Stomach Problems and Steroids

Oh dear, Gillybee - have just added to my own thread about possible stomach issues with the uncoated Preds!

I'm not really a typical enough case to help, as I have a hiatus hernia and gastritis anyway, so already on a stomach protector (Lansoprazole), but I do know that several on here were automatically prescribed or offered either that or Omezaprole on commencing steroids.

I know Mrs O will be along shortly to ask if you are eating your yoghourts - live ones are very helpful first thing as a stomach liner, might be worth a try? I recently found a really scrummy coconut flavour one!

Nefret

Steroids - irritated stomach lining, very likely! I only need a dose of about 4mg for it to pinch.

The enteric coated version pass through the stomach to be absorbed lower down thus avoiding that problem. Longer term some people still develop stomach problems with extended periods of higher doses. But every little helps as some company keeps telling us! :lol:

EileenH

Gillybee

I'm awkward....... from the outset I had stomach/bowel problems from both Omeprazole and Lansoprazole prescribed by my GP, the very drugs that are given to protect the stomach from the steroids! My rheumy told me not to take them and he reassured me that he'd never come across a 'burnt out stomach' from the steroids. Therefore in view of the very high steroid dose that I was taking I decided to take a small pot of live yoghurt daily with my muesli as a natural stomach liner before taking the steroids - four years later everything is fine (at least as far as I can see!).

So here I am, Nefret, recommending live yoghurt once again! :wink:

I think BettyE is another poster who believes in the yoghurt, too. Plus we both have a spoonful of Manuka Honey 10+ - great for the immune system especially whilst on steroids and that will help with the stomach too.

I don't know whether you are taking all uncoated pills, Gillybee, as that seems to be the latest direction being taken by GPs but, if you are and are having stomach problems, then it would probably be advisable for you to ask for enteric coated ones in future.

MrsO

[quote:9e6e297935]I think BettyE is another poster who believes in the yoghurt, too.[/quote:9e6e297935]

Yes, I am. Cannot prove anything but some time before my first round of PMR over 11 years ago, I was referred for endoscopy because my middle portion was so miserable. No sign of anything untoward but I think it was then that I took to yoghurt ( full fat plain Yeo valley ) Even when I was taking 30 mgs of Pred there were no digestive upsets and I have never had any more trouble ( Well, not in my gut, anyway ).Well worth a try I would say. BettyE

Yes Im another yoghurt fan !!

I used to take probiotic tablets at one time but changed to Yoghurt as I have been on non enteric tablets for probably about a year now and everything is fine

Best wishes

Mrs G

Hi all.

Although feeling remarkably well in general, and now with the added bonus of being almost pain free, I am still getting these annoying 'tummy niggles'.

To be honest it is more bowel problems than stomach, and I am sometimes rather 'windy' and get stomach cramps as well.

I have taken the advice given on this post and I am now taking yogurts, and fingers crossed, I think that I may be improving. I try to have a yogurt a day and actually really love the Yeo Valley natural one and could eat any amount of it!

I first noticed that my my tummy problems seemed to increase when I started taking the 1mg tablets. I am now taking one 5mg and four 1mg tablets in one sitting (total of 9mgs) with a drop to 8mgs next week.

Just wondering if taking all these tabs in one go could be the root of my tummy problems, or is it just coincidence? :?

I am seeing my GP next week and I will mention this to him.

Once again ladies, your thoughts and advice would be appreciated.

gilly.

Gillybee - that is exactly what happens to me. I have 5, 2.5 and 1mg pills and combine them appropriately, using my husband's pill cutter to get 0.5mg-ish. I can manage up to 2mg of the white ones providing I can take them with meal (which is, after all, what we are meant to do) no bother but when I tried doing what you are doing with 5+(4x1) to get to 9mg within a couple of days I had mild stabbing discomfort in my gastric area :cry: Nothing else had changed so I am confident it was just too much of the white stuff! I'm not even sure, to be honest, that it is the quantity of steroid in the stomach - it could be the carrier in the tablets that doesn't agree with me. I did - in a fit of \"don't waste money\" - decide I really ought to use up the packet of 5mg white tablets but as soon as I took a couple of them I had twinges so abandoned thoughts of economy :roll:

The first trial of a steroid taper when the PMR was first diagnosed didn't have that effect as far as I remember even though that was the white tablets - of course the enormous sense of relief that nothing else hurt may have distracted me! On the other hand, the enteric coated ones have not the slightest bad effect - I could take 20mg in one go using 2.5mg pills (double dose on alternate days) with my early morning cup of tea if I was quite stiff on the second morning so they were starting to have an effect by the time I went out! Not a problem now as although there is a bitof stiffness in the late afternoon and evening it has improved next morning.

The other thing that might cause a problem is the calcium/vit D tabs - some people find they cause wind and rumbles. Again I like mine :roll: - I know, I'm strange - and the ones I just got from the GP here are lovely lemon flavoured sweeties! They weren't the cheapest, I had to pay a bit extra over and above the prescription charge (usually 4 euros!), but nice flavour and texture - no rocks in the mix.

Eileen

Interesting......... my 5mg used to be coated but the ones I picked up today are not.... watch this space...

