“Steroid gut” refers to gastrointestinal problems from corticosteroid medications. These powerful anti-inflammatory drugs are synthetic hormones like cortisol, prescribed to reduce inflammation and suppress the immune system for conditions like inflammatory bowel disease, asthma, or autoimmune disorders. Their use can lead to uncomfortable or serious digestive side effects.
How Steroids Impact the Gut
Corticosteroids alter the gastrointestinal tract. They reduce the protective mucus layer lining the stomach and intestines, which normally shields the lining from digestive acids and enzymes.
These medications inhibit prostaglandin synthesis. Prostaglandins protect the stomach by promoting mucus and bicarbonate production and influencing local blood flow. When inhibited, the stomach’s defenses weaken, making it susceptible to damage.
Corticosteroids may also impair gut blood flow, reducing oxygen and nutrient supply to tissues. This diminished supply compromises intestinal cells, making them vulnerable to injury. Tissue repair mechanisms can also be impaired, delaying healing.
Beyond direct tissue effects, corticosteroids alter the gut microbiome, the community of bacteria in the digestive tract. Corticosteroid exposure can shift these microbial communities. This alteration in bacterial balance influences inflammation and overall gut health.
Signs and Symptoms
Individuals experiencing steroid gut may develop various symptoms. Common complaints include heartburn, indigestion, and nausea, sometimes with vomiting.
Abdominal pain is a prevalent symptom. Changes in bowel habits, such as diarrhea or constipation, can occur. These symptoms suggest irritation or inflammation within the digestive tract.
In severe instances, steroid gut can manifest as gastrointestinal bleeding. This may be indicated by black, tarry stools or visible blood in vomit. The most serious complication, though less common, is perforation, which requires immediate medical attention.
Diagnosis and Management
Diagnosing steroid gut begins with a review of the patient’s medical history, focusing on corticosteroid use. A physical examination assesses abdominal tenderness or other signs of gastrointestinal distress. If symptoms suggest a serious issue, further diagnostic tests may be ordered.
Endoscopy visualizes the lining of the esophagus, stomach, and duodenum to identify ulcers or inflammation. Stool tests may check for hidden blood. Imaging studies, such as X-rays or CT scans, can detect serious complications like perforations or severe inflammation.
Management of steroid gut involves a multi-faceted approach, always under medical supervision. Adjusting steroid dosage, by reducing it or transitioning to a different medication, is a common approach. Medications protecting the stomach lining, such as proton pump inhibitors (PPIs) or H2 blockers, are prescribed to reduce acid production and promote healing. Addressing complications like bleeding or perforation may require additional interventions, including endoscopic procedures or surgery.
Reducing the Risk
Individuals taking corticosteroids can take steps to minimize their risk of gastrointestinal issues. Taking oral steroid medications with food can buffer the stomach lining and reduce irritation. It is advisable to avoid non-steroidal anti-inflammatory drugs (NSAIDs), as combining them with corticosteroids can significantly increase the risk of stomach ulcers and bleeding.
Quitting smoking and limiting alcohol consumption are beneficial, as both can irritate the digestive tract. Discussing concerns about gastrointestinal side effects with a doctor is always recommended. While the role of probiotics in preventing steroid gut is still being researched, some healthcare providers may suggest them to maintain a balanced gut microbiome. Any dietary changes or supplement use should always be discussed with a healthcare provider to ensure they are appropriate and safe.