I have been diagnosed with intractable GERD.( 6 years) I undergone every test and x ray looking for the cause and nothing conclusive established other than I have GERD. So far only AXID seens to provide me with relief. Prilosec, Zantac, Pepsid, Motilium and Propulsid have failed to relieve the symptoms. I follow all eating and sleeping suggestions.
Occasionally I am fine other times even a glass of water can set me off. Three years ago a routine chest x-ray revealed a pericardial effusion. The fluid was drained and I developed pericarditis. I have been on prednisone ever since. My stomach will not tolerate a non steroid anti inflammatory. Whenever I reduce the prednisone to 4 or 5 mg per day I get another flareup. If I double the prednisone, the pain goes away and I return to the slow process of reducing the medication. Lupus and other terrible things have been ruled out. I Have intractable GERD and Idiopathic pericarditis. Do you see any connection between GERD and pericarditis? Do you have any suggestions what can be done to end both problems?
REPLY:
There is no obvious relationship between your two problems. A quick MEDLINE search failed to find any recent article which linked these two topics either.
The prednisone can worsen reflux like symptoms is some individuals and many people complain of nausea and indigestion especially at high doses. It is less likely though that your "GERD" symptoms are being affected by prednisone at low doses such as 4 or 5 mg.
It is interesting that your "GERD" symptoms respond to Axid and not to the very much more powerful acid inhibitory drug Prilosec. Did a 24 hr ambulatory pH monitor confirm episodes of reflux as the likely cause of the symptoms you relate to GERD? Did an esophageal manometry test show a low pressure lower esophageal sphincter? Was a "Bernstein" acid infusion done and did it reproduce your symptoms? You probably have discussed these things with your gastroenterologist but, if not, they may be the basis for further investigation.
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Bruce Sckolnick, M.D.
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