Pred and stomach upsets

[Apple6]

I’m just wondering if being on Pred makes my stomach more easily upset? I’ve been on it for 2 years now, but have always taken it with Omeprazole. I’ve noticed that I’ve had frequent bouts of vomiting over the last 2 years, whereas previously I hadn’t been sick for years and it was very rare. As a primary school teacher, I figured I had built up a very healthy immunity to bugs! Now it seems to be related to food rather than a bug, as I usually only have one episode of vomiting, always at night, then feel fine afterwards. Has anyone else experienced the same? Is there anything I can do to help?

[SnazzyD]

Hello, in this instance I don’t think it wise to point the finger at Pred etc just yet. Daily vomiting isn’t right and although low adrenal function on low Pred doses can cause nausea and indeed vomiting when it is acute, other issues need ruling out by a doctor. If it is adrenal insufficiency, it might be that you are teetering on crisis and need to do less or increase you dose a bit. Before seeing them, it saves a lot of time to gather information on patterns so you can help diagnosis. We can make suggestions but they can’t take the place of a proper professional advice.

Here are some questions. So it is worth noting how long after eating it happens and whether it is heralded by nausea or is just spontaneous. Is it only ever at night? Do certain foods make it worse. Any pain in the stomach of anywhere else? Are there any other symptoms of any sort hanging around? Is the other end ok? Are you losing weight? How do you feel in the meantime? Is the vomit containing food or just empty stomach contents? Does it coincide with any other medication within a few hours? Do you get a choice about vomiting or does it come whether you like it or not? There are other questions but these are an example in order to build up a ‘dosier’ to make sure you get a timely diagnosis by providing valuable information up front.

[Sophiestree in reply to SnazzyD]

excellent reply.

[Apple6 in reply to SnazzyD]

Thank you for your reply and I’m sorry if I mislead you with my question. It’s not daily vomiting, more like once a month. It’s usually at night, about 4-5 hours after eating my main meal. It is ‘ both ends’ and continues until I have emptied my stomach. It’s just so unusual as I used never to vomit. To me it feels like it’s something I’ve eaten that’s triggered it, and I just wondered if the medication is making my stomach more sensitive and less tolerant.

[SnazzyD in reply to Apple6]

Have you done a food diary and indeed a normal diary of activity, symptoms and places? I have always found thinking back isn’t very effective, especially if one is stressed and on the go.

It does come up here that people find that on low doses, old allergies and new allergies and intolerances crop up. I was the same and over about a year they gradually subsided apart from dark chocolate and brassicas (😩) on the dietary side. I was already gluten and largely dairy free before diagnosis.

When you do have a bout, is your food digested or has it passed out of the stomach? or is it like your gut has just gone into stasis and nothing happened in that 4-5 hours?

All said, it is unusual and not something where I think, “ah yes, that old Pred/PMR chestnut!”so I would still seek advice armed with some data. In the meantime if there is a glaring pattern, try and change something.

[Apple6 in reply to SnazzyD]

Good idea re food/ onset diary yes I will start one now. I’m interested that you don’t think it’s a common issue with Pred/PMR. I’m afraid I’m starting to blame it for everything! Thank you for your advice.

[LoveMygarden29 in reply to Apple6]

Could it be the Omeprazole. After taking it for probably about a year I had a couple of awful bouts of sickness and diarrhoea. I have now been changed to Famotidine with no problems. Like you, being sick is a very rare occurrence for me. Please consider this. Wishing you well. X

[SnazzyD]

Generally, direct side effects from Pred tend to fall away under 5mg. People can get stomach erosion from Pred and side-effects from Omeprazole but you don’t seem to be suffering in between the bouts. Periodic vomiting isn’t in the list of classic PMR symptoms and is too general a symptom to be able to pin on the two usual suspects when the line-up of other causes is so long.

[PMRpro Ambassador]

When I had a similar problem, many years before pred, I was referred to an immunologist because my records suggested the possibility of a food allergy. My symptoms were identical to yours - I could set the clock by the time it woke me and once everything was cleared out I felt fine and went to sleep though I was totally wiped out for some hours.

The most likely culprit for me appeared to be something in heavier red wines. nothing else was a constant. I have also had a couple of similar episodes after schnapps or gin which were heavy on botanicals, the more,herbs, the worse the episode. I never had it after white or rose nor certain lighter red wines which are common here in South Tyrol, Merlot, which is heavier, was a bit dodgy.

The immunologist agreed - it has all the hallmarks of an allergic reaction to something in food. She said it wasn't worth going through the testing route as there were thousands of things it could be and we could test forever and still be none the wiser. Since I had a fair idea of the area the problem lay, she simply said "take antihistamines before you drink red wine or eat anything you suspect!"

I did that for a long time, never had any problems, but eventually I got bored. One night it happened - and as soon as I woke up with the familiar churning stomach, I took 2 antihistamine tablets. Within an hour it had settled and I went back to sleep. And that is what I have done since.

Lidl sells very cheap packs of loratidine for hayfever - works just as well as Boots most expensive version ...

[Thelmarina in reply to PMRpro]

I love that your first thoughts are alcoholic! 😂👍🥂xx

[marionofnorwich]

I stopped taking Lansaprozole as it seemed to upset my stomach more than protect it. Not as dramatically as you are describing but I felt better without it, mainly loose stools as I recall. Mind you, I might try it again as lately I feel a bit 'indigestiony' after taking medication so I will let you know what happens

[Gimme]

I would say that my stomach has been a lot more civilised on pred than it was before I started taking it. I supposedly have IBS and I am a fructose malabsorber. I have followed a gluten free diet for about 20 years (long before I started pred earlier this year). Never any vomiting though.

What always glares at me whenever this topic comes up is the number of people with PMR that already had GI problems before their PMR diagnosis. I would be intrigued to know if it is higher incidence than in the general population and if it is somehow linked to the underlying autoimmune activity.

[perceptual63]

About 8 years ago I was on a PPI for Barrett's Esophagus and found, after discontinuing it after 1 ½ years, that it actually made my reflux worse after eating.

[PMRpro Ambassador in reply to perceptual63]

It would have done if you didn't taper it off very slowly - it can lead to rebound acid production.

[perceptual63 in reply to PMRpro]

I'm sorry I wasn't clearer. While I was on the PPI it seems to have caused me more reflux although it wasn't as acidic. It was only after coming off the PPI did I realize that while being on the PPI the PPI made my reflux worse.

[PMRpro Ambassador in reply to perceptual63]

Oh, I see.

[Ladyhillingdon]

I think a food diary would help to identify a possible food causing the problem.

I have not been able to eat anything in nightshade family , started with courgettes about 3 years ago.

[PMRpro Ambassador in reply to Ladyhillingdon]

Interesting - but courgettes aren't nightshades so it must be something else there.