Gastrointestinal Bleeding Risk with Prednisone Use

Mechanism and Quantifying the Risk

Patients taking corticosteroids have approximately a two-fold increase in gastrointestinal events compared to those not taking these medications 1
The American Geriatrics Society recommends considering gastroprotective agents when prednisone must be used in high-risk patients 2

Advanced age significantly increases the risk of GI complications with corticosteroid use 1
History of previous peptic ulcer or GI bleeding increases risk 2.5-4 fold 1

Proton pump inhibitors can reduce the risk of gastrointestinal bleeding by approximately 75-85% in high-risk patients 1
Concomitant administration of misoprostol, high-dose H₂-receptor antagonists, or proton pump inhibitors may reduce the risk for gastrointestinal ulceration in patients requiring corticosteroids 2
Testing for and treating Helicobacter pylori infection may further reduce risk, as eradication reduces the incidence of peptic ulceration 2

For patients requiring prednisone who have risk factors for GI bleeding, consider prophylactic gastroprotection 2, 1
If combination therapy with NSAIDs cannot be avoided, gastroprotection with a proton pump inhibitor should be strongly considered 2, 1
Patients should be monitored for potential adverse effects including gastrointestinal bleeding during corticosteroid therapy 3