What is the role of corticosteroids in the treatment of enteritis (inflammation of the intestines)?

From the Guidelines

Corticosteroids are recommended as a treatment option for enteritis in patients with inflammatory bowel disease (IBD), but not as first-line treatment for most cases of enteritis. Most cases of enteritis, whether viral, bacterial, or parasitic in origin, are self-limiting and should be managed with supportive care including hydration, electrolyte replacement, and possibly antimicrobial therapy for specific bacterial causes. For IBD presenting with enteritis symptoms, corticosteroids like prednisone (40-60mg daily, tapered over 8-12 weeks) or budesonide (9mg daily for 8-12 weeks) may be appropriate, as supported by the study by Turner et al. 1.

• Key considerations for the use of corticosteroids in enteritis include:
  • The underlying cause of the enteritis
  • The severity of the symptoms
  • The presence of any underlying medical conditions, such as IBD
  • The potential side effects of corticosteroids, including immunosuppression, hyperglycemia, mood changes, and bone density loss
• The mechanism of action of corticosteroids involves suppressing inflammatory pathways and immune responses that contribute to intestinal inflammation, as discussed in the study by De Simone et al. 1.
• For patients with severe acute colitis, IV corticosteroids are the mainstay of conventional therapy, and therapeutic alternatives for the rescue of steroid-refractory disease should be considered early, as recommended by the study by Zangenberg et al. 1.
• The use of corticosteroids in enteritis should be individualized and guided by clinical judgment, taking into account the specific needs and circumstances of each patient, as emphasized by the study by Harbord et al. 1.

Overall, while corticosteroids may be a useful treatment option for enteritis in certain cases, they should be used judiciously and under medical supervision, with careful consideration of the potential benefits and risks.

From the Research

Role of Corticosteroids in Enteritis Treatment

• Corticosteroids are used to treat enteritis, particularly in cases of moderate to severe disease 2, 3.
• Systemic corticosteroids, such as prednisone and prednisolone, are potent and fast-acting drugs for treating enteritis, but they are not effective in maintaining remission in patients with ulcerative colitis 2.
• Enteric corticosteroids, like budesonide, offer an alternative to systemic corticosteroids and can be effective in treating immunotherapy-related enteritis 3.
• The use of corticosteroids in enteritis treatment is often empirical, and there is a lack of solid evidence about therapeutic schemes 4.

Corticosteroid Regimens and Dosage

• There is no consensus on the optimum regimen for corticosteroid dose and duration in acute severe ulcerative colitis 5.
• Different units may use varying doses and durations of corticosteroids, with some starting with intravenous hydrocortisone and others using methylprednisolone or dexamethasone 5.
• Oral prednisolone is commonly used, with most units starting with 40 mg/day, but the reducing regimen and duration of treatment vary widely 5.

Alternative Therapies and Steroid-Sparing Strategies

• Immunomodulatory therapies, such as azathioprine and 6-mercaptopurine, can induce and maintain long-term remission in patients with corticosteroid-dependent eosinophilic oesophagitis 6.
• Low bioavailability steroids, which have high affinity for peripheral receptors and elevated hepatic first-pass metabolism, may offer a more favorable safety profile and are being evaluated for use in inflammatory bowel disease patients 4.
• Steroid-sparing has become an important therapeutic goal in inflammatory bowel disease management, and alternative therapies are being explored to minimize the use of corticosteroids 4.