Acid Reflux

[kate1978]

Hi all I had a flare a few weeks ago and had to go up to 10mg pred, which was disappointing, as I had got down to 3 and was trying to get down to 2 and a half.

I am getting really bad acid reflux, something I've never suffered from before, occasionally heartburn, but never like this

My GP thinks it's down to the steroids and has prescribed Omeprazole twice a day, and Gaviscon advance 4 times a day, it isn't helping, I am up in the night with it coming right in to my mouth, it burns my throat, I'm feeling pretty miserable, has anyone else experienced this?

I am finding it hard to put it down to the steroids

[SnazzyD]

Sounds rotten. Might be worth asking about testing for something else such as Helicobacter Pylori or even hiatus hernia. The heartburn previously may have been heralding more severe oesophagus inflammation. Definitely time to tell the doc it’s not helping especially when you’re using a PPI AND Gaviscon.

[DorsetLady PMRGCAuk volunteer]

If it was steroids I would have expected to happen at higher doses rather than the lower ones you’ve been on recently. Omeprazole is usually prescribed at the beginning, not this late on.

Has GP considered a hiatus hernia - thinks he needs to think outside the box on this?

Might be worth having a look at that and also GERD/GORD to see if your symptoms are similar. Then go back and ask, but in the meanwhile give the medications time to work.

[kate1978 in reply to DorsetLady]

Omerpazole was prescribed earlier I found I rarely needed to take them, it was just a bit of an ache in my chest came on in the night, this is totally different

[DorsetLady PMRGCAuk volunteer in reply to kate1978]

Ok. Maybe it is Pred then, like lots of medication you need to take regularly - perhaps if you’d done that you wouldnt have problem now. However if you think it’s different then you need to press GP for more investigation.

[Hindags in reply to kate1978]

I’ve had gerd for 40 plus years due to a hiatal hernia. Have been on Prilosec for years. Reflux/heartburn can be insidious. It can take a while for an irrititation to build into a miserable set of symptoms. I was in good control for long enough to be contemplating tapering off Prilosec when I got PMR and started on alendronic acid for osteoporosis. The first week I took AA I had trouble with heartburn. I had reflux and heartburn despite Prilosec. Then it settled down and I was good until recently. Somewhere between 4mgs and 3mgs I started getting bad reflux and pain radiating from the middle of my chest to my throat. The only thing I could think of was that my health plan changed the generic AA manufacturer just around the time things deteriorated. I have discontinued the AA and have slowly gotten better. But actually, once the esophagus is irritated, almost anything can bring on symptoms, even water. At that point there is almost no point in trying to identify what set it off. And it takes time to heal.

Nevertheless here goes my list of things that seem to have exacerbated reflux/heartburn....

Have you changed your diet in any way? Chocolate is a notorious irritant for some people, especially if it eaten in the evening, before bed. Have you gained weight? That can enhance reflux. Are you eating more dense foods? Are you wearing tighter clothing, a new bra? Lol..... Have you tried putting the head of your bed up about 6 inches - Books under the legs?

I could go on, as I often do, here. But you get the gist. Whatever set it off for you, just be a bit more cautious about what you eat, how quickly you eat, when you eat, etc. And probably being consistent with the omeprazole for a few weeks will help the irritation heal.

[kate1978 in reply to Hindags]

Thanks for your reply, not changed anything in my diet, have chocolate most evenings, but it's never been a problem, I'm underweight and could do with putting half a stone on! last night I tried to prop myself up with 3 pillows looks like I need to prop the bed up !

[Hindags in reply to kate1978]

A friend of mine, healthy young woman developed heartburn and reflux just from eating chocolate in the evenings. FYI.

[kate1978 in reply to Hindags]

Maybe stop eating chocolate then 😧

[Hindags in reply to kate1978]

Or eat it earlier in the day with something that washes it down?

[Laurapc]

I've had chronic reflux for years and take Pantoprazole very early in the morning (5-6 am) before anything else passes my lips. If you don't do that then you will experience symptoms. Anyone who has taken long term medication especially any type of anti-inflammatory will more than likely develop the condition and steroids do play havoc with your stomach which is why you should always take them with milk or after food.

[kate1978 in reply to Laurapc]

I always take my steroids just after breakfast, I'm totally puzzled by this, if it was caused by the steroids, how do people who need to take a high dose go on?

[DorsetLady PMRGCAuk volunteer in reply to kate1978]

I was prescribed Omeprazole when I started Pred. One 10mg dose of Omeprazole before breakfast, Pred with food or afterwards. Starting at 80mg now at zero.

[Laurapc]

There are stronger medications to control stomach acid. I don't know if there is a correlation between the amount of steroid taken to the reflux problem. There's lots of information online which explains it. You are like me, you produce a lot of stomach acid and I had the problem before I even started taking prednisone long term.My previous meds had caused it.

