Corticosteroids in liver disease: possible mechanisms of action, pharmacology, and rational use.

Since the original publications by Hench and his colleagues on the use of cortisone and ACTH in the treatment of rheumatoid arthritis, corticosteroid drugs have assumed an important role in the therapy of a large number of diseases, including disease of the liver and gastrointestinal tract. Although the precise mode of action of these agents is uncertain, there is increasing evidence that their beneficial effects result from actions on immunological and inflammatory processes. An understanding of such effects and of the clinical pharmacology of the corticosteroid drugs should lead to a more rational approach to therapy. This is particularly important in treating patients with liver disease who are prone to the unwanted effects of corticosteroid therapy and in whom the metabolism of these drugs may be altered. The aims of this paper are threefold: firstly, to outline the biochemical pharmacology of the corticosteroid drugs relevant to the clinical management of gastrointestinal and liver disease; secondly, to review current knowledge of the immunological and anti-inflammatory effects of these agents; and, thirdly, to discuss the use of prednisone and prednisolone in the management of a number of hepatic diseases. Although the basis of therapy of corticosteroids is probably similar in gastrointestinal and liver diseases, the indications for the use of corticosteroids in gastrointestinal disease are less clearly defined and are not discussed here.