Can prednisone cause GERD? The Link Between Corticosteroids and Acid Reflux

October 14, 2025 •

6 min read

Studies show a significant connection between corticosteroids and increased esophageal acid contact times. This evidence confirms that yes, can prednisone cause GERD symptoms, or worsen existing acid reflux issues.

Quick Summary

Prednisone can cause or worsen GERD by potentially increasing stomach acid and weakening the lower esophageal sphincter. Managing symptoms involves strategic dosing, dietary changes, and medical supervision.

Key Points

Prednisone and GERD are linked: Prednisone can cause or worsen symptoms of acid reflux, with studies showing increased esophageal acid contact times.
Multiple mechanisms involved: The drug may increase stomach acid production, weaken the lower esophageal sphincter (LES), and directly irritate the stomach lining.
Management strategies exist: Taking prednisone with food or milk, adjusting diet, and staying upright after dosing are effective management techniques.
Concurrent NSAID use increases risk: Combining prednisone with NSAIDs (like ibuprofen) significantly elevates the risk of severe gastrointestinal issues, including ulcers and bleeding.
Dosage and duration are key factors: The severity of side effects, including GERD symptoms, is generally higher with longer treatment periods and higher doses of prednisone.
Seek medical advice for protection: Your doctor may recommend specific antacids, PPIs, or other stomach protection, especially if you have a history of GI issues.
Watch for severe symptoms: Bloody stools, coffee ground vomit, or severe abdominal pain warrant immediate medical attention.

Understanding Prednisone and GERD

Prednisone is a powerful corticosteroid medication widely prescribed to treat a variety of inflammatory conditions, including asthma, autoimmune diseases, and allergic reactions. While highly effective at reducing inflammation and suppressing the immune system, it comes with a range of potential side effects, including a notable impact on the gastrointestinal (GI) tract. Gastroesophageal reflux disease (GERD) is a chronic condition in which stomach acid flows back into the esophagus, causing symptoms like heartburn and regurgitation. For those taking prednisone, especially at higher doses or for extended periods, the development or worsening of GERD symptoms is a known risk.

What is Prednisone?

Prednisone is a synthetic version of cortisol, a hormone naturally produced by your adrenal glands. By mimicking cortisol's anti-inflammatory and immunosuppressive effects, prednisone helps manage severe inflammation. It is a temporary solution for many acute conditions but is also used long-term for chronic illnesses, which can increase the likelihood of side effects affecting the digestive system.

What is GERD?

GERD occurs when the lower esophageal sphincter (LES), a ring of muscle at the entrance to your stomach, weakens or relaxes inappropriately. This allows stomach contents to flow backward into the esophagus, leading to irritation and a burning sensation, commonly known as heartburn. If left untreated, chronic acid reflux can damage the esophageal lining and lead to more serious complications.

The Mechanisms Behind Prednisone-Induced GERD

While the exact process is not fully understood, research points to several ways prednisone can negatively affect the GI system and exacerbate reflux:

Increased Gastric Acid Production: Some studies have indicated that corticosteroids can lead to an increase in the production of stomach acid. Higher acid levels in the stomach can intensify the symptoms of GERD, especially if the LES is already compromised.
Weakening of the Lower Esophageal Sphincter (LES): Prednisone, by mimicking cortisol, can potentially affect the muscles throughout the body, including the LES. Long-term steroid use has been linked to a reduction in the LES's responsiveness, making it less effective at preventing acid from refluxing into the esophagus.
Direct Gastric Irritation: Oral prednisone tablets can directly irritate the lining of the stomach and esophagus. This irritation can lead to gastritis (inflammation of the stomach lining) and increase the risk of developing ulcers, both of which can cause or worsen reflux symptoms.
Fluid Retention and Bloating: Prednisone can cause the body to retain excess salt and fluid, leading to bloating and abdominal distension. This increased pressure in the abdomen can, in turn, push stomach contents upward and contribute to reflux.

Factors Increasing Your Risk

While not everyone taking prednisone will experience GERD, certain factors can increase the risk of developing or worsening symptoms:

High Dose and Prolonged Use: The risk of severe side effects, including gastrointestinal issues, tends to increase with higher doses and longer treatment durations.
Concurrent NSAID Use: The risk of developing ulcers and GI bleeding is significantly higher when prednisone is combined with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin. This combination should be avoided unless specifically directed by a doctor, who may also prescribe stomach protection.
Pre-existing GERD or Ulcers: Individuals with a history of GERD, peptic ulcers, or gastritis are more susceptible to experiencing problems while on prednisone.

How to Manage Prednisone-Related GERD Symptoms

If you experience GERD symptoms while taking prednisone, several strategies can help, but any changes should be discussed with your doctor:

Dietary and Lifestyle Adjustments

Take with Food or Milk: Consuming prednisone with a full meal or a glass of milk can help reduce irritation to the stomach lining.
Stay Upright: Remaining upright for a few hours after taking your dose can help prevent acid from flowing back into the esophagus.
Modify Your Diet: Avoiding common reflux triggers like spicy, fatty, acidic, and caffeinated foods can reduce symptom severity.
Eat Smaller, More Frequent Meals: Opting for smaller meals throughout the day instead of large ones can help ease the digestive process.
Avoid Smoking and Alcohol: Both can weaken the LES and worsen GERD.

