Silent Acid Reflux is a possible side effect of taking prednisone

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This discussion focuses on Silent Acid Reflux (Laryngo-pharyngeal Reflux or LPR) as a potential side effect of prednisone, particularly for patients with Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA).

nh_user_47431 initiated the thread, sharing that they misdiagnosed their symptoms as sinus issues until recognizing them as LPR, which is characterized by throat lump sensations, hoarseness, and chronic cough, rather than classic heartburn. They asked the community for management strategies and whether symptoms improve as prednisone doses taper.

Several members shared personal experiences and remedies:

  • Sleeping Position: nh_user_437681 advised against adjustable beds or wedges, suggesting instead to raise the head of the bed using lumber to keep the mattress flat. nh_user_47431 noted they are considering a foam wedge.
  • Dietary & Lifestyle Changes: nh_user_47431 reported significant improvement using coconut milk yogurt with live cultures, taking it before prednisone, and drinking water with apples. nh_user_765122 found relief with aloe vera juice. nh_user_765122 also mentioned avoiding acidic foods and using Rayos (delayed-release prednisone), though they worried about PMR flares.
  • Medical Interventions: anon53727290 and nh_user_518657 noted that doctors often prescribe Proton Pump Inhibitors (PPIs) like Pantoprazole or Rabeprazole alongside prednisone. However, nh_user_765122 refused PPIs due to worsening symptoms and ineffective Prilosec, while anon53727290 has managed long-term GERD with omeprazole.
  • Symptom Correlation: nh_user_765122 described a progression from chest tightness to throat issues and dry mouth, diagnosed as silent reflux via endoscopy and throat scope. anon53727290 linked their symptoms to a hiatal hernia exacerbated by prednisone.

The thread highlights that while prednisone can increase stomach acid or exacerbate existing conditions like hiatal hernias, symptoms may resolve after tapering. Users emphasize the importance of diet, sleep elevation, and open communication with doctors about these subtle but impactful side effects.

1

From a recent discussion I have just learned the existence of Silent Acid Reflux (laryngo-pharyngeal reflux (LPR)).  I wish I had known about this last year as it would have saved me going to doctors and having tests that were for the wrong reason.  My GP and I thought my symptoms were from sinus issues but seeing an allergy doctor for testing, following that doctor's special diets, antibiotics for possible sinusitis and even seeing an ENT for a CT scan of my sinuses came up with no improvement.

Eileen has posted some excellent information on a recent topic called:  "Has Anyone Taken L-Glutamine with Prednisone" and when I saw the list of symptoms I was shocked.....they were all my symptoms and my problems weren't from my sinuses but from my stomach.  I've seen many references to acid reflux on this forum but since I don't get heartburn or "acid regurgitation/taste in throat" I didn't think it applied to me.  How wrong I've been.

https://patient.info/forums/discuss/has-anyone-taken-l-glutamine-with-prednisone--492183

I am starting a new discussion about this so if there is anyone else on this forum with symptoms like mine, you will be sure to see this information.

Now that I know the problem I'm hoping you can tell me about what you have tried for your acid reflux problems (silent or not!)

1.  Does your reflux decrease as you get to lower doses of prednisone?

2.  Does it go away when you have been off prednisone?

3.  The Mayo Clinic says to raise the head of your bed.  I've also read about sleep wedges you can put on top of your mattress.  Anyone had good results with these?

4.  The Mayo and Cleveland clinics say a throat camera scope may be needed (an in-office procedure).  I'm suspecting this test is for long term serious symptoms and not short-term caused by prednisone and that I don't need to push for it.  But did you have the scope test or did your doctor just tell you things to do/meds to take?

Here is a portion of Eileen's post from the link above as it lists the symptoms of Silent Reflux.  There is a lot more information about this condition in that discussion topic.

The most common symptoms of LPR are:

- A sensation of food sticking or a feeling of a lump in the throat

- A hoarse, tight or 'croaky' voice

- Frequent throat clearing

- Difficulty swallowing (especially tablets or solid foods)

- A sore, dry and sensitive throat

- Occasional unpleasant "acid" or "bilious" taste at the back of the mouth

- A feeling that too much mucus/phlegm is collecting in the throat

- Sudden coughing or choking spasms at night

- Chronic cough

- Excessive burping, particularly during the day

2

I have a fancy bed that raises up at the head and the foot.  This is not a great idea because you can't sleep on your side without an awkward twist in your torso.  A better idea is to lift the whole bed so that the bed is still flat.  So do not use bed wedges or get a fancy bed, just add some lumber under the head.

