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Crohn's Disease Forum » Treatment » Prednisone/Entocort » Prednisone-what does it do?


03-29-2015, 12:37 AM   #1
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Prednisone-what does it do?

Like the subject line says - I can't find any information about what this drug actually does. All I find are horror stories about its side effects.

The FAQ on this website says it "reduces symptoms in a matter of days". I have no overt symptoms. I have occult bleeding from small bowel ulcers but there are no symptoms from that. My anemia is completely resolved. The hematologist says my ferritin level is better than his!

NOTHING says pred heals the ulcers.

I have two strictures. NOTHING says pred heals the strictures.


The FAQ also says "While Prednisone is excellent for inducing clinical remission, it has been shown to be poor when it comes to the healing of the mucosa". That's my problem - I have ulcerated mucosa. Why are they forcing me to take pred? (40mg tapered over 11 weeks to 5mg)


The FAQ also says it "induces clinical remission". But nothing explains to me what that means. I have *NONE* of the symptoms of Crohn's, yet after more tests, all of which were completely normal except a repeat capsule, I'm told I have to take this drug.

No one is telling me why it will help me. I know it won't help me. It will make me feel like crap and I feel perfectly fine right now. Without going into all the history, this whole odyssey started because I lost 75 pounds. Now I'm to take this terrible drug so that I can gain all that weight back. What was the point? I should have just stayed fat.

I already can't sleep and that's nothing new - can't fall asleep, can't stay asleep, can't go back to sleep when I awaken after 2 hours. If I get 5 hours a night its a really good night. With pred I won't sleep at all.

I haven't started it yet, but I'm running out of reasons to delay starting.

What does prednisone do?


PS - I wish I could use more than one post icon. Add Frustrated, Anxious, Crohn's, Advice, Vent, Scared to the one I used.
03-29-2015, 01:47 AM   #2
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Prednisone reduces inflammation which is what causes the ulcers. It's mainly meant for short term use so hopefully your GI is interested in adding something else to help prevent inflammation. Strictures can be caused by inflammation or scar tissue or both. If it's mainly inflammation then the steroid will help but if it's scar tissue then no medication can help as it's damaged tissue (it can be treated with a balloon dilation, strictureplasty or resection). If you do start taking it remember that you must taper off of it as stopping suddenly after taking it for 7 days can be dangerous. Around 3 months with a taper is a short amount of time so you may not notice very many side effects.

If you still aren't comfortable with taking it and your doctor doesn't have any plans for something else to take to help prevent inflammation then you may want to seek out a second opinion.
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Diagnosis: Crohn's in 1991 at age 9
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Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
03-30-2015, 11:05 AM   #3
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You really need to ask your doctor. I wish I could answer your question or direct you to some useful resource, but as you've already found out yourself, the information isn't easy to find.

This site does have detailed information about prednisone: http://reference.medscape.com/drug/p...nsol-342747#10

And it has information on the treatment of Crohn's including steroids: http://emedicine.medscape.com/articl...40-treatment#3

But it's very much aimed at medical professionals, so understanding the science and trying to apply it to your situation is beyond me.

I understand your dilemma, prednisone can have some awful side effects. However, you can't predict which ones you'll get and some can be treated. For example, I've never gained weight from taking prednisone, and when it caused me insomnia my doctor prescribed me a medication that makes me sleep better than I had ever done in my life before. Prednisone and prednisolone also gave me lots of energy.

So don't make the decision not to take prednisone prematurely, as its benefits can outweigh its problems in many cases. In your case, it may be that it will prevent future complications that could develop if your Crohn's goes untreated. That can happen with Crohn's, however, I'm not sure if it's a possibility in your particular situation. I really think you need to contact the doctor who prescribed it for you and get his/her explanation. Explain your worries and ask whether there are other ways to treat your Crohn's. Also remember that if you do take prednisone, the duration of your course can be altered and the dose adjusted depending on your response to it. Many of its side effects do not develop until a person has spent many weeks on it, and the vast majority are completely reversible.
03-30-2015, 03:15 PM   #4
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Out of all the IBD meds out there, pred would worry me the least. It's used to reduce inflammation quickly, while you and your doctor work on a maintenance drug. My son took it for about 10 weeks then tapered over 10 weeks. He gained about 15lb. His energy and mood were outstanding. He did get puffy cheeks and bumps but they went away within a couple of weeks after beginning to taper. You just don't want to have to take it often, as it can weaken your immune system.
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03-30-2015, 10:11 PM   #5
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Prednisone reduces inflammation which is what causes the ulcers. It's mainly meant for short term use <snip>. Strictures can be caused by inflammation or scar tissue or both. If it's mainly inflammation then the steroid will help but if it's scar tissue then no medication can help as it's damaged tissue.
Thanks so much for all the information. You answered more in three sentences than all the doctors I've seen. The pred is meant to be only 11 weeks assuming the taper actually works and I can get off it.

adding something else to help prevent inflammation
I don't know what drug prevents inflammation.

