Gas & gurgles, is it overindulgence or pred?

[EnyaBlue]

I am having issues with burping, bloating, gas and wind. It is uncomfortable and inconvenient, but not painful. It has been ongoing for at least 5 weeks and I put it down to Christmas food and drink. However, last night it was at its worst and kept me awake. I had a very busy day yesterday, ate more bread and carbs than usual and had 2 glasses of wine. I tapered Omeprazole last year and stopped completely in Oct after reading that long term use should be avoided. I had previously never suffered with reflux or history of heartburn . I felt OK, but then these gastric symptoms started around end Nov/start Dec. Is it the pred (I take it with plain yogurt and kefir) or do I need some stomach protection?

[piglette]

It does not sound like a PMR problem but more of a stomach problem. If you have had the problem for over three weeks it is usually recommended that you see a doctor.

[EnyaBlue in reply to piglette]

Thanks piglette. I will monitor for a few days whilst trying to get back to my normal diet. If no improvement will seek GP advice

[Sharitone]

Was there any reason to suppose that the omeprazole was not needed? I also tried reducing to 10mg a day last year because my stomach seemed okay, but then after a couple of months the sore stomach symptoms returned. Like you, I was motivated partly by the PIL saying that you should not take it for more than 4 years. I had to go back to 20mg, where I have been reasonably comfortable ever since. GP said he had been taking it for 5 years without any worries, and he is a youngling!

[EnyaBlue in reply to Sharitone]

Thanks Sharitone. I guess it was motivated by the PIL and other info, read on here and elsewhere. I have diverticulosis, but previous to PMR no other gastric issues except occasional bloating and wind if I ate too much of the wrong thing. These things were solved by keeping my diet in check and taking psylium husk keeps bowel regular. I went down to 10mg of Omeprazole without a problem and felt generally better for a whiles without it. Perhaps I need a little of it sometimes, but not sure if you can take it on and off or have to take it every day?

[piglette in reply to EnyaBlue]

I did not realise you had diverticulosis. It is quite possible that is your problem. Some people take basic yogurt rather than Omeprazole with their pred, which can work sometimes, but as you have other stomach problems it may not work.

[EnyaBlue in reply to piglette]

I didn't realise that the diverticulosis might be an issue. Can you explain please as I am genuinely interested? I was never prescribed anything for it, just told to take more fibre to keep bowel regular. I have had lower abdo pain in the past, but none at the moment or over recent weeks. No medic has mentioned this in relation to PMR, pred, omep but then it is difficult to get a practitioner to look holistically.

[piglette in reply to EnyaBlue]

My father had diverticulosis, which had diverticulitis and he had problems like that. It may be nothing to do with that of course. Interestingly enough my father was told to eat less fibre. White bread not brown bread!

[EnyaBlue in reply to piglette]

Thanks

[piglette in reply to EnyaBlue]

Good luck, I hope the pain goes away.

[Sharitone in reply to EnyaBlue]

You can take it every other day if you want, but it doesn't sound like that would do you any good. You probably do need some medical input.

[PMRpro Ambassador]

More than usual carbs and alcohol could have been the reason for the worsening last night, I think the stopping the omeprazole may have something to do with the flatulence so maybe try restarting - you can get it or a substitute OTC to experiment a bit.

But if it persists, I think you need to discuss it with the GP - just in case so they can rule out anything really nasty.

[PRL1957]

I had a few days of very painful 'gut-ache' when I came off omeprazole. (I just stopped suddenly, rather than tapering down; nobody warned me to taper.) I put it down to a rebound in my stomach acid production and, possibly, an associated change in gut biome.

Gaviscon a few times per day and taking a few more omeprazole tablets at 1 - 2 day intervals helped.

But my symptoms went away after a few days, so it might not be the same as yours.

[DorsetLady PMRGCAuk volunteer in reply to PRL1957]

when I came off omeprazole. (I just stopped suddenly, rather than tapering down; nobody warned me to taper.\

If you’d asked, we would have…. 🤣

[PRL1957 in reply to DorsetLady]

Well, yes - but at the time, I didn't know what I didn't know.

Do you think my 'acid rebound and change in gut biome' hypothesis might be correct?

[DorsetLady PMRGCAuk volunteer in reply to PRL1957]

Probably not the person to ask in all honesty - according to my late husband I have the constitution of an ox - he didn’t.

But would say the recent issues are more likely to be Christmas fare plus more carbs and bread… but you may well require some stomach protection.