My 1mg have never been coated but I have always eaten 'live' yogurts and since listening to Mrs O switched these to when I take my steroids at breakfast time and have had no problems....something might change now all steroids un-coated...will let you know!

Now, the Calceos a different kettle of fish!!!! They do give me wind and tummyache and I know it is them

But a small price to pay..... being mainly vegetarian have this problem anyway!!!

The Calceos have def added to the mix

Fifties girl - it has to be specified on the prescription if you want the enteric coated, otherwise the pharmacy will just dish out the white stuff. MrsK posted about the fact that the guidance was to be only enteric coated if needed a bit back - but although the official line was that there is no difference, many docs are now finding patients coming back to say they get indigestion with the non-coated variety. It was said that plain plus a PPI (the cheapest available) was a better (i.e. cheaper) solution - I ask why, as the PPI interferes with calcium absorption and puts you at increased risk of osteoporosis, some people can't take them and, frankly, why should I need to take extra medications I didn't need before. The more medications, the worse the compliance. And the Americans are bothered enough for the FDA to say PPIs should not be used more than 2 weeks at a go and not prescribed longterm (more than 6 months).

EileenH

Eileen, what are PPI's? Stomach protectors I presume.... which I do not take......but I have also read that steroids without theenteric coating are far more readily absorbed and therefore much better at reducing inflammation?

Seeing rheumy in a week and a half for all the results of all my tests/scans and doc a week later so will certainly raise this with both of them.

But having my PMR 'L'plates up I know nothing :roll: :roll:

Hi gillybee

I wonder if you have tried taking Manuka honey? Although I have always had the live yoghurt with my breakfast and before taking the steroids, I have also always had Manuka honey at the same time. Abandoned the Proton Pump Inhibitors (both Omeprazole and Lansoprazole) after a couple of weeks as they upset my stomach leading to bowel problems like you (weird because they're supposed to do the opposite! :?) whereas taking a mix of coated and uncoated tablets from 9mgs and only uncoated tablets from 5mgs have not had any bad effects at all.

I also start the day with lemon juice squeezed into warm water, so any one of these three things, or a combination of all three, could have been protection

The Manuka honey must bear the UMF mark (unique Manuka factor) as this guarantees the strength, and I have factor 10.

So pleased to hear that your PMR pain is behaving! :D

MrsO

[quote:535d258c7a]The Manuka honey must bear the UMF mark (unique Manuka factor) as this guarantees the strength, and I have factor 10.

[/quote:535d258c7a]

So do I and have done for several years. Like Mrs.O Icould not tolerate the PP inhibitors. When I returned them to the dispensary at our surgery, saying they made me feel worse, the pharmacist replied without batting an eyelid, \"Yes, they do some people\".!! :roll:

Cannot remember who recommended Manuka honey but it certainly works for me. Ditto the yoghurt.This was long before PMR struck for the first time eleven years ago.

If you don't have a handy Holland and Barrett ( not sure if full name is allowed ) their website is very good and their delivery charges very reasonable.

Have a good Sunday, everyone. BettyE

Question answered - PPIs are Proton Pump Inhibitors and they stop the mechanism for the production of acid in your stomach which is what is often blamed for indigestion and is what does the damage if you have reflux - heartburn. The acid in your stomach doesn't damage the stomach lining as it is designed to resist it but the cells lining your gullet are not. However, indigestion can also be due to too little acid and presumably if that the case for you, you will feel even worse with the PPIs. Their forerunners were H2 antagonists - also interfere with the production of the acid but in a different way. And then there are the \"coating\" mechanisms like gaviscon and friends and the neutralisers like rennie and co.

I'm sure I've mentioned it before - PPIs are associated with developing osteoporosis because the reduction of acid in the stomach also interferes with absorbing calcium and the FDA in the USA have warned against long term use of them. I can't get my head round the idea of handing over prescriptions for multiple drugs that have the same side-effect - it has to compound the problem.

The enteric coated pills pass through the stomach and are broken down and absorbed further down the gut. This avoids the irritation of the stomach lining. There has been some concern about the enteric coated pills and the way they are absorbed. It seems to be a bit more uneven and in some cases the blood level may vary from day to day and so, in some cases, the anti-inflammatory effect seems poorer because effectively the dose received is lower than expected. The blood level certainly goes up much sooner with the white ones because they are absorbed directly from the stomach whilst the coated ones take a couple of hours to be broken down and absorbed. I use the enteric coated -because the GP did that automatically as she has had patients with problems with the others. I take my double dose every second day and the effect lasts well over 36 hours - I'm very satisfied with how it works and hve no desire to change.

This problem does seem to be more associated with the gut diseases such as Crohn's where the gut lining is damaged anyway. They are also more expensive - and the combination of the two factors has led to the idea of using just the non-coated tablets as they were claimed to demonstrate no more side-effects and be more reliably absorbed. Until the idea was put into practice and enough people who take them long term are having problems and are now willing to go back and say so. So we can have them if we want to and tell the doctor. Some people have no bother at all with the white ones - as you've seen from the other replies. I'd use them if I didn't, but I do seem to.

EileenH