I made an appointment with the IBD expert this morning(it's not until Apr 30), then sent email with the reason for the visit - i.e. I wanted to know what all three drugs would do to me before I start taking them. His very curt response was that he discussed all this in detail during our one consultation (which he said was 1.5 hours but it wasn't!) All I remember him talking about are the biologics - he wrote out all their names. Entyvio is his first choice but the insurance won't approve that without trying other things and them not working. Even then I don't remember him saying what the biologics do. Maybe he did - I was overwhelmed. I have no one to go with me so I have to try to ask questions and write answers and make sense of it all quite rapidly.


If you do start taking it remember that you must taper off of it as stopping suddenly after taking it for 7 days can be dangerous. Around 3 months with a taper is a short amount of time so you may not notice very many side effects.
Yet another question answered - how long is "short" or "long" on pred.


you may want to seek out a second opinion.
As for a second opinion I had to laugh, a sick disturbed laugh. I've actually seen five different GI doctors. One discussed a whole list of possibilities from cancer to parasites with Crohn's in there but since no symptoms - not high on his list, another said Crohn's - no question but that's his specialty, another said NSAID enteropathy - definitely not Crohn's, another said it's ambiguous - let's see what a repeat PillCam or DBE shows, and the last said he had no idea - lets do the IBD serology. He was going to repeat the CT enterography but when he read that two didn't show a thing he went to the repeat PillCam.

It's mainly meant for short term use so hopefully your GI is interested in adding something else to help prevent inflammation.
The IBD expert has also prescribed azathioprine. I have much the same questions about that, but since this is in the prednisone thread I didn't include those questions. Just like the pred, I have no idea what the aza actually does. Will it heal my ulcers, strictures, and inflammation?

As I said above, he really wants to do a biologic so now he's recommending Humira. Same questions.
03-30-2015, 10:54 PM   #6
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You really need to ask your doctor. I wish I could answer your question or direct you to some useful resource, but as you've already found out yourself, the information isn't easy to find.
Tried that - didn't work. Actually, what I did today was made an appointment with the IBD expert (earliest is Apr 30). Then I followed up in an email with what I wanted to discuss at the appointment i.e. what the various drugs do - do they heal ulcers, inflammation, strictures. His curt response was that he'd explained all that in detail. NOT!

But it's very much aimed at medical professionals, so understanding the science and trying to apply it to your situation is beyond me.
I'll look at the links you sent, but if it's technical it probably won't make any more sense to me than everything else I've read.

when it(pred) caused me insomnia my doctor prescribed me a medication that makes me sleep better than I had ever done in my life before. Prednisone and prednisolone also gave me lots of energy.
I've asked about my insomnia throughout the years and no doctor has ever taken any interest in helping. To be taken seriously about lack of sleep would be a surprise to me.


So don't make the decision not to take prednisone prematurely, as its benefits can outweigh its problems in many cases. In your case, it may be that it will prevent future complications that could develop if your Crohn's goes untreated. That can happen with Crohn's, however, I'm not sure if it's a possibility in your particular situation.
I'd actually made the decision to take the drugs - I just wanted to know which one did what since there are no consistent symptoms to get better. I want to know what is supposed to go away and what I'll be left with. Will I continue to have occult bleeding and the anemia because the existing ulcers aren't healed by these drugs - only new ones prevented from forming? Will I continue to have the obstruction symptoms from the strictures or will that go away - the one and only real issue I have that causes severe pain and vomiting (last time was July).


I really think you need to contact the doctor who prescribed it for you and get his/her explanation.
See above. He even said in his email that he'd "mail her another copy of the Crohn's medication instruction booklet". What OTHER copy? There never was one to begin with! He gave me nothing and I even asked specifically for such a thing. I have downloaded and read the CCFA Understanding IBD Meds book, but it doesn't answer any of these questions either.

The total text about steroids in the above booklet:
These medications, affect the body’s ability to begin and maintain an inflammatory process. In addition, they work to keep the immune system in check.

That doesn't tell me pred heals anything, or fixes anything.

