Prednisolone and Gastritis

[Bleakley1]

Hi,

I have been PMR sufferer for a number of years now. Currently on 7mg. Had tapered to 6mg but no PMR said no chance I want 7. Sooo back to 7 I went and ok PMR wise at the moment.

My question is this. Are there any Gastritis sufferers out there? I was due to go on holiday in June but ended up at A and E with severe tummy pain. Holiday cancelled as was told I needed an Endoscopy. Endoscopy revealed chronic gastritis. Very painful. Surgeon said prednisolone is not helping but knows I have to take. I am on lansopropil twice a day and Gaviscon to back it up.

Unfortunately when I have a bout of this the medication does not take the burning spasms away.

Does anyone else suffer from this and what do you take for the pain?

Barbara

.

.

[PMRpro Ambassador]

One potential solution in the UK to to get them to switch you to enteric coated/gastro resistant pred. The coating ensures that the gut isn't exposed to the pred until after the stomach which reduces the risk of gastritis. There have been a couple of people who struggled with the PPI approach alone but e/c pred did the trick although some still need Gaviscon too.

Were you put on lansoprazole from the start? Did you have gastritis nevertheless? For about a third of patients PPIs don't work at all - they are useless. For another third, PPIs cause other GI problems. H2 antagonists have a different mechanism so different side effects so are also worth trying.

[Bleakley1 in reply to PMRpro]

yes I have been on Lansoprazole since the start of PMR five years ago

The gastritis was diagnosed recently but I have a feeling it has been bothering me mildly for quite a time which I put down to IBS. It’s only this year that I have had a couple of severe bouts which resulted in an Endoscopy and therefore the diagnosis. I will have a go at asking surgery for enteric coated but know they are reluctant because of cost. My Pharmacist suggested dissolving the pred in some water so that tummy doesn’t have to work hard to break tablets down. Thanks for your reply and advice some of the other remedies you suggest are certainly worth a try.

[PMRpro Ambassador in reply to Bleakley1]

Cheaper than a patient with extensive gastritis problems - they've already funded a scope!!! Nor patients with severe adverse effects - cost can't be an excuse.

[Bleakley1 in reply to PMRpro]

ha! The irony is I paid for a scope myself. I only received the nhs letter to go for a consultation last week. At A and E way back in June they marked request for Endoscopy as urgent. Didn’t happen. So went privately in July.

My pharmacist says the 1mg tablets are not made enteric coated. Only the 5mg. I certainly cannot take a load of ones. They really upset me. I usually end up cutting the fives with a pill cutter.

[DorsetLady PMRGCAuk volunteer in reply to Bleakley1]

“My pharmacist says the 1mg tablets are not made enteric coated”. 

Incorrect - they are manufactured by following -but there have been shortages recently -but that’s not the same thing!

Alliance Healthcare (Distribution) Ltd

Phoenix Labs Ltd

Plus there are also 2.5mg manufactured… your pharmacist needs a kick in the proverbial !

[Predderman2020 in reply to DorsetLady]

I am trying to get 1mg ones to get me under 5 mgs (enterocoated). In Malta, I have to go to Hospital with a special prescription. Not ideal. Dissolving ordinary tabs, which I did to help get exact dose when tapering certainly did not help my tummy and may even have pushed me over the edge. Good luck.

[PMRpro Ambassador in reply to Bleakley1]

Your pharmacist is wrong. And you mustn't cut the enteric coated tablets - that totally negates the purpose of the enteric coating.

Gastro-resistant come in 5, 2.5 and 1mg. You can combine to make any dose, reduce in 1/2mg steps down to 2mg, The number of doctors and pharmacists who are too lazy to learn the truth seems to grow steadily.

[Bleakley1 in reply to PMRpro]

I am not cutting the enteric coated ones as haven’t got any.

[Predderman2020 in reply to Bleakley1]

nb - I put my problem down to dissolving the Pred - good for titrating, but awful for hitting he stomach from throat downwards.

[Predderman2020 in reply to PMRpro]

I have the same issue - Now I am on 5mg I can have the GastroResistant version. But also on no onion, no fried, little fat, no alcohol. Gaviscon and Omeprazole, and lots of yoghurt, home test for Heliobact (negative). Some improvement but still pain. Chilli was the worst recently. To be honest, I expected things to improve by now. Hmmm.

[PMRpro Ambassador in reply to Predderman2020]

Think I'd be demanding a GP "do" something!

[Predderman2020 in reply to PMRpro]

Good advice. As soon as i get home!

[BethCH]

I have gastritis and duodenitis which pre dates my GCA diagnosis (Feb 22). Not quite sure how this site works but are you able to look at my previous posts? My H2 blockers and careful eating plan seem to be controlling it atm. I know for sure that if I was to have ice cream now, then I will be up all night and likely be ill for next few days. Before GCA, GP also prescribed sucralfate (rather than take gaviscon) in addition to PPI’s. He described it as a ‘game changer’ and it certainly worked to stop that dreadful burning and reflux. I don’t need it now but it helped to give the inflammation in tummy time to heal. However, I have no idea whether it will affect absorption of pred as it coats the stomach or whether there are interactions or side effects. The gall stone ‘diet’ tends to be my go to to protect my tummy but over time I have introduced some more ‘fatty’ things within reason. It is a difficult balance with the low carb pred ‘diet’. Luckily, I do love veggies and fruit. I do hope you find a solution because I know it is so miserable and the pain is beyond unpleasant. Good luck.

[PMRpro Ambassador in reply to BethCH]

Your previous posts and replies can be read on your Profile page

[Bleakley1 in reply to BethCH]

Thanks for reply Beth. I have found that various foods don’t work for me anymore. I had the gall bladder diet years ago and wish I hadn’t thrown it out. Gall bladder was removed so thought I would not need it anymore.

