How Do Gastrointestinal Corticosteroids Work?

Gastrointestinal corticosteroids are a class of medications used to relieve itching, swelling, soreness, and burning from hemorrhoids (swollen veins in the lowest part of the rectum and anus), proctitis (swelling in the rectum), inflammatory bowel disease (inflammation of all or part of the digestive tract.), and other rectal problems. They act as an anesthetic on the skin to relieve minor pain, itching, and discomfort.

These are administered as oral tablets (delayed and extended-release) and topically (creams, lotions, enema, foam, and suppositories). Suppositories help to relieve rectal pain, itching, bloody diarrhea, and bleeding by reducing swelling in the rectum and anus.

Gastrointestinal corticosteroids have anti-inflammatory actions and suppress the immune response. They are used based on their potency, the area of the body to which they will be applied, and the type of skin condition being treated. They work in the following ways:

• Anti-inflammatory steroids are released whenever the body experiences stress, disease, or trauma. They interact with the DNA in the cell to produce proteins called “lipocortin,” and these proteins, in turn, block the chemical “arachidonic acid” necessary for inflammatory response, leading to less inflammation.
• Immunosuppression-Immune cells fight infections with the help of defensive cells (meant to neutralize invading viruses and bacteria). They also release toxins in the body, causing more inflammation. Corticosteroids hinder this action and prevent tissue damage that can be caused by excessive inflammation.
• Vasoconstriction (they constrict the blood vessels)-Inflammation leads to dilatation of blood vessels around the infected site; corticosteroids constrict the capillaries (smallest blood vessels) and reduce swelling and pain.

Gastrointestinal corticosteroids are used to treat conditions such as:

• Hemorrhoids (swollen veins in the lowest part of the rectum and anus)
• Ulcerative colitis (a condition that causes swelling and sores in the lining of the large intestine and rectum)
• Ulcerative proctitis (a mild form of ulcerative colitis)
• Crohn’s disease (a chronic, or long-term, condition that causes inflammation of the digestive tract)
• Eosinophilic esophagitis (a chronic, allergic inflammatory disease of the esophagus-the tube connecting the mouth to the stomach)
• Cholangitis (an infection of the bile ducts, the tubes that carry bile from the liver to the gallbladder and intestines)
• Immunoglobulin A nephropathy (caused by deposits of the protein immunoglobulin A inside the kidney)
• Inflammation and pruritus associated with corticosteroid-responsive dermatoses (a general term used to describe any skin defect or lesion on the skin)
• Anal fissures (a cut or a tear in the thin, delicate lining of the anus)

Many of the side effects resolve on their own after stopping the medication.

Common side effects include:

• Burning
• Itching
• Irritation
• Dryness
• Abdominal pain
• Dyspepsia (a persistent or recurrent pain or discomfort in the upper abdomen)
• Nausea
• Headache

Other rare side effects include:

• Folliculitis (a common skin condition in which hair follicles become inflamed)
• Hypopigmentation
• Striae (stretch marks)
• Rectal bleeding
• Hypertrichosis (localized excessive hair growth)
• Secondary infection

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of gastrointestinal corticosteroids include:         

• Analpram E
• Analpram HC
• Anucort-HC
• Anusol HC
• Budesonide
• Cortenema
• Cortifoam
• Entocort EC
• Epifoam
• Hydrocortisone rectal
• Hydrocortisone topical/pramoxine topical
• Ortikos
• Peranex HC
• Pramosone
• Pramosone E
• ProCort
• Proctofoam HC
• Proctol
• Proctomyxin
• Proctosedyl
• Proctosedyl Ointment
• Uceris
• Xyralid RC