The text about immunomodulators is a bit more helpful.
This class of medications modifies the body’s immune system so that it cannot cause ongoing inflammation.

Sounds like that one would prevent inflammation but wouldn't heal anything existing. So no new inflammation, but existing stays and so do the bleeding ulcers.


Also remember that if you do take prednisone, the duration of your course can be altered and the dose adjusted depending on your response to it.
That's interesting - I was told I had to stick to the exact dosing I was given. The only change mentioned was perhaps having to extend the use if I reacted to stopping it.

Many of its side effects do not develop until a person has spent many weeks on it, and the vast majority are completely reversible.
Eleven weeks seems like forever to me.
03-31-2015, 04:40 AM   #7
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Even then I don't remember him saying what the biologics do. Maybe he did - I was overwhelmed. I have no one to go with me so I have to try to ask questions and write answers and make sense of it all quite rapidly.
Maybe you could record your appointments?

Crohn's always involves quite a bit of uncertainty. Even when the diagnosis is certain and there are no conflictimg views on the best course of treatment, how a patient will respond to the treatment is still unknown.

What made you stop seeing the other doctors? Did you agree with any of them about your diagnosis?
03-31-2015, 09:26 AM   #8
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Maybe you could record your appointments?

Crohn's always involves quite a bit of uncertainty. Even when the diagnosis is certain and there are no conflictimg views on the best course of treatment, how a patient will respond to the treatment is still unknown.

What made you stop seeing the other doctors? Did you agree with any of them about your diagnosis?
While that is an excellent idea - and something I never thought about - I have no way to record an appointment.

The first doctor read the PillCam and gave me that myriad of possibilities, then passed me along to the second who did the DBE. He said surgery or medication, and passed me along to the IBD expert. While waiting on that appointment date, I decided I wanted another opinion and actually got in to see the fourth IBD guy before the third. Those were the two with diametrically opposed opinions. I went back to see both number two and four a second time. The fifth guy was in desperation to try to get a choice between Crohn's and NSAIDs but he said he didn't know what it was. He ordered the serology and repeat PillCam. While this guy is closest to home, it takes months to get in to see him. Plus, he spends most of his time doing routine colonoscopies so isn't really an IBD expert.

I did choose to stop seeing the one guy who kept pushing for surgery and felt it was NSAIDs. Well, originally he said cancer, but after the 3rd CT decided against that. While I liked the idea of "cut it out and get it over with", the continued occult bleeding didn't match that diagnosis. If it was NSAID damage, it would heal on its own after stopping them, which I did in November. If I was healing, why was it still bleeding? My return appointment with the fifth guy is early June (saw him in mid Feb). I may or may not keep that appointment depending upon what transpires in the meantime.

So I did the repeat PillCam to find out if anything had healed and now it's stuck. The first one came out without a problem in 48 hours even though I have the strictures (it wasn't known at the time of the first PillCam why it stopped for a while before moving on but after the DBE it was determined it stopped at the strictures.) But since it came out, we all thought the second would do the same. Wrong.

I've contacted the DBE guy to see if he thinks we should fish it out, or wait. I have questions for the IBD guy before starting the medication, but he's not really a "answer question" kind of guy. So, right now, I'm waiting on responses to emails. I'm ready to start the meds. I want to do that this week - just wish I knew which side effects I live with and which I report.
04-01-2015, 04:09 AM   #9
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Both Humira and Aza help prevent inflammation which yes would help to get rid of your current ulcers and inflammation. Steroids help to reduce the inflammation quickly as it can take up to three months for the other meds to fully work.

I'm sorry to hear that the pill cam is stuck. When was your last one done? Inflammation can build up quickly so it's best to take the fake pill that dissolves in case it does get stuck before taking the real one. Hopefully it will pass on it's own soon without needing surgery. I might have read your posts wrong but I don't recall you mentioning that you've had a colonoscopy, when was your last one?
04-01-2015, 05:01 PM   #10
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Both Humira and Aza help prevent inflammation which yes would help to get rid of your current ulcers and inflammation. Steroids help to reduce the inflammation quickly as it can take up to three months for the other meds to fully work.

I'm sorry to hear that the pill cam is stuck. When was your last one done? Inflammation can build up quickly so it's best to take the fake pill that dissolves in case it does get stuck before taking the real one. Hopefully it will pass on it's own soon without needing surgery. I might have read your posts wrong but I don't recall you mentioning that you've had a colonoscopy, when was your last one?
Colonoscopy was 7/18/14 at same time as EGD. Both were completely normal. My problem area is at the end of the jejunum and start of the ileum - not a "normal" location at all.

