Gastroenterological side effects of steroids and immunotherapy – preliminary report

Side effects of drug administration are often observed within the gastroenterological system. They become the most common adverse effects among all complications caused by medications. Additionally, diseases of the gastrointestinal tract can influence drug pharmacokinetics, which is reflected either in the therapeutic activity or side effects of the drug. Multivariate action of glycocorticoids makes them the most often used therapeutic preparations. Their hormonal, anti-inflammatory, antiallergic, antimitotic or immunosuppressive activity is used in the therapeutic process. Apart from them, azathioprine, cyclosporine A, tacrolismus, and some antineoplastic drugs came into immunosuppressive treatment. Their action is based on the inhibition of lymphocyte functions, decrease in cytokines secretion, depletion of humoral and cellular immunological reactions, and modification of chronic inflammation. Peptic ulcer disease and duodenal ulcers are regarded as the most severe complications of long-term steroid therapy. In pathogenesis of this condition inhibition of prostaglandin synthesis, decrease in their protective action on gastric mucosa, and drop of gastric mucus production are underlined. It is emphasized that high prevalence of ulcers is associated with parallel use of non-steroidal anti-inflammatory drugs. Chronic steroid treatment predisposes also to intestinal absorption disorders, calcium and vitamin D deficiency, malnutrition and secondary osteoporosis. Stomatitis, nausea, vomiting, diarrhoea, acute pancreatitis and liver disorders are the most common side effects of immunosuppressants. Due to gastrological side effects it is recommended to protect gastric mucosa with the administration of proton pump inhibitors.