“Please sir, I want some more:” When Rescue Becomes Routine With Prednisone in IBD Care

For decades, corticosteroids have been the gastrointestinal equivalent of duct tape: they fix almost everything, at least long enough to convince us the job is done. But as every homeowner eventually learns, duct tape isn’t a long term structural solution…which is why I wish I still lived in an apartment.

In this episode of the JDD Podcast: Corticosteroid Stewardship Series, Dr. Adam Friedman welcomes Dr. Adelina Hung, a board-certified gastroenterologist, hepatologist, and founder and director of the Inflammatory Bowel Disease Program and MASH Clinic at Sinai Health System in Chicago. Together, Drs. Friedman and Hung explore why corticosteroid stewardship has become just as essential in gastroenterology as it is in dermatology. They examine how repeated corticosteroid exposure quietly accumulates across specialties, why the true burden of toxicity often goes unrecognized, and how today’s expanding arsenal of steroid-sparing therapies is reshaping clinical decision making. The discussion also tackles the difficult balance between rapidly controlling disease activity and avoiding the long term consequences of repeated steroid use, while highlighting the importance of patient education, multidisciplinary communication, and ensuring that access barriers do not become the default indication for another prescription. From cumulative adverse effects and patient counseling to multidisciplinary collaboration and health equity, this conversation challenges the longstanding mindset that another course of prednisone is simply part of doing business. All in, the biggest complication of corticosteroids isn’t the first prescription, it’s losing count of all the ones that came before.