3

I'm guessing mine started at high dose of Prednisone. 15 mg

I had tightness in chest for 3-5 hours in afternoon.  Doctors didn't care. I read on one site, this can be symptom of Pred, chest tightness.  But it never said why NOR that is was of could lead to acid reflux. So I ignored it.

Like you, never heart burn feelings, no stomach pain, no gas, no odd taste, nothing.  But the pill stuck in throat feeling started.  Then stayed. 

Then...dentist told me I had lots of plaque. I never have that. They asked if I have dry mouth.  I said I didn't think I did.

Weeks later, my mouth got dry at night, tongue sticky.  Then mouth turned red, sore, swollen. Soon, few white bumps.  I diagnosed it as Thrush.  Took anti fungal for 7 days. That worked.

but lost tastebuds for months!!!!!!!  This really was depressing.

Had endoscopy as per rheumy.  They just said mild silent acid reflux.  Did NOT give me any resolution!!!!  

I asked Primary doctor for ENT referal.  He did the throat scope, no big deal, but saw lots of inflammation!  Said, it was acid reflux.

I said it was the Prednisone.  He laughed and said, no, he gives Prednisone to people with inflammation in throat.  Ugh.

I refuse PPIs due to worse symptoms they can cause.  Actually I took Prilosec for 14 days as per Primary doctor, but they didn't work.

My symptoms changed to gurgling in my throat even after I drink water.

I rarely eat acid foods now. No tomatoes, no lemon, no citrus, barely any wine on occasions, no carbonation drinks, ... No Apple cider vinegar which I tried. It burns throat too much.

The ONLY thing that is now helping is I started Rayos 6 days ago, and the gurgle or flutter or spasm feeling is much, much less. I'm on Rayos 6 mg. 

I'm worried because my PMR pains are a tad worse in my shoulders, so I will not be able to increase my Rayos as easily as the Prednisone. So fingers crossed I don't flare worse. 

Yes...doctors NEED to listen to us and tell people of possible acid reflux, silent AF!  Thanks for posting, I hope we can help others!!

4

All of the above, plus more, byrning going diwn when eating, even bland foods. I used to be able to eat hot spicy foods even before bed, know that's overall not good, but even so wouldn't be bothered in the least. And, now when I think about it, all started since prednisone. I just accepted it as, "oh another age related inconvience". Thanks for bringing this subject up, I'll certainly talk to my PMR specialist when I see him in March, to get his opinion.

5

Also what helps some is I drink 2 oz of aloe Vera juice before I eat breakfast. Then another in afternoon. Not near my medicines however incase it could maybe impeed absorption. 

6

Re LPR (Acid Reflux): I've been on ped for 8 months for PMR. I began at 60mg and I'm down to 11.5 with flare-up. From the beginning my rheumi prescribed 40 mg of Pantoprazole to be taken with my pred to counteract possible LPR. I have had had no apparent LPR symptoms.

7

I was almost automatically prescribed pariet (rabeprazole) alongside pred. I started a seperate topic on this forum wondering if the pariet dose can be reduced as the pred is reduced.

8

I wanted to share what I have been trying in case it works for someone else having reflux issues.

I have recently been trying yogurt and have been having significant improvement to my reflux symptoms.  I have a sensitivity to all dairy (cow, goat, etc.) so I have been eating coconut milk yogurt with live cultures.

I've experimented with when to have the yogurt and prednisone at breakfast and I have the best results if I eat yogurt first thing followed by my pred and then with 1 glass of water (my pharmacist told me to be sure to drink a glass of water with the pred).  Then I have my other breakfast foods followed by a second glass of water.

I read that water and apples help dilute the acid so I make sure I drink plenty of water with meals and I have some slices of apple with my lunch and dinner.

Improvements I'm having:  calmer stomach, less coughing, less throat-clearing, voice is less hoarse, less mucus in my throat. 

A surprising and so welcome change is that my energy and brain fog are better.  I know these aren't on the list of reflux symptoms but I'm assuming the high stomach acid has been creating other nutritional issues and when the acid decreases so do these problems.