Medical Management

Antacids: Over-the-counter antacids like Tums or Milk of Magnesia can provide temporary relief from heartburn.
Prescription Stomach Protectors: For those at higher risk or with persistent symptoms, a doctor may prescribe medications like proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid.
Consider Enteric-Coated Prednisone: Some patients may benefit from enteric-coated versions of prednisone, which are absorbed further down in the small intestine rather than the stomach, potentially reducing stomach irritation.

Comparing Prednisone Effects: Short-term vs. Long-term Use


Side Effect	Short-Term Use (e.g., <1 month)	Long-Term Use (e.g., >1 month)
Heartburn/GERD	Possible, especially with high doses or concurrent NSAID use.	More likely and potentially more severe due to increased acid production and LES weakening over time.
Stomach Irritation	Irritation, nausea, or upset stomach can occur quickly.	Increased risk of gastritis and peptic ulcers.
GI Bleeding/Ulcers	Risk is lower, but elevated when combined with NSAIDs.	Significantly higher risk, particularly with higher doses and combined NSAID use.
Overall GI Impact	Generally manageable with simple strategies like taking with food.	Requires proactive management, often with prescription stomach protectors.

Alternative Solutions and When to See a Doctor

While prednisone is sometimes necessary for medical conditions, it's not a lifelong solution for most. A doctor may be able to taper the dose or explore alternative therapies for your underlying condition. Never stop prednisone abruptly without medical supervision, as this can lead to a serious condition called adrenal crisis.

When to seek immediate medical attention: Contact your doctor or go to the emergency room if you experience signs of a serious GI issue, such as:

Black, tarry, or bloody stools
Vomiting blood or material that looks like coffee grounds
Severe, persistent abdominal pain
Unexpected or excessive bleeding

Conclusion

For many patients, prednisone is an essential medication that provides significant relief from inflammatory and autoimmune conditions. However, the connection between prednisone and GERD is clear, with the drug capable of causing or exacerbating acid reflux symptoms. This is due to potential mechanisms involving increased stomach acid and a weakened esophageal sphincter. The risk is particularly high with long-term use and concurrent NSAID therapy. By understanding the link and implementing preventative strategies like taking the medication with food and avoiding trigger foods, many patients can manage their symptoms effectively. It is vital to maintain open communication with your healthcare provider to discuss any side effects and ensure your treatment plan remains safe and effective.

Resources

National Institutes of Health (NIH)
OncoLink
Healthline
Cleveland Clinic Health Essentials
Drugs.com
Hospital for Special Surgery (HSS)
Verywell Health
Chest Journal
Cancer Research UK
PubMed
ScienceDirect

Citations

Insight Into the Relationship Between Gastroesophageal Reflux... PMC, 2017
Oral Corticosteroids Increase Esophageal Acid Contact Times... ScienceDirect, 2002
Heartburn and Steroids: Does One Lead to the Other? Healthline, 2024
Prednisone (Sterapred®, Prednisone Intensol) OncoLink, 2025
Steroid Side Effects: How to Reduce Corticosteroid... HSS, 2023
Can Prednisone Cause Stomach Pain? HealthCentral, 2023
Heartburn and Steroids: Does One Lead to the Other? Healthline, 2024
Effect of Prednisolone on Gastric Function and Structure... Gastroenterology, 1969
Oral corticosteroids increase esophageal acid contact times in... PubMed, 2002
Prednisone (Sterapred®, Prednisone Intensol) OncoLink, 2025
How to use Prednisone - The University of Kansas Health System
Heartburn and Steroids: Does One Lead to the Other? Healthline, 2024
What Are Prednisone's Side Effects? Verywell Health, 2025
Steroid Side Effects: How to Reduce Corticosteroid... HSS, 2023
Steroids (dexamethasone, prednisolone...) Cancer Research UK, 2022
Corticosteroids May Worsen Gastroesophageal Reflux... Chest, 2007

Disclaimer: This article provides general information and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a healthcare professional for specific medical guidance.

Frequently Asked Questions

To prevent heartburn from prednisone, take the medication with a full meal or a glass of milk to protect your stomach lining. Avoid lying down immediately after taking it, and limit or avoid foods that typically trigger acid reflux, such as spicy, fatty, or acidic foods.

Yes, research indicates that prednisone and other corticosteroids can increase gastric acid secretion. Higher levels of stomach acid can intensify the burning sensation of heartburn and contribute to GERD symptoms.

Yes, taking prednisone with food or milk is highly recommended. This helps to minimize irritation to the stomach lining, which can be a direct cause of upset stomach, nausea, and heartburn.

Yes, prednisone can increase the risk of developing stomach ulcers, especially with long-term use. The risk is significantly higher when combined with NSAIDs, so this combination should be used with extreme caution.

Some patients may benefit from enteric-coated prednisone tablets. These pills have a special coating that prevents them from dissolving in the stomach, instead allowing them to be absorbed in the small intestine, potentially reducing stomach irritation.

Your doctor may prescribe medications to protect your stomach while taking prednisone, such as proton pump inhibitors (PPIs) like Prilosec or H2 blockers like Zantac. Simple antacids like Maalox or Tums can also provide relief for mild symptoms.

For short-term prednisone use, GERD symptoms often subside shortly after discontinuing the medication. However, if you are on long-term therapy or have pre-existing reflux, it may require continued management and discussion with your doctor.