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Fact Checked

A Special Kind of Steroid to Help with Crohn’s Disease

About 1.6 million people are living with inflammatory bowel disease (IBD) in the United States. These individuals often have to deal with unpleasant symptoms, which leads to poor quality of life. 

Crohn’s disease is a type of IBD that affects a significant portion of the gastrointestinal (GI) tract. The GI tract has many different functions like digestion of food, absorption of nutrients from food, and elimination of waste. When an individual has Crohn’s disease, their GI tract may stop working correctly. 

Crohn’s disease accounts for about 50% of all IBD cases and leads to chronic irritation of the GI tract. 

The constant irritation of the GI tract can cause symptoms, like:

  • Persistent diarrhea
  • Abdominal pain
  • Rectal bleeding/bloody stools
  • Weight loss
  • Fatigue 

The causes of Crohn’s disease are not well understood. What is known is that a person’s genetics, environmental, and lifestyle triggers play a role in how symptoms start and then persist. We know the immune system becomes overactive and attacks your own GI tract, leading to symptoms.

Potential triggers that can cause Crohn’s disease: 

  • Smoking
  • Use of antibiotics
  • History of appendix removal
  • Non-steroidal anti-inflammatory (NSAID) drugs
    • Examples include ibuprofen and naproxen
    • Diet
    • Different foods can unpredictably affect individuals
    • There is no single diet that can be linked to Crohn’s disease and its flare-ups
    • Individuals should avoid foods which cause their flare-ups 
    • Some people have a gluten intolerance, known as celiac disease; this can lead to Crohn’s disease over time if celiac disease is untreated or gluten is not avoided

Individuals may experience this condition very differently and can have different symptoms. When there is a period without any symptoms, it means the disease went into remission. Medications and avoiding triggers may help move the condition into remission. On the other hand, When Crohn’s is active, it can be classified as mild, moderate, and severe. 

The good news is that about half of all individuals who do have Crohn’s are in remission thanks to proper medication use and trigger avoidance. 

Despite our poor understanding of what causes Crohn’s, we have a pretty good understanding of symptom management and the use of medications that put Crohn’s back into remission.  

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Steroids for Crohn’s

Symptoms of Crohn’s disease result from an overactive immune system. Following this logic, it makes sense to suppress the immune response - to help control symptoms. 

Steroids are the classic medications used to suppress the immune system. They come in different types and formulations. 

One of the more common steroids that comes to mind is prednisone. While prednisone effectively controls symptoms of Crohn’s disease, it comes with many undesirable side effects. These side effects are common to all steroids because once they enter the bloodstream, they start working on many different parts of the body. 

Side effects of steroids include:

    • Acne
    • Rounding of the face 
    • Body hair growth
    • Mood swings 
    • Insomnia
    • Weight gain
    • Stretch marks
    • Hair loss

Budesonide


A reasonable question to ask is: how do we control symptoms of Crohn’s disease and, at the same time, avoid the side effects of steroids?

The answer comes in the form of a very particular formulation of oral budesonide dosed once a day. 

This form of budesonide, once ingested, moves along the GI tract and does not get absorbed by the body. It works on the surface of the GI tract and reduces inflammation in the gut. It is called a multi-matrix system. This system prevents budesonide from being absorbed into the body and thus minimizes side effects.

Oral multi matrix budesonide should not be used longer than 4 months. Ideally, it should not be taken for longer than 2 months if Crohn’s goes into remission. Once remission occurs, the dose can be reduced. It should also only be used to induce remission for mild and moderate Crohn’s disease. It should not be used in severe Crohn’s disease or once remission is achieved.

Budesonide works best if it is taken in the morning and can be taken with or without food.

Individuals tolerate this formulation of budesonide very well. Only about 20% of patients reported any side effects. The chances of developing side effects increase when budesonide is taken longer than recommended. A study looked at individuals with Crohn’s taking budesonide and found that no side-effects had developed within 2 months of treatment

Individuals are also able to maintain remission of Crohn’s for a long time thanks to budesonide. An 8-week course of oral budesonide was shown to prevent remission for up to a year in 50% of all patients. 

Compared to other steroids, oral budesonide is effective and, most importantly, leads to fewer side effects.

Bottom Line 

Crohn’s disease can be a debilitating condition if left untreated. Budesonide is an option for many individuals who have mild or moderate Crohn’s disease. 

The oral formulation of budesonide comes as a multi matrix system, which reduces typical steroid side effects. Budesonide is effective at putting Crohn’s into remission and can help many people live comfortably. 

This medication should be taken by mouth once daily as directed by your healthcare provider. If you think budesonide might be an option for you, make sure you speak with your primary healthcare provider first. 

Reference List

  • What is inflammatory bowel disease (IBD)? Centers for Disease Control and Prevention. Updated March 22, 2018. Accessed September 16, 2020. https://www.cdc.gov/ibd/what-is-IBD.htm
  • The Facts About Inflammatory Bowel Diseases. New York, NY: Crohn’s and Colitis Foundation of America; 2014. http://www.crohnscolitisfoundation.org/assets/pdfs/updatedibdfactbook.pdf
  • Crohn’s disease. Celiac Disease Foundation. Accessed September 16, 2020. https://celiac.org/about-celiac-disease/related-conditions/crohns-disease/
  • Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn's Disease in Adults [published correction appears in Am J Gastroenterol. 2018 Jul;113(7):1101]. Am J Gastroenterol. 2018;113(4):481-517. doi:10.1038/ajg.2018.27
  • Benchimol EI, Seow CH, Otley AR, et al. Budesonide for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2009;(1): Cd002913
  • Magro F, Estevinho MM. Moving from efficacy to effectiveness: budesonide multimatrix in ulcerative colitis. United European Gastroenterol J. 2019;7(9):1153-1155. doi:10.1177/2050640619878588
  • Tursi A, Giorgetti GM, Brandimarte G, Elisei W. Safety and effectiveness of long-term budesonide treatment in maintaining remission in patients with mild-to-moderate Crohn's disease. Inflamm Bowel Dis. 2007;13(9):1184-1186. doi:10.1002/ibd.20145
  • Tremaine WJ, Hanauer SB, Katz S, et al. Budesonide CIR capsules (once or twice daily divided-dose) in active Crohn's disease: a randomized placebo-controlled study in the United States. Am J Gastroenterol. 2002;97(7):1748-1754. doi:10.1111/j.1572-0241.2002.05835.x
  • Campieri M, Ferguson A, Doe W, Persson T, Nilsson LG. Oral budesonide is as effective as oral prednisolone in active Crohn's disease. The Global Budesonide Study Group. Gut. 1997;41(2):209-214. doi:10.1136/gut.41.2.209
Published October 1st, 2020 by Dr. Tomasz Jurga, PharmD, BCPS, BCACP, CDCES
Fact Checked by Chris Riley

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