Diarrhoea

[NewPMR]

I’m three weeks into taking Pred along with 20mg of Omaprezole. I’ve had increasing bouts of stomach cramps at night followed by diarrhoea instead including some blood. I can’t speak or see doctor straight away as I’m away. I’ve stopped taking the omaprezole until I can get a poss lower dose or nothing at all. Don’t know what else to do as I can’t stop taking Pred. I know it’s prescribed to protect the stomach but it seems to be having the reverse effect. Worried stopping suddenly will have a nasty effect but I’m stuck between a rock and a hard place. Apologies for title and rant! 🙁

[SnazzyD]

It might be worth calling 111 for advice since you have blood in the stool. If you need help locally they should be able to guide you. Could just be a tear but you don’t know. Do you have any other symptoms?

Pred gave me pretty loose motions in the morning which got better with dose dropping. However, it didn’t have blood and any other motion in the day was ok. Stopping Pred without advice wouldn’t be wise as it is about 3 weeks since you started. Although you are on the cusp of where you can’t stop abruptly, we are not all the same.

It could also be the Omperazole which can give people iffy guts as it did me. Stopping proton pump inhibitors, of which Omeprazole is a type, it isn’t a good idea because you can get rebound acid. You might need an alternative type like Famotidine which acts differently to cover your stomach.

[NewPMR in reply to SnazzyD]

Thank you for your reply, it definitely wasn’t just a tear but I had a very bad bout so I will see if that happens again. I’ve done an e consult with my doctor so hoping for advice from her and on here. I don’t have any other symptoms. I know I cant stop the pred but dare not keep taking the Omaprezole. 😬

[PMRpro Ambassador]

Omeprazole does have a record for causing upset GI tracts - ironic I know. You probably haven't been on it long enough for the rebound acid production on stopping to be too much of a problem but get some Gaviscon just in case it is uncomfortable.

However - as Snazzy has said, if you have blood in your stool you do need medical advice as soon as possible. Is it bright red on the surface or dark and mixed in with the stool? Any mucus?

[NewPMR in reply to PMRpro]

Just had the most rushed conversation with my dr, so much so I could hardly understand her. She has prescribed something other than omeprazole to take at night, but I didn’t get what! Insisting it’s dangerous to take nothing. As I’m away she says I must take regular gaviscon in the meantime. Are most folks on stomach protection with the Pred? Thanks for advice

[PMRpro Ambassador in reply to NewPMR]

I've never taken anything unless there was an additional need like needing NSAIDs or a procedure that needed them and I'm not the only one. They don't make the same fuss here in Italy! Not everyone has problems. But a phone call like that is not acceptable.

And the blood in the stool still needs investigating.

[NewPMR]

thank for your reply, I’m not really sure but it was as though I was bleeding internally a bit, I thought it was possibly because the diarrhoea was so bad. I did a bowel screening that was sent to me a couple months ago which was ok though I know things can change quickly. Thanks for the advice

[PMRpro Ambassador in reply to NewPMR]

It probably isn't anything serious but you DO have to check with the doctor to be sure it isn't something nasty.

[NewPMR in reply to PMRpro]

Thank you I will get advice from doctor

[Fatsiajaponica in reply to PMRpro]

Hi, haven't learned how to tag people in yet but just replied to NewPMR, can you check it out? Thank you

[DorsetLady PMRGCAuk volunteer in reply to Fatsiajaponica]

TAGGING A FELLOW MEMBER IN POST OR REPLY

Type or select @ from menu under comments box.

Start to type the name of the person you want to tag [no space] - and a list of possible names should come up.

Click on the correct name and their name will be entered.

When you click Reply for the comment, the @ disappears and the name appears in blue in the reply.

From this - in FAQ under Using Forum..

healthunlocked.com/pmrgcauk....

[SnazzyD in reply to NewPMR]

Bleeding “because the diarrhoea was so bad” is even more a reason not to wait. You might have an infection or some sort of colitis; not necessarily ’the dreaded’. If you were healthy and not on a moderate dose of steroid dose it might wait. The description PMRPro asks for is quite important though.

Presumably the e consult is an office hours thing. 111 will give you advice now.