[Lee1945]

Ask if you can try taking Lansoprazole when you wake up in the morning and then wait 30 minures before eating or drinking anything

[PMRpro Ambassador]

I really would ask for it to be checked out properly since you would have expected it to have happened before if it is just the pred. I agree with the others - this shouldn't be assumed to be the pred until proven otherwise.

But in the meantime, try Zantac/ranitidine instead of or in addition to the omeprazole. Omeprazole is said not to work for about a third of patients but it also doesn't work for 24 hours if only dosed once. Are you in the UK? Ask (tell) the GP you would like enteric coated pred - because that should eliminate pred being the cause of the reflux.

Once you are on the PPI there should be little or no acid during the day - but if the problem is at night it may be you need to change the timing of the PPI or add ranitidine at night:

ncbi.nlm.nih.gov/pmc/articl...

In plain English: Once a day, in the morning, PPIs suppress acid production after meals but new cells are produced during the day once the PPI is no longer in the body. At night there is effect of gravity to keep the stomach contents where they should be so you may have problems. Try raising the head of the bed as well.

[kate1978 in reply to PMRpro]

Yes I'm in the uk this morning I decided to take 4 2and a half coated tablets instead of 2 5s I will see if that helps as they are coated

[PMRpro Ambassador in reply to kate1978]

Why on earth do they mix coated and uncoated tablets? They enter the blood stream at different rates! There is little difference in price - so why not give 5s, 2.5s and 1s as enteric coated? Sometimes I do despair...

[Constance13]

“Disappointing” is acceptable - devastated is not! Keep at 10mg for a few days, then start reducing slowly slowly again, there’s no rush.

At times I have quite bad acid reflux (not so often now though thank goodness). Omerprazole works OK for quite a few people, as does Gaviscon. At night it has been suggested to take a little pot of porridge (raw) to bed at night and just eat a teaspoon or two when the reflux is bad (that’s what I do - and it works) I suppose it wipes up the acid when made wet!!!

[kate1978 in reply to Constance13]

Worth a try thanks

[Mrs-CJ in reply to Constance13]

Is raw porridge the same as raw oats, like I use to make oatmeal?

I would like to try your suggestion for the odd time I feel “reflux-y” 😊

[Constance13 in reply to Mrs-CJ]

Yes! It certainly works for me. Swells in the stomach I suppose and uses up the reflux!?!😂

[kate1978 in reply to Constance13]

Do you mean porridge not mixed with milk or water? Just dry?

[Constance13 in reply to kate1978]

Yes! 🎄🎄

[pmrkitty]

I suffer from the same. Mine is attributed to gallstones. Check your gallbladder, I hope you find relief.

[kate1978 in reply to pmrkitty]

Thank you

[kate1978 in reply to pmrkitty]

I do know I have gallstones, as it was picked up when hospital were looking for something else many years ago, I rarely get any pain from them

[pmrkitty in reply to kate1978]

Make sure you only use coated prednisone or if you can, get Rayos. If you live in the States and have medical coverage you can get a coupon from the pharmacy (your doctor will know who has Rayos) and get it for $10.00, otherwise it is way too expensive. Hope this helps.

[kate1978 in reply to pmrkitty]

I'm in the uk , yesterday I used the coated ones and had a better night, I wonder what the English equivalent for ray is ?

[piglette in reply to kate1978]

It is called Lodotra in Europe but it is not available on the NHS.

[PMRpro Ambassador in reply to kate1978]

Lodotra and only available in the UK privately, 30 tablets of any dose cost about £25, come in 5, 2 and 1mg tablets and you combine then to make up the dose, can't be cut. So you need up to 4 tablets per day, costs up to £100 per month. No coupons...

[Grants148]

I also suffer with heartburn and it has become worse since l increased my dose of Pred.,and my stomach is really bloated,much worse than when l was on a higher dose.l am on 5 mg now,but seem to be putting on weight. I wish you a good outcome .

[kate1978 in reply to Grants148]

Thank you

[Lonsdalelass in reply to kate1978]

I too have been getting acid reflux /heartburn which has been getting slowly worse, Dr told me to stop the Adcal as I told him I thought it was causing it. I've not had Adcal since Friday, and only notice a slight improvement today, but

of course haven't tried sleeping yet so can't really say if it is the Adcal to blame but it's been awful, especially during Saturday night, when I was up several times, wanting to burp and getting that burning rush at back of throat. Couldn't sleep. Hubby said it might have been the hot spicy pizza I had for tea, he's probably right. I am really hoping it's nothing serious as I don't want to have an endoscopy if I can help it. By the way, it's good to read others have been having gaviscon as I thought we couldn't take antacids along side pred. And the dry porridge sounds a good tip, thanks Constance. X

[kate1978 in reply to Lonsdalelass]

It's horrible isn't it! I'm not sure what Advil is ?

