Steroids in GI (Prednisolone, Budesonide, Methylprednisolone)
Powerful inflammation-reducers used SHORT-TERM for IBD flares, autoimmune liver disease, microscopic colitis, EoE, and severe AIH. Not for long-term use due to many side effects.
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
Drug class
Corticosteroids
Examples
Systemic: prednisone, prednisolone, methylprednisolone (Solu-Medrol IV). Topical/local-acting: budesonide (Entocort, Cortiment, Budenofalk) — released in the gut with limited systemic absorption; dexamethasone for some uses.
How it works
Steroids broadly suppress the immune system and reduce inflammation. They are extraordinarily effective at calming acute inflammation but have many side effects with long-term use because they suppress many normal body functions.
What it treats
- Acute IBD flares (oral or IV depending on severity)
- Microscopic colitis (budesonide)
- Autoimmune hepatitis (induction and bridge to azathioprine)
- Eosinophilic esophagitis (swallowed budesonide or fluticasone)
- Severe alcoholic hepatitis (selected patients)
- Acute severe ulcerative colitis (IV methylprednisolone)
How to take it
Prednisone or prednisolone for IBD flare: typical course 40 mg daily, taper by 5 mg per week, total course 6-8 weeks. Take in the morning with food.
Budesonide (Entocort, Cortiment) 9 mg daily for 8 weeks, then taper. Targets the right colon and small bowel — much fewer systemic side effects than prednisone.
Methylprednisolone IV 20-60 mg every 6-12 hours in hospital for severe flares.
Swallowed steroids for EoE: budesonide oral suspension or fluticasone inhaler swallowed (not inhaled).
Common side effects
- Increased appetite, weight gain
- Insomnia, mood changes (irritability, euphoria, depression)
- Acne, easy bruising
- Fluid retention, swelling
- Increased blood sugar (steroid diabetes — usually reversible)
- Increased blood pressure
- Cushingoid appearance with longer use (round face, buffalo hump)
- Budesonide has FAR fewer systemic side effects
Serious side effects — call your doctor
Severe psychiatric reaction (psychosis, severe depression, suicidal thoughts)
Stop steroid (under medical supervision) — emergency.
Sudden vision change
Possible glaucoma or cataracts — see ophthalmology.
Severe abdominal pain
Possible perforated ulcer or pancreatitis — emergency.
Signs of infection (fever, cough, urinary symptoms)
Steroids mask and worsen infection — assess promptly.
Adrenal crisis if stopped abruptly: severe weakness, low blood pressure, vomiting
Emergency. Never stop systemic steroid suddenly after >2 weeks of use.
Interactions
Many. Steroids reduce effect of vaccines (avoid live vaccines). Increase blood sugar (adjust diabetes meds). Reduce effectiveness of blood pressure meds. Increase ulcer risk with NSAIDs. Reduce calcium absorption (need supplementation). Many CYP3A4 interactions.
Monitoring
Short course: blood pressure, blood sugar in diabetics. Longer term: bone density (DEXA), eye exam, blood pressure, blood sugar, weight, mood. Calcium + vitamin D supplementation if >3 months use.
When and how to stop
Steroids must ALWAYS be tapered after >2 weeks of use — never stopped abruptly. Sudden withdrawal causes adrenal crisis. Use for shortest duration possible. Bridge to a steroid-sparing maintenance therapy (azathioprine, biologic, mesalamine) so you don't need long-term steroids.
Pregnancy & breastfeeding
Steroids can be used in pregnancy when needed. Cleft palate risk slight in first trimester (small absolute risk). Budesonide preferred when possible due to limited systemic absorption.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- How long is my steroid course, and what's the taper plan?
- Do I need calcium and vitamin D supplements?
- What's my "steroid-sparing" plan to avoid long-term use?
- Should I use budesonide instead of prednisone if eligible?
Medically reviewed by: SGA Patient Education Panel · Last reviewed 24/04/2026