9

Good to know! I used to take the pills after breakfast too, but then started taking pills 1/2 through my big breakfast, so yes that helps. The Aloe Vera has been helping some too. 

Perhaps I'll try before breakfast and see what happens.  I'm now on nighttime Reyos, but my darn Plaquinel also messes with acid in mornings. 

Thanks Mrs. CJ.

10

I'm new to PMR but have had GERD (reflux) for 43 years.  It took 6 yrs to diagnose because no heartburn.  Belching, bloating, and for me, headache at the top of my head, forehead and around and in back of my eyes. Sometimes I used to feel my thinking slow.  Symptoms were always worse at times of natural acid surges after meals.  Water could bring them on when things were really bad.  I've been on omeprazole 20mg bid for years and asymptomatic.  Now, 3 weeks into Prednisone I'm having my old symptoms. 

The headache is the worst part because I am always having to decide if it is a GCA headache and do I have to get to the emergency room for treatment.  

 

11

That's a long time to have reflux!  Now taking the prednisone seems to be making it worse. Perhaps your doctor can adjust your reflux meds, or maybe there are some diet changes you can make. The internet has a lot of things to do with your diet and it sounds like each person has to figure out what foods to avoid....even though there are many foods that commonly cause reflux. 

Lately my reflux has been worse so I need to pay closer attention to what I am eating and get this back under control. 

I dont have the headaches so I can't comment on that, but I hope you are feeling better soon. The PMR is bad enough to be dealing with, without having reflux stuff happening too!

12

Thank you very much for you reply and concern.  I actually have an hiatal hernia and that keeps the acid coming up.  I've been lucky not to have damaged my esophagus over the years.  I did have an esophageal spasm two nights after the first does of fosamax so I've adjusted things and seem to be able to tolerate it.  I sleep more elevated after the fosamax, and add mylanta as needed to coat the esophagus.  

I had a fancy bed once, but it ws bad for my back. LOL>

13

Ah, a hiatal hernia makes sense. My mom has one and that effects her acid reflux too. 

I wish we had had one of those beds where I could raise my side. I've been considering getting a foam bed wedge but they are expensive and might not work. anyway, if I keep to a good diet I sleep ok!

14

I also am having GERD from prednisone.  Just started 2 weeks ago, 20 mg for a 5 days, 10mg for 5 and now on 5mg till I get RA flares under control and can taper off.  I have had GERD and hiatal hernia issues starting in 2014 when I first got on pred for RA.  Last 3 years no GERD and no pred for maybe 5-6 years. I picked up some meds today and asked about if pred could be causing gerd and headache.  He said the pred was hard on digestive tract and take it with breakfast.  I have no doubt the pred is responsible for my gerd symptoms and just hope it has not flared up the hiatal hernia which I think had fixed itself for last few years.  Pred is a real "love/hate" type drug for me, so many side effects, but it does put the damper on the RA when nothing else seems to work.  First post here, just did an internet search on pred and gerd to see what I could find out and this was first hit.  I am going to try and get off the pred in next 2 weeks, a month is enough with all the negative side effects.

15

Good luck with the prednisone taper. I have PMR so I'll be cozying up to Pred for some time to come. 

I have been taking omeprazole for too long, for the gerd from the hiatal hernia. I've heard of reflux fixing it self with weight loss, diet, loose ck

losthing, elevated sleeping position and avoiding food 3 hours before bed, but Izvestia never heard of a hiatal hernia self repairing. Good for you. 

16

Yes, one thing prednisone does for some people is increase their stomach acid enough to cause reflux problems. You are lucky to only be on it for a short time. I've been on pred over 4 years and will still need it for awhile longer. Good luck!

17

hi @LayneTX,

I know that this is an old thread but i wanted to know what you have done to relieve the chest tightness ? I have been taking pred for the last 4 months and after i stopped I had chest tightness.

18

I have all the symptoms you mentioned except for the burping and cough. I also have a lot of congestion. I have had this problem for many years and saw an ENT doctor who stuck a camera up a nose ( thinking if was post nasal drip) and said there was nothing wrong. I am now taking long term prednisolone and my symptoms have got worse. My doc yesterday said it was GERD made worse by prednisolone and is booking an appointment for me to have an endoscopy.

19

This post is six years old!

If you want a more active community go to HealthUnlocked, the PMRGCAuk community. Sorry I can’t post a link but you shouldbe able to google HealthUnlocked.