[Lonsdalelass in reply to kate1978]

Did I say Advil? I meant Adcal.... It is a calcium and Vitamin D3 supplement prescribed by the doctor. You have to suck or chew it, they are chalky and big. Taken to help protect your bones. By the way, I've had my gallbladder out in January so I know I haven't got gallstones and can't blame it on that. Bloody annoying though. I sit worrying about what's causing it and don't want an endoscopy so don't really want to keep making a fuss at the Dr's! I'm a right wuss.

[Lonsdalelass in reply to Lonsdalelass]

Both my mother and sister have a hiatus hernia, think it's hereditary, so I may have one too, bloody hell!

[kate1978 in reply to Lonsdalelass]

It's probably similar to calceos I take it twice a day for bones, when I remember 😊but it hasn't caused me any problems , sometimes difficult to find time to take everything

[Lonsdalelass in reply to kate1978]

Sounds as if its the same, and yes it isn't always easy to remember them all is it? X I'm off to bed now, to hopefully sleep well!! Preferably with no burping!!! Ha! Don't know what's worse sometimes, burping or snoring! Xx

[PMRpro Ambassador in reply to Lonsdalelass]

You can still have problems even after having your gall bladder out!!

medicalnewstoday.com/articl...

So you may be experiencing left over ones - or new ones forming...

[kate1978 in reply to PMRpro]

Just read that info on gallstones bit scary but interesting

[Lonsdalelass in reply to PMRpro]

Thanks for that info PMRpro. Always learning something new on this forum.

[Rimmy]

As reflected in the responses this can be a complex problem the cause of which isn't always obvious. I have had GERD for years but fortunately for me it is pretty well controlled by Lansoprazole - However I need a 'double dose' 30mg in the morning and 30mg again in the evening before dinner. This works for me BUT I have noted that if I eat certain foods I can still get a gassy feeling in my stomach (usually things like carbs/bread) - and if you do also happen to have a hiatus hernia this 'pressure' can push any residual acid back up your oesophagus - which can be terribly painful. If you burp a lot this can also be a sign of gall bladder problems as well as general indigestion and this can then be a problem. You do need to get to the bottom of this both for your comfort and to protect the lining of your oesophagus which can erode over time if exposed to too much acid. I am sorry for you I know this can be hellish and also impact on sleep. By the way if you do get an 'attack' which wakes you up drink a lot of water to dilute the acid and prop your pillow up as much as you can (semi-sitting up in bed) - just don't lie flat because that will make it much worse.

Hope it improves soon !

Rimmy

[kate1978 in reply to Rimmy]

Thank you, strangely I never used to burp but I have since all this kicked off

I do have gallstones but they rarely give me any trouble, if it carries on I will go back to the doctor it's really horrible

[saffron52]

Hi Kate1978

When I had acid reflux a few years back just put some solid wooden blocks UNDER the head of the bed about 5" to 6" thick and and 10" long. Low tech but it works and I have never really had reflux again as severe, they are still under the bed after years later. You should go to the doctors to get it checked out, my period of intense reflux, heartburn bloating etc. was eventually found to be Helicobacter Pylori (Pylori H) which after taking antibiotics for a few months I was fine. Take care Angie x

[kate1978 in reply to saffron52]

Thanks for your advice, I think I will consider getting the bed raised

[Tinkermore1941]

This can help until you find a better solution. When it gets this bad, usually awakening you, take a tablespoon of apple cider vinegar. Be sure and rinse your mouth and swallow some water after to rinse the acid of it off your teeth.

[kate1978 in reply to Tinkermore1941]

Thank you for your advice

[LJhome]

I also suffer from gastric reflux and was diagnosed with an hiatus hernia. I am back on the Omeprazole having stopped steroids 2 years ago (post PMR) I did try ranitidine as there are less side effects but it did not help. I hope you get it sorted soon as it is really unpleasant.

[kate1978 in reply to LJhome]

Does having hiatus hernia need an operation? How was it diagnosed?

[piglette in reply to kate1978]

I read that one in four women over 40 had an hiatus hernia. In a meeting recently this actually was the statistic. My mother and father both had hiatus hernia. Over 60% over 50 are supposed to have them. I did read that everyone over 80 had one but I am not sure how true that is.

[kate1978 in reply to piglette]

Gosh it is quite common then! Does it need an operation?

[piglette in reply to kate1978]

It seems very rarely people have surgery, I know quite a lot of people with hiatus hernia but none have had surgery, changing your lifestyle, stopping smoking, buying over the counter pills or visiting the doctor for pills usually helps.

[kate1978 in reply to piglette]

Don't smoke,don't drink, eat reasonably healthy, never have take always, do like chocolate and have some most days

Thanks for the info

[Purple-Owl]

I understand acid reflux is mostly due to imperfect closure of the sphincter that usually prevents the (acid) stomach contents from escaping. Maybe the muscle weakness characteristic of PMR affects this sphincter, making it less efficient. Just a thought.

[alvertta]

I take pantoprazole 40 mg every morning and rantididine 300 mg before bed every day. Controls my acid reflux.