The only exception for the use of steroids in GI bleeding would be if the bleeding is caused by inflammatory bowel disease flares, where steroids like prednisone might be indicated as part of the treatment. However, this is not directly supported by the provided evidence 1.
Risk Factors for GI Bleeding
It is essential to identify and manage risk factors for GI bleeding, including:
- History of GI bleeding or peptic disease
- High alcohol consumption
- Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs)
- Receiving a combination of antithrombotic drugs
- Chronic use of steroids 1
From the FDA Drug Label
Gastrointestinal 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 Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent.
The role of corticosteroids in managing gastrointestinal (GI) bleeding is not to manage GI bleeding, but rather to be used with caution in patients with certain GI conditions, as they may increase the risk of perforation.
- Key points:
- Corticosteroids may increase the risk of perforation in patients with active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis.
- Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent. 2 2
From the Research
Role of Corticosteroids in Managing Gastrointestinal (GI) Bleeding
- The use of corticosteroids in managing GI bleeding is not directly addressed in the provided studies, but their potential to increase the risk of GI bleeding is discussed 3, 4.
- A systematic review and meta-analysis found that corticosteroids increase the risk of gastrointestinal bleeding or perforation by 40% (OR 1.43,95% CI 1.22 to 1.66) 4.
- The risk of GI bleeding associated with corticosteroid use is higher in hospitalized patients (OR 1.42,95% CI 1.22 to 1.66) compared to those in ambulatory care 4.
- Another study aimed to assess whether continued administration of corticosteroids for >24 hours increases the rate of GI bleeding in adult critically ill patients, but the results are not provided 3.
Management of GI Bleeding
- The management of upper GI bleeding involves the use of proton pump inhibitors, endoscopy, and transcatheter arterial embolization or surgery in cases of failed endoscopic hemostasis 5.
- Non-steroidal anti-inflammatory drugs (NSAIDs) can cause foregut symptoms, peptic ulcer disease, and small bowel enteropathy, which can be complicated by GI bleeding and perforation 6.
- Limiting NSAID use or co-administration with proton pump inhibitors (PPIs) can reduce dyspepsia, peptic ulcer disease, and rates of complications 6.
Corticosteroid Use in Inflammatory Bowel Disease (IBD)
- Corticosteroids are effective for the short-term treatment of IBD, but long-term use is associated with significant adverse effects 7.
- Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients, including an increased risk of venous thromboembolism, fragility fracture, and infections 7.