Steroid therapy

Hi everyone,

Regulars here might remember that I posted some time ago seeking help for the gastric problems caused by my PA. Unfortunately I'm in the minority who can't take probiotics or lime juice (or digestive enzymes, the list goes on...) Things got worse recently and the discomfort and pain that I feel from my gastritis left me eating just fish and carrots (definitely a low point) then something happened, I suffer from asthma and tend to stick to my ventolin inhaler as I'm not too bothered by it except in Autumn/winter peiod. I began having asthma that was difficult to control so I dusted off a preventative inhaler (steroid) that I've hardly ever used, and within two days my gastritis calmed down and I could eat for the first time in 6 months. I'm going to mention this to my specialist, but it also leaves me with a dilemma; do I really want to go down this route with all the side effects it might entail? I've read that steroid therapy has been used on PA patients with some success. Can anyone shed some light on this topic?

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  • Hi Expatkerry. In terms of asthma treatment, the preventer is the more important part of treatment than the reliever, the theory being that the preventer stops (or reduces) the breathing issues so the need to use the reliever becomes less necessary...because the breathing issues occur less frequently (in some people, not at all). It's always better to prevent rather than relieve (if you get what I mean). But oops, sorry, you weren't asking about that, so...

    Interestingly, my GP diagnosed me with asthma 10 years ago (no diagnostic tests), then two years ago I went through a round of testing and was told - no evidence of asthma! So the steroid inhaler (the preventer) was stopped...and all my gastric issues got worse. Much worse. And my weakly positive ANA test shot up and is now, according to the Gastroenterologist, extremely high. So hmm...

    Not long ago I read a paper by Turner and Talbot in which they talked to the fact that a patient with a very high level of IF antibodies showed marked reduction of these (and a symptomatic improvement) following treatment with steroids. Again, so hmmm....

    So....can't really answer your question...but steroids do have powerful anti-inflammatory actions and though the dose is quite small in asthma inhalers, it's not a stretch to think that they may have a beneficial effect on anything 'inflammatory' going on in the body. But I could be wrong πŸ˜–

    It's certainly something that would benefit from further research...and perhaps someone else on the forum may have a more science and research based answer πŸ˜€.

    Very interesting....πŸ‘πŸ‘

  • hi Foggyme, That is interesting what happened when You stopped the inhaler (I've always avoided them becuase I'm afraid of steroids). Apparently 30 to 40 percent goes into the GI tract which could explain the phenomen.

  • Interesting Expatkerry. And it leads me to ask (off the top of my head and with no research), are IF antibodies lowered when people use steroid based inhalers...does this result in the inability to get diagnosed with PA (since doctors appear not to have heard of antibody negative PA) and more importantly, could a low dose of steroids (or intermittent / occasional courses) lead to a lowering of IF antibodies, a reduction in the inflammatory response, and the possible slowing or prevention of gastric atrophy? But this might just be silly instant thinking πŸ˜–.

    Don't know...but will have a look to see if I can find any more information.

    And I'm going to follow this post 'cause it could prove to be interesting πŸ˜€.

    Really good thought provoking post Expatkerry...thank you πŸ˜€ x

  • Hello All,

    Just a post script to this post about steroids, I found a publication online which describes steroid therapy on a handful of PA patients in the sixties. The results are interesting, those patients without extensive metaplasia responded well to the therapy, B12 absorption was enhanced, parietal cells reappeared and intrinsic factor and acid secretions were found to be present during the therapy even the gastric mucosa showed signs of regenerating. Here's the link:

    jci.org/articles/view/10539...

    I wonder why this therapy has been abandoned, I will be asking my doctor.

    Food for thought.

  • Hi Expatkerry. Wow...thanks for the paper...saving for a treat read tomorrow morning.

    Food for thought indeed...for something to look so promising, and then be abandoned...words fail me.

    I think I have a questions to ask at the PAS B12 conference in December!

    Are you going...if not, I'll make a note to send you information about anything I manage to winkle out of the learned folks πŸ˜€.