[PMRpro Ambassador in reply to PRL1957]

Acid rebound - definitely. It is a known problem with stopping PPIs suddenly. Microbiome - not sure, would have to see if anyone has looked at that.

[PMRpro Ambassador in reply to PMRpro]

And indeed - they have

gut.bmj.com/content/65/5/740

and it does, hence the risk of C.Diff infections. Whether it also makes other differences I don't know.

[PRL1957 in reply to PMRpro]

Hi, PMRpro,

Thanks for replying.

Clostridium difficile is an interesting suggestion. About 10 weeks after I stopped taking prednisolone and omeprazole, and well after my brief initial period of stomach ache, I had a second brief episode that culminated in me being sick. I had spent the afternoon gardening and moving a compost pile, and had assumed my problem was due to some bug I had picked up while doing that.

It did not appear to be food-related; my wife had eaten the same as me, without any problems.

But I wonder if I had C. difficile brewing.

Thankfully, I have had no further issues since that day last May.

[PMRpro Ambassador in reply to PRL1957]

The change in the biome allows nasty bugs to get a foothold that that might not otherwise. But you would know if C.Diff was raising its head ...

[PRL1957 in reply to PMRpro]

Yes - probably not C. diff. My wife (a retired nurse) tells me that C. diff. patients in hospitals require barrier nursing and can close wards. But it might have been some other bug that took advantage of my changed stomach environment.

[EnyaBlue in reply to PMRpro]

Interesting article, thank you for sharing. Will mention to doctor in forthcoming visit. Acid rebound - would have assumed this would happen shortly after stopping ppi, not after 2 months, but I don't know, you have a lot more knowledge and experience than me.

[PMRpro Ambassador in reply to EnyaBlue]

My reply was to PMR1957 whose problems DID start immediately and they wondered as to the cause.

No, rebound is going to happen ommediately - 2 months later it needs investigating.

[EnyaBlue in reply to PRL1957]

I tapered to 10mg of omeprazole, then stopped. I did have a few days of discomfort and like you put it down to rebound of acid production. But then seemed to be OK for a couple of months. Will try Gaviscon. Can you take omeprazole as and when as you suggest, I wasn't sure? Gut microbiome changes is an interesting one, but it is not something I know about either. Thanks for your reply

[PRL1957 in reply to EnyaBlue]

I would not want to take omeprazole (or any other proton pump inhibitor - PPI) medication 'willy-nilly', although it appears to be in Pyrocalm 'over the counter' indigestion medication from Boots, see:

boots.com/pyrocalm-control-...

So, I presume many people may take omeprazole 'ad lib' when they have a stomach ache.

Rather than blocking the proton pump chanels that generate stomach acid, Gaviscon works by neutralising acid by 'ion exchange' and forming an alginate layer to impede reflux. I cannot say if it will help you; I'm not entirely sure how much it helped me, as I had nothing to compare with.

As for the change in biome hypothesis, I do not KNOW that it was an issue for me. The worrying thing if the discomfort persists might be Helicobacter pylori (H. pylori), which can cause stomach ulcers, see:

mayoclinic.org/diseases-con...

nhs.uk/conditions/stomach-u...

==============================

But, I see from your other replies that you have diverticulosis. That might be more of an issue as steroids may cause further problems, see:

thelancet.com/journals/lanc...

academic.oup.com/bjs/articl...

(although some workers reported a protective effect of steroids).

I am not a medic. (My doctorate is in polymer science.) So, as Piglette suggested, if your symptoms persist, it would be wise to see your GP.

[EnyaBlue in reply to PRL1957]

I have read the articles, thank you for sharing. All very interesting. Staggering that Boots medication has 20mg of omeprazole in it and that people are self administering on an ad hoc basis! H-pylori effect noted

Changes in gastric environment due to omeprazole and pred is very useful to know. As is your reminder of the potential nasty effects of diverticular disease if left untreated.

Meanwhile, trying Gaviscon. Symptoms have calmed down a bit over past 24hours, though discomfort still around. Seeing Doctor on Thursday, but now feel much more knowledgeable and aware of potential scenarios due to great advice on this forum. Thank you.

[Tanner145]

My neighbour has diverticulitis and often has those symptoms. That would be my first thought. Plus those changes in diet. Good luck

[EnyaBlue]

Thanks to those who have replied, much appreciated. I sent a message to my GP surgery yesterday listing my symptoms. As a result the doctor has requested to see me and I have an appointment on Thursday.