Reflux pain ( indigestion)

[Breconblue]

This is my second year of Prednisolone ( with 4 month gap, PMR returned) last year was incredibly straightforward monthly tapering down to nil no real side effects. This year, tapering then back up due to pain. Now on 8 mg. I have been taking Omeprazole (20mg) but started to have severe reflux pain . I upped Omeprazole to maximum 40mg, with little effect. Went up GP who prescribed Ranititine in addition at night as I was also getting pain during the night. This helped but I’m still getting pain. I’m quite worried I will end up with stomach ulcer or worse. Has anybody else had to stop Prednisolone for this reason ?

[SheffieldJane]

Ranititine has been removed from the shelves of Walmart due to research findings linking it to cancer. There is more information if you google it.

It seems that you need further investigations for these symptoms preferable referral to a specialist. This severity of your symptoms is not typical of our conditions. Good luck!

[Breconblue in reply to SheffieldJane]

Thanks SheffieldJane, I know the symptoms not associated with PMR as such, but Prednisolone is associated with Gastric irritation, which is why PPIs ( Omeprazole) is prescribed as preventative.

[SheffieldJane in reply to Breconblue]

Yes I meant that suffering so much, even though you take medication for the gastric irritation provoked by Pred treatment, is unusual. I would suspect something else in addition to steroid effect.

[Hidden in reply to SheffieldJane]

It's only certain brands that have been recalled.

[Hidden]

Hi brecon blue, if you are in UK are you on coated pred? You shouldn't need a ppi then. As you are finding ppi have there own side effects. One of the side effects of omeprazole is.... Acid reflux. It may be you need to try another version of PPI or ask for coated/gastric resistant pred. In the meantime prop up the head end of you bed so the reflux does overwhelm. Hope you get it sorted.., 🌻

[Breconblue in reply to Hidden]

Thank you. Apparently enteric coated Prednisolone no longer prescribed. Gp said “

Expensive , and no evidence more gastric protective’ I suspect it’s the former which is the driver! Tbh the pain of the reflux as bad as the PMR was!

Anyway my long awaited app with Rheum is this afternoon I will raise the issue ( if I’m given time!!)

[Hidden in reply to Breconblue]

He is lying. Tell him you need it and ppi not working. It will be more expensive in the long term and the cost of ppi and pred is not that different. If no action see another Dr in practice and if no joy then put a complaint in. They do work tand there are lots of people here that know it!

[Blearyeyed in reply to Breconblue]

Really emphasize that you are suffering with this gastric irritation and reflux despite being on Omeprazole and Ranitidine and that you have requested enteric coated medication from the GP but they did not supply it. Tell them you think this could help as it does for other patients and you feel like this is a decision based on cost and not your medical needs.

Ask them to include the recommendation in their follow up letter to the GP that you are prescribed enteric coated Pred in future to protect your stomach .

You may also be offered further tests to investigate if you have any other stomach issues. This would be a sensible thing to do. If they don't offer it to you I think it would also be sensible to ask if you should have your stomach examined properly and if they can organise these tests or a referral to the right Department.

If you are in the UK and using brand name supplies of Ranitidine , or generic brands supervised by EU regs you don't need to worry about the scares on this medication , you have enough to think about.

Take care , think strong and let us know what happens.

[Breconblue in reply to Blearyeyed]

Ah thanks, Bleary. Very positive reply. One gets incredibly downbeat sometimes with this! Will post outcome of app. Setting off early as my sense of direction ( like to blame Pred, ) but prob never was wonderful 🤪we can’t blame all ills on Pred I guess ...

[piglette in reply to Breconblue]

I cannot believe your doctor said enteric coated was no longer prescribed. As Poopadoop says it is a downright lie. There has been a problem recently with the 1mg tablet, but that seemed to be the manufacturer.

[PMRpro Ambassador in reply to Breconblue]

It isn't expensive, especially when it may save the extra PPI and, even more importantly, removes a layer of side effects.

S/he is exaggerating - the difference in cost is minimal when it is all added up and a lot of patients will tell you it made a difference to their gastric problems.

A few years ago it WAS much more expensive, about a 17-fold difference, so the NHS discouraged its use. For short term use it probably doesn't make a lot of difference but for long term use it does. and when patients couldn't cope with it the NHS said it could be used if necessary. Shortly afterwards, the suppliers of plain pred increased the price so the difference was much less anyway.

Three/four years ago the following figures applied:

30 tabs plain pred £1.30

30 tabs PPI £1.86

2x dispensing charge paid by NHS to pharmacy IRO £2

Total just over £5

30 tabs enteric coated £1.86

1x dispensing charge iro £1

Total IRO £3

They will have changed a bit - but the relative numbers won't be enormously different.

[Chrisellie]

I didn’t find omeprazole suitable for me. Lansoprazole worked well.

[Breconblue]

The Rheumatologist I saw yesterday refused to change me to Enteric coated but prescribed Esomeprazol instead of Omleprazole. Waiting for Boots to order in Fingers crossed