Why do corticosteroids (cortico-steroid) cause gastritis?

From the Guidelines

Corticosteroids cause gastritis primarily by inhibiting prostaglandin synthesis, which normally protects the stomach lining, and this effect is well-documented in patients receiving long-term systemic corticosteroid therapy 1. When prostaglandin production decreases, there is reduced mucus secretion and bicarbonate production in the stomach, diminishing the protective barrier against stomach acid. Corticosteroids also impair the normal healing process of the gastric mucosa by suppressing cell proliferation and repair mechanisms. Additionally, they increase gastric acid secretion while simultaneously reducing blood flow to the gastric mucosa, creating a perfect environment for mucosal damage. This combination of effects leads to inflammation of the stomach lining (gastritis), which can progress to ulceration if the medication is continued long-term. To prevent corticosteroid-induced gastritis, proton pump inhibitors like omeprazole (20-40mg daily) or pantoprazole (40mg daily) are often prescribed alongside corticosteroid therapy, especially for patients on higher doses or longer treatment courses 1. Taking corticosteroids with food and avoiding NSAIDs can also help reduce the risk of developing gastritis. Some patients may be at higher risk of developing gastritis, such as those taking nonsteroidal anti-inflammatory drugs or anticoagulants, and may require additional preventive measures, including histamine 2 blockers or proton pump inhibitors 1. It is essential to monitor patients on corticosteroid therapy for signs of gastritis and to take proactive measures to prevent this complication, especially in patients with risk factors for gastrointestinal complications, as identified in studies on the use of NSAIDs and COX-2-specific inhibitors 1. In clinical practice, the use of proton pump inhibitors has been shown to decrease the risk of bleeding ulcers in high-risk patients, and their use should be considered in patients receiving corticosteroid therapy, particularly those with a higher risk of gastrointestinal complications 1. Overall, the prevention of corticosteroid-induced gastritis requires careful consideration of the patient's risk factors and the use of appropriate preventive measures to minimize the risk of this complication. The most recent guidelines recommend careful monitoring of patients on corticosteroid therapy and the use of preventive measures, such as proton pump inhibitors, to reduce the risk of gastritis and other gastrointestinal complications 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.

Corticosteroids may cause gastritis because they increase the risk of gastrointestinal perforation in patients with active or latent peptic ulcers, and may also increase the risk of bleeding in the gastrointestinal tract. The exact mechanism is not explicitly stated in the label, but it is recommended to use steroids with caution in patients with gastrointestinal conditions. 2

• Key points:
  • Increased risk of gastrointestinal perforation
  • Increased risk of bleeding in the gastrointestinal tract
  • Use with caution in patients with gastrointestinal conditions
• Main idea: Corticosteroids may increase the risk of gastritis due to their effects on the gastrointestinal tract.

From the Research

Corticosteroids and Gastritis

• Corticosteroids have been associated with an increased risk of gastrointestinal side effects, including gastritis, peptic ulcer disease, and gastrointestinal bleeding 3.
• A study found that patients using inhaled corticosteroids had an increased risk of adverse gastrointestinal events, including gastritis, compared to those using only inhaled albuterol 4.
• The risk of upper gastrointestinal complications, including gastritis, was found to be higher in patients using oral steroids, with an adjusted odds ratio of 1.8 5.
• The use of corticosteroids in combination with nonsteroidal antiinflammatory drugs (NSAIDs) was found to increase the risk of upper gastrointestinal complications, including gastritis 5.

Mechanism of Gastritis

• The exact mechanism of corticosteroid-induced gastritis is not fully understood, but it is thought to be related to the suppression of the immune system and the disruption of the gastrointestinal mucosa 3.
• Corticosteroids may also affect the production of stomach acid and the functioning of the gastrointestinal tract, leading to an increased risk of gastritis 4.

Treatment and Prevention

• Treatment of corticosteroid-induced gastritis typically involves the use of proton pump inhibitors, histamine H2 receptor inhibitors, and antacids 6.
• Alternative therapies, such as food-based products, have been proposed as potential treatments for gastritis, but more research is needed to fully understand their effectiveness 6.
• The use of spacer devices with inhaled corticosteroids may help reduce the risk of adverse gastrointestinal events, including gastritis 4.