[NewPMR in reply to SnazzyD]

Thank you I will get some advice but it’s good to get advice on here as well

[SnazzyD in reply to NewPMR]

Yes, sometimes we just want to sound it out before we commit to the rigmarole of getting help. Also, I think we get so used to suffering that the bar is raised for when we think something is bad enough!

[Fatsiajaponica]

Hi, just wanted to add that I had explosive diarrhoea, took me a while to work out what was causing it but it was the omeprazole. Of course follow and get Drs advice, sorry you are having to cope with this on top of being newly diagnosed. Sometimes it takes a while to sort out how these various meds affect you but you will work it out. My best wishes.

[NewPMR in reply to Fatsiajaponica]

Just had the most rushed conversation with my dr, so much so I could hardly understand her. She has prescribed something other than omeprazole to take at night, but I didn’t get what! Insisting it’s dangerous to take nothing. As I’m away she says I must take regular gaviscon in the meantime. Are most folks on stomach protection with the Pred? Did your doctor prescribe something different for you? Thanks for advice

[Fatsiajaponica in reply to NewPMR]

Yes, there are other options which I have seen people on here get along fine with. I have to admit that to date I haven't asked for an alternative, take my pred with yoghurt but if my stomach causes me issues I'll review.

We had a AGM of the PMR/GCA members and had 2 professors, one focused on the PPIs (i.e. omeprazole) and a bone specialist for the supplements (vit D and calcium and biphosophonates like aledronic acid), you have reminded me to look at that again. The PPI is not just as you take your meds but in some way acts systemically, assume that means the whole body system (need some experts to help us here). @PMRPro ? Maybe worth giving the alternative you have been offered a go and let me know how it goes. I would prefer to mitigate some of the effects of pred but that diarrhoea was so explosive, lasted all morning and made me feel unwell so I am nervous about trying something else but think I should. I guess if it happens again I will know straight away and can get back to an even keel. This is how it goes sometimes.🤷‍♀️

Take care and keep us updated. Also perhaps join the PMR/GCA charity and you can watch the AGM talks!

[PMRpro Ambassador in reply to Fatsiajaponica]

The systemic effect of pred is that it acts on the prostaglandins in the tissue and that is what they believe causes the damage to the lining of the stomach, more than the mechanical effect of the tablets on the stomach. Most of the concept to taking pred with food is that it dilutes the acid but that isn't the whole story.

[Excelsior80 in reply to PMRpro]

I think I read somewhere that prescribing a PPI like omeprazole was only necessary if the person was thought to be at risk of gastric problems, or if steroid dose very high? But not sure. Like FatsiaJaponica Im not taking one but feel perhaps I should .... I must watch that AGM talk!

[PMRpro Ambassador in reply to Excelsior80]

I think the opinions vary widely - my info came from the sharp end, an endoscopist who SEES the effects probably due to long term pred! And there is a great crossover from the US and CMA medicine to avoid litigation (cover my a*** medicine if you aren't familiar with the term ) There is no such great emphasis here unless there is another reason - I've been given one when NSAIDs have been needed and a high dose for a month was routine after a cardiac ablation. But NEVER omeprazole which is old and associated with lots of side effects. Here they use pantoprozole which is said to have fewest effects.

[NewPMR in reply to PMRpro]

Seems I’ve been prescribed Famotidine, I don’t have it as yet so I haven’t tried it. I will let everyone know how I get on with it! As the doctor put the fear of God in me if I didn’t take something, I’m going to have to give it a try! Also taking vitamin D and calcium supplement as my vitamin D is a bit low. Very cheap combined tablets from savers the chemist. 👍

[Pollyone in reply to NewPMR]

I buy Calci D from the chemist about £4.60 a month and it’s what doctors prescribe except mine didn’t and I found I could buy it so decided to do that as I’m low on bone strength. Easier for me to just buy than try and persuade the surgery. They wouldn’t even let me ask for 1 mg more Prednisolone without consultant letter. Am looking around for another surgery but not easy!

[NewPMR in reply to Pollyone]

They were only £1.39 for a tub of 60 I think, and you take two tablets a day which is the required amount. Certainly, 100% RDA of vitamin D.

[PMRpro Ambassador in reply to NewPMR]

I'd put the fear of god in any GP who was that insensitive to me!!! Some do go a tad OTT!!

[NewPMR in reply to PMRpro]

😂👍