Steroids and Your Stomach: The Cost of Long-Term Relief

Steroids are powerful medications widely used to control inflammation in chronic conditions like rheumatoid arthritis, asthma, lupus, and inflammatory bowel diseases. While they offer much-needed relief and help patients manage pain and autoimmune flare-ups, long-term use—especially without medical supervision—can come at a heavy price. This was recently highlighted in a case that presented to us in an emergency: a patient with rheumatoid arthritis, on chronic steroid therapy, arrived with multiple small bowel perforations, a life-threatening complication requiring immediate surgical intervention.

This unfortunate case serves as a stark reminder of the hidden gastrointestinal (GI) risks associated with prolonged steroid use. In this blog, we’ll explore how steroids affect the digestive system over time and why regular medical monitoring is essential for those relying on them long-term.

A middle-aged patient, battling rheumatoid arthritis for several years, had been on long-term oral steroid therapy to manage joint pain and inflammation. With no recent adjustments to medication and no significant follow-ups, she presented to us with acute abdominal pain, fever, and signs of peritonitis (infection in the abdominal cavity).

Upon investigation and surgical evaluation, she was found to have multiple perforations in the small intestine—a rare but known complication of chronic steroid exposure. Fortunately, prompt surgical intervention saved her life, but this case reflects the silent damage steroids can cause when used continuously without oversight.

How Steroids Affect the GI System

Steroids, especially glucocorticoids like prednisone, are designed to suppress inflammation by altering immune responses. However, their long-term impact on the gastrointestinal tract can be profound:

1. Increased Risk of Gastric Ulcers

Steroids weaken the protective mucosal lining of the stomach, especially when used alongside non-steroidal anti-inflammatory drugs (NSAIDs). This makes the stomach more vulnerable to acid damage, leading to peptic ulcers and discomfort, particularly in the upper abdomen.

2. Gastrointestinal Bleeding

Over time, the erosion of the GI lining can lead to internal bleeding. This may manifest as black stools (melena) or vomiting blood. For patients on high doses or taking other ulcer-causing medications, the risk multiplies.

3. Delayed Healing

Steroids impair tissue regeneration and collagen production, which slows the healing of ulcers, surgical wounds, and even minor GI injuries. This delayed recovery increases the risk of further complications, like perforations.

4. Increased Susceptibility to GI Infections

Since steroids suppress the immune system, patients become more prone to infections in the gut, such as Clostridium difficile (C. diff), which can cause severe diarrhea and colitis. Fungal infections like candidiasis may also emerge in immunocompromised individuals.

5. Pancreatitis

Though relatively rare, steroid-induced pancreatitis is a known complication. The pancreas becomes inflamed, leading to sudden and severe abdominal pain, nausea, and vomiting—often requiring hospitalization.

6. Worsening of Pre-existing GI Conditions

Patients already diagnosed with conditions like GERD (acid reflux), peptic ulcers, or inflammatory bowel disease (IBD) may notice increased frequency and severity of symptoms due to prolonged steroid exposure.

7. Liver Stress and Fatty Liver Risk

Especially with anabolic steroid use, but also with glucocorticoids over time, the liver can become overloaded, leading to fatty liver changes and elevated liver enzymes, which may go unnoticed until liver function is compromised.

Why Regular Monitoring Is Crucial

Patients with chronic illnesses such as rheumatoid arthritis, lupus, or Crohn’s disease often require a multidrug regimen. Over time, the body’s response to medications can change, and what was once therapeutic may begin to cause harm.

Prolonged use of the same high-dose medication without regular monitoring is risky. Drug side effects may remain silent until a crisis emerges—like a GI bleed or intestinal perforation.

That’s why it's important to:

Consult your doctor regularly — at least every few months. Discuss side effects and report any new or unusual symptoms. Get blood tests to monitor liver function, inflammatory markers, and nutritional deficiencies. Ask about dose tapering or alternative treatment options when possible.

Steroids have a valuable role in managing inflammation and controlling autoimmune diseases, but long-term use must always be weighed against the potential side effects—especially those affecting the gastrointestinal system.

This case serves as a reminder for patients and healthcare providers alike: - Relief should never come at the cost of safety. - Regular review of medications is essential to adapt to the body’s evolving needs. - Ignoring symptoms like persistent abdominal pain, bloating, or changes in bowel habits can delay life-saving care.

Prioritize your gut health. Stay informed. Stay monitored.

For expert GI care and surgical guidance, consult with a specialist trained in recognizing and managing these complications with precision.

With regards, Dr. Shashikiran B D Surgical Gastroenterologist / GI Surgeon Expert in Advanced Laparoscopic & Robotic Surgeries 🌐 www.drshashikiran.com

This article is created exclusively for Dr. Shashikiran B D's website and is intended for informational and educational purposes only. It does not provide medical advice or recommendations for any condition. Individuals should consult a qualified medical expert before making any lifestyle changes, choosing any sort of medical treatment or considering surgical options. Medical opinions and treatments can only be provided through one-on-one consultations tailored to each individual’s needs. Please do not consider this blog as a substitute for professional medical advice. Note that the spelling of "esophagus" can be written as "esophagus" or "oesophagus." Both spellings are correct and depend on whether UK or US spelling conventions are used. Here, both spellings are used for optimization purpose only

Additional Information About Dr. Shashikiran B D

Dr. Shashikiran B D, an expert Surgical Gastroenterologist and GI Surgeon, offers comprehensive care to guide patients through their recovery journey. With his extensive experience in minimally invasive and robotic surgeries, patients receive precise and tailored treatment plans. Life after Heller's Myotomy is not just about surgical recovery; it involves a proactive approach to health management through diet, lifestyle, and regular medical care. Patients can look forward to an improved quality of life, enjoying meals without discomfort or fear of regurgitation. For more information or to schedule a consultation, visit www.drshashikiran.com.