Can steroids cause acid reflux? (+3 tips)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss whether steroids can cause acid reflux or not, what is the link between steroids and acid reflux, what are the risk factors and what to do to treat or manage acid reflux caused by steroids.
Can steroids cause acid reflux?
Yes, steroids can cause acid reflux. Particularly, oral corticosteroids like prednisone can sometimes, exacerbate acid reflux or gastroesophageal reflux diseases (GERD) (1). This happens because steroids increase the production of acid in the stomach and also weaken the sphincter which prevents stomach acid from flowing back to the esophagus.
This can lead to symptoms like heartburn, acid reflux or irritation of the oesophagus. However, not everyone who takes steroids will experience these symptoms and the severity can vary among individuals. If you are experiencing acid reflux or heartburn while taking steroids, it is essential to discuss these symptoms with your healthcare provider.
This can help you determine the cause and treat for a cure to your condition.
What is the link between steroids and acid reflux?
The link between steroids and acid reflux is complex. Steroids are medications that reduce inflammation but they also cause a number of side effects including acid reflux (2).
Steroids can lead to acid reflux or heartburn by relaxing the lower oesophagal sphincter (1). The lower oesophagal is the muscle that helps to keep stomach acid from flowing back up n to the oesophagus. When steroids relax the lower oesophageal sphincter, it causes the stomach acid to move back up into the oesophagus leading to acid reflux and heartburn (3).
Corticosteroids are also found to increase the production of acid in the stomach (4) by stimulating the release of gastrin, a hormone that acts on specialized cells in the stomach lining called parietal cells, triggering them to produce more stomach aid (5).
Oral corticosteroids can have a direct effect on the stomach lining (6). They may irritate the stomach lining leading to inflammation and discomfort of the oesophagus exacerbating the symptoms of GERD or acid reflux. The immunosuppressive response of corticosteroids may also contribute to the incidence of oesophageal discomfort or acid reflux.
What are the risk factors for steroid-induced acid reflux?
The following can be the risk factors for an individual that may cause them to experience acid reflux while taking steroids.
Physiological factors
If you have an underlying health condition or existing gastrointestinal conditions such as gastrointestinal disorders including oesophagitis, peptic ulcer or connective tissue disorder such as systemic lupus erythematosus and obesity, you are more at risk of having acid reflux while taking steroids.
Certain medications and lifestyle choices can also influence certain side effects caused by your medication. Some individuals take NSAIDs (7) or are habitual in smoking or alcohol consumption can impact the digestive system and lead to gastrointestinal discomforts including acid reflux.
Each person reacts differently to medications. Due to varying body physiology, genetic contributions and metabolic rates, the intensity and incidence of side effects may differ in each individual. This is attributed to individual sensitivity.
Pharmacological factors
Higher doses of steroids and long-term use can elevate the risk of acid reflux or worsening GERD symptoms. Prolonged exposure to steroids can lead to increased side effects.
Some steroids, particularly prednisone are more likely to cause gastrointestinal side effects as compared to inhaled to topical steroids. Oral steroids are absorbed systemically and can have broader effects on the body, potentially impacting the digestive system more significantly (7).
Corticosteroids may interact with other medications such as NSAIDs to contribute to acid reflux or worsen the symptoms of the appearing side effects on the gastrointestinal tract (8). If you are already taking NSAIDs, consuming alcohol or have a habit of smoking, then you might be at an increased risk of acid reflux.
What to do if steroids cause acid reflux?
If you are taking steroids and experiencing acid reflux, consult your healthcare provider for open communication. Your healthcare provider can evaluate your condition determine the exact cause of this effect and suggest a tailored plan for the treatment and management of this condition.
Pharmacological treatment
Your doctor may suggest the following medications to help you treat the acid reflux caused by steroids. The following medications may be prescribed:
- Over-the-counter antacids like Tums or Rolaids can provide quick relief by neutralizing stomach acid. They are suitable for occasional heartburn but may not be ideal for long-term control of acid reflux (9).
- H2 blockers like ranitidine, famotidine, and cimetidine may help reduce the production of stomach acid. They can offer long-lasting relief as compared to antacids (10).
- Proton Pump Inhibitors (PPIs) such as Omeprazole, Pantoprazole, and esomeprazole block acid reduction more effectively than H2 blockers. They are used for more severe and persistent conditions and can promote healing for the oesophagus in case of esophagitis caused by acid reflux (11).
- Prokinetics such as metoclopramide help strengthen the oesophagal sphincter and speed up stomach emptying. These are less commonly used due to potential side effects.
- Gaviscon can also be prescribed as they are foaming agents and create a foam barrier at the top of the stomach content, reducing reflux into the oesophagus.
How to manage acid reflux?
A few tips to manage acid reflux are as follows:
- Avoid trigger foods that can exacerbate the conditions. These include spicy food, caffeine, acidic food, citrus food etc.
- Eat smaller and frequent meals instead of large meals as they can overfill the stomach.
- Limit fried and fatty foods.
- Avoid lying down or going to bed immediately after eating your meal. Allow at least 2-3 hours for digestion.
- Chew food thoroughly to aid digestion.
- Quit smoking and limit alcohol consumption.
- Elevate the head of your bed around 6-8 inches while lying down. This can prevent the backflow of acid.
- Over-the-counter medications such as antacids can be used to manage the symptoms. Tums with pepto-bismol can also be taken to treat this gastrointestinal side effect.
- Stress can be a cause or may worsen the symptoms of the gastrointestinal issues experienced by the patient. Yoga, deep breathing and regular exercise can help with the relaxation of the mind.
Final words
In my opinion, steroids can cause acid reflux. This is a common side effect of steroids. However, the oral route can create more complexities due to a wider range of actions. A number of pharmacological treatment options are available to treat acid reflux caused by steroids. However, a detailed consultation is crucial.
Was this helpful?
References
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Lazenby JP, Guzzo MR, Harding SM, Patterson PE, Johnson LF, Bradley LA. Oral corticosteroids increase esophageal acid contact times in patients with stable asthma. Chest. 2002 Feb;121(2):625-34. doi: 10.1378/chest.121.2.625. PMID: 11834680.
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Seino, S., Seino, Y., Matsukura, S., Kurahachi, H., Ikeda, M., Yawata, M., & Imura, H. (1978). Effect of glucocorticoids on gastrin secretion in man. Gut, 19(1), 10–13. https://doi.org/10.1136/gut.19.1.10
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Seager, J. M., & Hawkey, C. J. (2001). ABC of the upper gastrointestinal tract: Indigestion and non-steroidal anti-inflammatory drugs. BMJ (Clinical research ed.), 323(7323), 1236–1239. https://doi.org/10.1136/bmj.323.7323.1236
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Nugent, C. C. (2023, August 17). H2 Blockers. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK525994/
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Kahrilas, P. J., Boeckxstaens, G., & Smout, A. J. (2013). Management of the patient with incomplete response to PPI therapy. Best practice & research. Clinical gastroenterology, 27(3), 401–414. https://doi.org/10.1016/j.bpg.2013.06.005
