Steroids Are Not Used to Treat IBS
Corticosteroids have no role in the treatment of Irritable Bowel Syndrome and should not be prescribed for this condition. 1
Why Steroids Are Not Indicated
No evidence of efficacy: Eight randomized controlled trials evaluating corticosteroids for IBS showed no significant benefit, and oral corticosteroids were actually associated with negative effects on outcomes. 1
IBS is not an inflammatory condition: Unlike inflammatory bowel disease (IBD), IBS does not involve intestinal inflammation that would respond to corticosteroid therapy. 1
Significant harm without benefit: Prolonged steroid use causes numerous adverse effects including increased infection risk, osteoporosis, suppression of the hypothalamic-pituitary-adrenal axis, diabetes, weight gain, and cardiovascular disease—all without providing symptom relief for IBS. 1
Evidence-Based Treatments for IBS Instead
For IBS with Diarrhea (IBS-D):
- Loperamide (4-12 mg daily) for stool frequency and urgency control 1, 2
- Tricyclic antidepressants (start amitriptyline 10 mg daily, titrate to 30-50 mg) for abdominal pain and global symptoms 1, 2
- 5-HT3 antagonists like ondansetron (start 4 mg daily, maximum 8 mg three times daily) for refractory cases 1, 2
For IBS with Constipation (IBS-C):
- Linaclotide (guanylate cyclase-C agonist) as second-line therapy 2
- Lubiprostone (chloride channel activator) with lower diarrhea risk 2
- Soluble fiber (ispaghula 3-4 g/day, gradually increased) 2
For All IBS Subtypes:
- Antispasmodics (dicyclomine, peppermint oil) for abdominal pain and cramping 1, 2
- Psychological therapies (cognitive-behavioral therapy, gut-directed hypnotherapy) for moderate to severe symptoms 1
Critical Distinction from IBD
The evidence you may encounter regarding steroids relates exclusively to inflammatory bowel disease (Crohn's disease and ulcerative colitis), not IBS. 1 These are entirely different conditions:
- IBD: Involves chronic intestinal inflammation visible on endoscopy/imaging; steroids induce remission but should be minimized due to toxicity 1
- IBS: A functional disorder of gut-brain interaction without inflammation; steroids provide no benefit 1
Common Pitfall to Avoid
Do not confuse IBS with IBD when considering treatment options. If a patient presents with symptoms suggestive of IBS but has red flag features (bloody diarrhea, weight loss, fever, anemia, elevated inflammatory markers), investigate for IBD or other organic pathology before diagnosing IBS. 1