[BethCH in reply to Bleakley1]

yep, me too. They said I could eat ‘what I want’ after a couple of weeks of the op. Well it was fine for a while, until the gastritis diagnosis. However, gall stone pain was worse than gastritis so no regrets. The diet is on line but from the sounds of it, your issues started with pred and as PMR Pro says, maybe coated pred will help.

[Bleakley1 in reply to BethCH]

Beth,meant to ask when you have the pain what do you take to relieve it?

[BethCH in reply to Bleakley1]

Just paracetemol or co-codamol. At night, I just had to get up, sit upright and watch tv with a cup of twinings ginger tea until it settled. More recently, I take 10mg amitriptyline for neuralgic pain in my right side where my gall bladder was- this seems to work and helps sleep as a bonus. But was advised not to take co-codamol and amitriptyline together

[Bleakley1 in reply to BethCH]

thanks Beth. Paracetamol was not even touching it for me. I will try cocodamil. I find chamomile tea a calmer down but ginger tea a good suggestion too

[Bleakley1]

Problem with getting the enteric coated ones is that my surgery are loathe to prescribe them because of the cost but I will give them another plea.

[Floridafan in reply to Bleakley1]

If you aren’t successful with your plea another alternative is to buy empty enteric coated capsules which will work in the same way. Just pop your Prednisolone into one of the empty capsules and take as normal. I haven’t tried them myself but there are others on the forum who have.

[cmToddy]

hi there. I have a lot of acid reflux and tummy issues. For spasms I take 1000mg Paracetamol and I suggest trying Ibuscopan to ease the tummy problems. Worth a try so good luck. Also I take Gastro coated Pred.

[Bleakley1 in reply to cmToddy]

thanks will try

[Bleakley1 in reply to cmToddy]

Thanks I took 600mg for the pain yesterday. Didn’t even touch it.

[moonieboy9358]

There is a form of steroids that is absorbed in the small intestine. I think it is called Rayos. But i am not sure of the name. Ask your pharmacist or chemist.

[DorsetLady PMRGCAuk volunteer in reply to moonieboy9358]

Not sure they are available in UK …

[moonieboy9358 in reply to DorsetLady]

I think it is called Rayos. Please ask your chemist. I have found that a pharmacist or chemist is a great resource. I ask the questions all the time

[Bleakley1 in reply to moonieboy9358]

thanks

[DorsetLady PMRGCAuk volunteer in reply to moonieboy9358]

I know it is called Rayos - one of our members in Italy uses them I believe, what I am saying is they are not readily available under the NHS in the UK where Bleakley1 resides.

[PMRpro Ambassador in reply to DorsetLady]

Only privately - and they aren't absorbed from the lower gut, just from the stomach but after a delay of about 4 hours when taken with food.

Enteric coated/gastro-resistant are absorbed from the lower GI tract - the coating ensures they pass through the stomach untouched.

[PMRpro Ambassador in reply to moonieboy9358]

They aren't absorbed from the lower gut, just from the stomach but after a delay of about 4 hours when taken with food to create the correct gastric environment.

Enteric coated/gastro-resistant are absorbed from the lower GI tract - the coating ensures they pass through the stomach untouched. They are available in the UK. Lodotra(Europe)/Rayos (USA) should not be confused with enteric coated pred - it is designed to be absorbed from the stomach.

And it is extremely unlikely most pharmacists will have heard of Lodotra/Rayos. It was approved for use in the UK for RA to minimise morning symptoms but that was stopped before Covid, not sure exactly when, because it is pretty expensive. In the UK it is probably a similar cost to in Europe, about £30 for 30 tablets irrespective of dose. In the USA they cost thousands of dollars for some reason - heaven knows why - and are rarely covered by insurance.

[Bleakley1 in reply to PMRpro]

thanks for explanation

[bakingD]

Hi

I had severe gastritis last Xmas unable to eat - lost loads of weight and felt awful- endoscopy confirmed this- switched to enteric coated Prednisolone and slowly healed and have been fine since- I refused a PPI as have osteoporosis

I still take my Pred with food but can have a normal diet including spicy food- am careful with alcohol

Good luck xx

[Bleakley1]

Thank you. Going by the number of replies I have had all of them so useful the overriding advice seems to be enteric coated is the way to go. I am on holiday at the moment so as soon as I am home plea you GP coming up. It’s such a sore pain when it happens,you don’t know where to put yourself. I had a short bout of it yesterday (on holiday. ) Silly me thought I could be like everyone else and had a glass of wine! Wished I hadn’t. 😒

)

[Telian]

I was diagnosed with severe gastritis when in A&E with heart attack symptoms. I was already on Lansoprazole and Loratidine. Had an endoscopy which confirmed the gastritis and was put on Famotidine 40mg at night. It works a treat. Also take Prescribed Gaviscon with each meal and before bed. I can manage it now. The Endoscopy Doctor said 6 years of taking Omeprazole had caused the gastritis! I’d had no gastric symptoms until the ‘heart attack’ symptoms. A&E Doctor said with severe gastritis it can mimic them. Good luck.

[Bleakley1 in reply to Telian]

Thanks for reply. Like you my gastritis was going into my chest and the I had. Oesophageal spasm which is also like a heart attack. Sooo frightening. I have listened to all the replies and the good advice. I did not realise that gastritis was a problem that many of us have,

[Telian in reply to Bleakley1]

The symptoms are scary and so like heart problems - my GP sent me to A&E immediately. I asked the hospital consultant why were the symptoms similar to heart issues - he said they are when the gastritis is severe. It’s unbelievable that something prescribed actually causes what it’s supposed to be preventing.

[Bleakley1 in reply to Telian]

yes the pills that are keeping PMR at bay do cause other problems. It’s seems so unfair.