  • The study used 10 to 40mg of pred, which is way beyond physiological doses (around 5 to 8 mg pred), and will cause cushing's syndrome. These days pred in those doses is used to treat autoimmune diseases like crohns or lupus, but sometimes the cure is worse than the disease. High doses of pred can cause bone loss, induce diabetes, cause crazy weight gain, knock out the immune system (which is why it works to reduce antibodies) and all sorts of other nasty side-effects, not to mention potential long-term suppression of your own adrenal gland.

    In PA, I doubt the risks and side-effects of high doses of steroids outweigh the benefits. Not sure if one round (e.g. 6 to 12 months) would be enough to suppress PA antibodies for life, so repeat administration might be necessary as with other autoimmune diseases. And physiological doses would not have any meaningful effect.

  • Hi jade_s. Yes, I agree, steroids are powerful drugs and there are side effects. But, just wondering if extremely low doses (as per the 200 - 400mcg prescribed to asthmatics) could potentially have a beneficial effect? And avoid the side effects related to high dose steroids? Don't know...but certainly worth thinking about...would,really like to see more research on this πŸ˜€.

  • Ah I see what you mean! :) Well, I'm wondering if the effect isn't perhaps a slightly different mechanism -- Addison's (destruction of adrenal gland) is also an autoimmune disease, and one of the symptoms is gastrointestinal distress. I wonder if some of those people helped by the inhaler are in fact on the road to Addison's, and the extra steroids is compensating for their own reduction of cortisol (or perhaps they have some minor adrenal damage from low levels of adrenal antibodies, though the medical community wouldn't recognize that - to them it's all or nothing when it comes to Addison's). Also just thinking out loud here!

  • Wow!

    I'm almost certainly going to get some prednisolone to treat my neuropathy. Looks like it may be two-birds, one stone.

  • Wow indeed...I'm going to try and catch that bus too πŸ˜€.

    Good luck...would be very interested to hear how it goes πŸ‘

  • Hi Expatkerry...just a thought...very interesting paper...would be worth posting again in a new post so more folks will see it.

    Sure there'd be lots of interest πŸ˜€

  • Hi, I take on board what Julie has to say about high doses whic would explain why it's no longer considered as therapy. Spoke to a GP about it in passing last night and he says vert little steroid passes into GI tract (his words: Homeopathic dose) which Is not what I've read but he wasn't surprises That I was feeling the benefits. It may well ne a question of dose, I Hope the new round 'I feel normal' feeling lasts!

    ps I'm in France so can't go the confΓ©rence.

    a Nice weekend to You all😊

  • Hi Expatkerry. Like you, suspicious of the GP's explanation of 'homeopathic dose'. And the question of dose is an interesting one (as per my reply to jade_s, above).

    I love the idea of new found normal...really hope that this is long lasting πŸ˜€. Would be really interested to hear how it goes.

    And ah ha...the expat is really expat (thought it might be).

    Shame about the conference - if I find out anything I'll let you know. Likewise if I discover anything else. Made a note so I don't forget πŸ˜–πŸ‘.

    And a nice weekend to you too.

    Take care πŸ˜€.

  • Thanks, and I'll keep You all posted.

  • πŸ‘πŸ‘ x

  • Homeopathic *rolling eyes* the things people say...

    A drug doesn't have to make it all the way to the stomach via the GI track directly to have an effect there. If that was the case, then we'd all have to inject B12 next to the damaged nerves for it to do anything. :-/ Hellooo, have they not heard about the "vascular system" - a magical network in the body that transports life-giving molecules throughout the body. Sorcery, black magic, I tell you!

    Yes would be interesting to hear what they have to say at the conference. As I mentioned above, perhaps there's some link between PA and Addison's (or Addison's like) disease, since they're both autoimmune. And they were both discovered by the same man - PA used to be called Addison's anemia. ;)

  • Lol...these GP's, they certainly come out with some nonsense! Seems to be many things they've not heard of 😱😱.

  • he says vert little steroid passes into GI tract

    erj.ersjournals.com/content... says

    After inhalation, part of an inhaled drug is deposited in the lungs, whilst the major fraction is deposited in the oropharynx. If the mouth is not rinsed, this part is eventually swallowed, and absorbed from the Gastrointestinal (GI) tract

    For a while I worked on some inhaled steroids and trying to figure out how much was absorbed from the lungs vs the GI tract was a problem.

  • I read 30 to 40 percent