Dr. Ghassan Wahbeh, director of Seattle Children's IBD Center, discusses the downsides of treatment with steroids.
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0:05 Steroids are one of our oldest time-tested medication options to treat inflammatory bowel disease, and that's ulcerative colitis, Crohn's disease, or unclassified IBD, which has features of both conditions. The unique thing about steroids is that they work in a way that we do not understand 100%.
0:27 We think that they tend to reduce the inflammation by interrupting the inflammation pathway at multiple levels, but unfortunately they do not successfully heal the lining of the intestine. Healing the lining of the intestine--or any part of the wall of the intestine that is inflamed because of, for example, Crohn's disease-- that is an important target of our therapy plan.
0:50 Steroids offer a lot of patients, fortunately, some improvement in the short term, but in the long run they do not sustain that effect, and also they come at a price to pay. The price is the multiple side effects that happen. A lot of these side effects are reversible. They happen when our children take steroids, and they go away after the steroids are discontinued. An example of these short term effects could be: increasing the appetite; making the face a little puffy, a little red; making us moody, whether it's up where we are overactive, or down where we feel sad or blue. They can also affect the sleep cycle, cause muscle spasms, and sweating. Blood sugar can go up, the blood pressure can go up, with steroids.
1:41 More importantly, the steroids that we take could actually suppress our own body's ability to produce steroids. Therefore, we cannot stop the steroids right away, and we have to wean the steroids gradually until we're able to allow the body to produce its own share of steroids.
1:58 In the long run, repeat courses of steroids, or high doses of steroids, or prolonged courses of steroids, can actually weaken the bones. Because of these side effects, and the fact that steroids do not heal the lining of the intestine, it is important to look for strategies to avoid using steroids altogether.
2:16 The reason why avoiding steroids is important, is the mounting evidence now that using steroids early on in the course of treating IBD can actually have a negative effect on the course of the disease later on.
2:29 We have different strategies to try to avoid using steroids early on in the course of the disease, and also to avoid repeat use of steroids if we have to use them altogether. Tune in to two of our other talks that look at preventing use of steroids, and strategies to prevent reuse and multiple use of steroid courses in the future.