Crohn's disease is a chronic inflammatory condition of the digestive tract. The inflammation of Crohn's disease damages the digestive system organs, typically causing pain, diarrhea, intestinal bleeding, malnutrition and weight loss. Health-care professionals commonly use corticosteroid medications, or steroids, to treat Crohn's disease, because these drugs have potent anti-inflammatory properties. Long-term use of steroids, however, can lead to side effects and complications. The protracted use of steroids for Crohn's disease requires careful consideration of the potential risks and benefits.
Hyperglycemia
People taking corticosteroids for Crohn's disease may experience elevated blood sugar levels, or hyperglycemia. This complication occurs because corticosteroids alter normal glucose metabolism. Among Crohn's disease patients on long-term corticosteroid therapy, persistent hyperglycemia can lead to a drug-induced form of diabetes mellitus, Dr. Doug Knutson and colleagues reported in an August 2003 article in "American Family Physician." Complications associated with steroid-induced hyperglycemia among Crohn's disease patients mirror those of organic diabetes mellitus. Severe chemical imbalances, such as diabetic ketoacidosis, can develop in Crohn's disease patients with steroid-induced diabetes. Insulin therapy may be required.
Osteoporosis
Long-term corticosteroid treatment for Crohn's disease increases the risk of osteoporosis, Dr. Jean-Paul Achkar reported in an electronic article published by the American College of Gastroenterology. Osteoporosis is a condition in which decreased bone mass and mineral content lead to bone fragility. People with osteoporosis have an increased risk of broken bones. In a 2004 article published in the medical journal "Minerva Medica," Dr. Peter Vestergaard reported that 32 to 38 percent of people with Crohn's disease have decreased bone mass. Dr. Vestergaard further stated that increased fracture risk among people with Crohn's disease is primary attributable to corticosteroid use.
Increased Infection Risk
Corticosteroid-induced suppression of the immune system helps control the damaging effects of Crohn's disease in the digestive tract. This same immunosuppressive effect, however, can also increase vulnerability to potentially life-threatening infections. In a December 2005 article in the journal "Clinical Gastroenterology and Hepatology," Dr. Anurag Agrawal and colleagues reported that corticosteroid treatment is associated with a significantly increased risk of Crohn's disease-related abscesses of the abdomen and pelvis. A 2009 study by Dr. Josh Marehbian and colleagues in "The American Journal of Gastroenterology" confirmed an increased infection risk among those with Crohn's disease taking immunosuppressant therapy. The authors specifically noted an increased risk of tuberculosis, Candida yeast infections, herpes zoster and bloodstream infections.
References
- National Institute of Diabetes and Digestive and Kidney Diseases: Crohn's Disease
- "American Family Physician": Management of Crohn's Disease--A Practical Approach; Doug Knutson, M.D., et al.; August 2003
- American College of Gastroenterology: Inflammatory Bowel Disease
- "Minerva Medica"; Prevalence and pathogenesis of osteoporosis in patients with inflammatory bowel disease; Peter Vestergaard, M.D., Ph.D.; December 2004
- "Clinical Gastroenterology and Hepatology"; Effect of Systemic Corticosteroid Therapy on Risk for Intra-abdominal or Pelvic Abscess in Non-operated Crohn's Disease; Anurag Agrawal, M.D., et al.; December 2005
