From the Research
Dexamethasone causes gastric reflux primarily by reducing the protective mechanisms of the stomach and esophagus, and the most effective way to manage this is by using proton pump inhibitors like omeprazole 20-40mg daily as prophylaxis against reflux symptoms. This corticosteroid medication decreases mucus production in the stomach lining, inhibits prostaglandin synthesis which normally protects the gastric mucosa, and relaxes the lower esophageal sphincter (LES) 1. When the LES is relaxed, stomach acid can more easily flow backward into the esophagus, causing reflux symptoms. Additionally, dexamethasone can increase gastric acid secretion and delay gastric emptying, further contributing to reflux 2.
Some key points to consider:
- Dexamethasone stimulates gastric acid secretion by activating the phosphatidylinositol-3-kinase (PI3 kinase) pathway 1
- The use of proton pump inhibitors such as omeprazole can help reduce the risk of gastric reflux and ulceration associated with dexamethasone use 3
- Patients taking dexamethasone should consider taking it with food to minimize irritation, avoiding lying down for 2-3 hours after taking the medication, and may benefit from H2 blockers (such as famotidine 20mg twice daily) as additional prophylaxis against reflux symptoms
- Elevating the head of the bed and avoiding trigger foods like caffeine, alcohol, and spicy foods can also help manage dexamethasone-induced reflux symptoms.
It's worth noting that while other studies have investigated the effects of dexamethasone on gastric reflux, the most recent and highest quality study 3 suggests that proton pump inhibitors like omeprazole are the most effective in managing dexamethasone-induced gastric reflux.