The patency capsule was discussed but since the first pillcam (9/3/14) passed through the strictures, it was decided it wasn't needed this time (3/26/15). Not to mention my insurance won't pay for a patency capsule - only the real thing.

I really, really, really don't like the IBD expert to which I've been referred, but when asked about seeing someone else their appointment availability is six months out. I'd decided I had to take the pred and aza as long as they heal the existing ulcers and inflammation and prevent more.

In the meantime, the GI guy who did my DBE is recommending, instead of a repeat DBE, surgery to not only retrieve the pillcam, but resect the portion of the bowel with the strictures and inflammation and ulcers. He said don't start the meds if I'm going to have surgery because they would HINDER healing of the resection.

So I'm back to waiting...and indecision.

Just to verify what you've told me:
Prednisone heals inflammation. It doesn't heal the ulcers, but if the inflammation is gone, the ulcers will heal on their own.
Azathioprine prevents more inflammation but doesn't heal existing - that's why one has to take the pred at the same time.
Humira both heals and prevents inflammation. Like the pred, it doesn't heal the ulcers but get rid of the inflammation and the ulcers heal. Humira acts faster than aza.
04-04-2015, 05:21 AM   #11
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It's an extremely simple way of putting it but that's ok. Aza and Humira will help your current inflammation as well but Prednisone works a lot faster so that's why it's taken as well for a short period of time.

They can affect your ability to heal and since you may need surgery to remove the camera it might be best to wait. If it's scar tissue then a resection may be a good idea especially if you've been suffering from repeat partial obstructions which can lead to full obstructions and those can be life threatening. After the surgery then you may not need the steroid and could use Aza to help prevent inflammation in the future and hopefully avoid this situation again. Keep us posted.
04-04-2015, 12:37 PM   #12
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It's an extremely simple way of putting it but that's ok.
I'm a simple kind of gal.


Aza and Humira will help your current inflammation as well but Prednisone works a lot faster so that's why it's taken as well for a short period of time.
The ulcers are bleeding. The bleeding causes the anemia. I want this gone! But since no doctor addressed the ulcers I was so confused.


They can affect your ability to heal and since you may need surgery to remove the camera it might be best to wait.
Exactly what the GI guy who did the DBE said.

If it's scar tissue then a resection may be a good idea especially if you've been suffering from repeat partial obstructions which can lead to full obstructions and those can be life threatening.
Not to mention very painful. The DBE doc also said after the resection they'll do a pathology on what's removed and have a definitive answer about whether it's Crohn's. I had a couple of dilations of the small bowel discovered on x-ray back in 2009 which resolved once the impacted colon was cleaned out. I can't help but wonder if the area of the strictures are the same place. No doc is even interested in talking about that idea.


Thanks for listening to my babble. It helps to just "talk" it out.
04-04-2015, 10:02 PM   #13
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You've had blockages since 2009? It's very likely that you do have some scar tissue. Did you say it was dilated in the past?
04-04-2015, 10:27 PM   #14
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You've had blockages since 2009? It's very likely that you do have some scar tissue. Did you say it was dilated in the past?
It's long and drawn out, but the short version - nothing was diagnosed in 2008-2009 when things started. Eventually it was determined a significant change in diet caused constipation (which I didn't initially recognize) that became almost completely impacted. After 8 months of increasingly worsening obstruction symptoms, tests that showed nothing, and a stupid resident doctor, a plain x-ray showed, in her words, "you're full of shi*". The only reason I got her to do that, was I finally insisted on discussing my change in bowel habits. No one had ever asked. Lots of laxatives, enemas, etc. cleared up the very hard and dry stool. It took another six months before the pain and vomiting stopped. But then ten months later I had another episode. Since 2010, iit comes randomly once or twice a year.

That initial x-ray showed "two loops of dilated small bowel". Everything I ate had no where to go - hence it expanded the small bowel. So, not a dilation done by procedure at all. Two repeat x-rays weeks apart showed the distended bowel getting smaller after I'd started the laxatives.

I want to believe that ballooned bowel contracted, starting the strictures that has caused the off-and-on obstruction symptoms through the years. But no doctor will even consider that 2008 has anything to do with now.
04-05-2015, 12:40 AM   #15
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Considering you're still undiagnosed, I have a hard time believing that they aren't related. You had pain and vomiting for 6 months after the obstruction cleared? Sounds more like you were dealing with a partial obstruction during that time. Your doctor really dropped the ball back then.
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