Gastritis is this pain normal? : Early hours of... - IBS Network

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Gastritis is this pain normal?

Lizzy88 profile image

Early hours of this morning I woke up with upper stomach/chest pains that was radiating into my upper back, the pain was so bad I couldn’t sit or lay down. I literally thought my chest and insides were tearing apart.

Went to A&E and after an ECG and blood tests it turns out it’s not heart related but Instead something called gastritis! I never heard of this and I thought it was the same as gastroenteritis!

My question is what is the differences and what causes this gastritis? I have previously suffered with acid reflux and indigestion before but nothing ever like this! I’ve been put in Omeprazole 80mg daily.

16 Replies

Gastritis is, to all intents and purposes, extremely painful heartburn. It is acid climbing the esophagus and coming into the mouth, it passes through the tube, in your chest, on its way up from the stomach, where it originates. Omeprazole works very well, in reducing the symptoms and ill effects of the excess acid, but does mean you require regular blood tests. 80 mg is a very high rise to be on, so I would definitely check that with my GP or pharmacist, later on today, (Monday).

I get gastritis as well and the pain is so bad I have thought I was having a heart attack at times.omeprazole are very good but agree with FRreedman that is a very high dose you are on.hope it gets better.

Thanks both you your replies! Makes me feel better that I’m not the only one with these symptoms and I’m not going mad or imagining it!

Like I said I always thought gastritis was the same as a stomach bug!

Yer I spoke with my Gp and he has advised that if the hospital consultants have said to take 80mg then I must.

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Hidden in reply to Lizzy88

Does anyone have a sore throat?

Hello, this sounds like an oesophageal spasm. They can last up to a couple of hours, a persistent aching pain radiates to your jaw, back and chest, and yes, I've been to A&E a couple of times for this. You can feel the oesophagus pulling on your neck too, but the torso pain is usually greater. It is associated with gastritis, which is inflammation of a part of your stomach. 80 mg of omeprazole is only 40 mg of the active enantiomer, the other 40 mg is inactive - they could have given you 40 mg of Nexium which is the same but a bit more expensive. This is typical for this condition and should work well. If it was an oesophageal spasm, you will recognise when this comes on, first feeling it as an ache in your jaw, the only way to deal with it is to take a couple of ant-acids and some Ranitidine or omeprazole as soon as possible, and sip some warm water. It can just come on sporadically in the night as you mention.

Lizzy88 profile image
Lizzy88 in reply to Stuart24

Thank Stuart24, your words have really helped! I just felt like the drs In a&e were thinking I was imagining it! But i wouldn’t have never gone up there if I wasn’t in so much pain! I literally thought I was having a heart attack! Awful sensation! Have you had any further tests? Or just on the medication?

Stuart24 profile image
Stuart24 in reply to Lizzy88

Hi Lizzy, no medication, not now anyway. It took me 10 years before someone actually diagnosed this correctly, but it is spot on, and I know someone else who has this. Just get the gastritis treated, and I'll send you my copy/paste general advice later. It may not happen again now you are on the omeprazole. To me it still happens a couple of times a year for no apparent reason, but it is acidity related. If it starts now, I throw everything at it ASAP; Nexium, Gaviscon, and Buscopan and rest, it usually breaks it within about 30 mins.

Stuart24 profile image
Stuart24 in reply to Lizzy88

Hello, this is my general response to help people find a baseline. First, go to the doctors and get yourself checked for intestinal infections, and whatever other tests they want to do. Most people find they are all clear, and that IBS is a condition brought on by our modern diet, freely accessible food, sedentary lifestyles and is usually initially set off by a GI infection or other trauma to the GI tract. Particularly for IBS-D (diarrhoea predominant), the gut becomes hypersensitive to certain triggers, and the official description is that a physical brain-gut dysfunction develops which causes the gut to over-react to very mild stimuli. This leads to inflammation, worse gut performance that seems to spiral out of control. Be aware that in this state you can get new GI infections, or other GI issues that are not connected to IBS, so you need to be vigilant for this, and if concerned then visit your doctor again.

The good news is that this situation is reversible, and you need to be positive that with the correct understanding and behaviours you can get back in control of your life.

After 27 years of suffering with IBS I have found that the long-term solution that actually works for controlling it is about FIVE key topics: your vitamins, daily fasting periods, digestive enzymes, toxic food additives, and adrenalin control.

You are effectively the manager of a “food nutrient extraction factory”, I know that sounds obvious, but I have found that IBS is not about medicines, but about changing the way you run the factory, and learning how to get the best performance out of it. I don’t recommend any medicines for long term use, as so far in my experience they only work in the short-term and eventually become less effective. Equally, I just don’t want to be dependent on medicines until one day when I have no other choice.

So after your doctor’s tests, if IBS is the diagnosis, then the first thing to sort out is your vitamins and the timing of your eating and fasting periods. An incident of food poisoning or infection can start you on a cycle that you need to make a really concerted effort to break out of. IBS causes vitamin deficiencies which are practically impossible to overcome in most people’s diets, especially because you are probably eating selectively to manage your symptoms. Your vitamin levels affect the health of your intestines, and the health of your intestines affects your vitamin absorption and your production of digestive enzymes; and it is a vicious circle that you have to break.

So, get some really good, expensive, multi-vitamins (ideally constituted for your age) and take them without fail every day before your breakfast. Get a blood test for Vitamin D and get you doctor to judge your supplement level required in IU’s to get you well healthy for Vitamin D. Do not get vitamins with high calcium and magnesium content initially as certainly in large doses these minerals can mess you up as they consume your stomach acid, and magnesium particularly can give you diarrhoea. You should get enough of these minerals from your diet. If you are on the low FODMAP diet, go for all lactose free dairy products to boost your calcium, as unfortunately the diet tends to cut out almost all of the good calcium sources.

Second, sort out your fasting periods immediately. This is normally overlooked by GP’s, but is an absolutely essential element for resolving IBS. Your small intestine should be practically sterile, and your stomach acid along with bowel cleaning contractions during fasting (called MMC) will usually do the cleaning. But, you need to fast for this to be effective, and by that I mean, ABSOLUTELY NO eating in between meals, ideally drinking only water. Imagine that you never washed your dinner plates and just kept putting food on them all the time!, they would be filthy and full of bacteria. In your guts, this results in SIBO (Small Intestine Bacterial Overgrowth), which is apparently responsible for 85% of IBS cases, but is only one of factors that you need to address. You need to give your small intestine plenty of time free of food for cleaning and maintaining the factory. The modern scenario of have cupboards full of rich foods permanently available day and night is a modern luxury outside of human evolution. Your stomach will sort itself out when you have got control of your small intestine (although if you've got gastritis you'll need to finish a course of omeprazole first), and then your large intestine will improve later as nutrients are more efficiently absorbed from your small intestine. Furthermore, you should be able to avoid future bouts of gastritis as during the fasting periods, your stomach acid is more neutral at nearly pH 4. As a basic program, eat a good breakfast at say 7am (porridge with 50% almond milk or lactose free milk) or what suits you and then a good lunch at 12 o'clock - absolutely no food in between. After lunch, no food at all for at least 5 hours, and eat well again for your evening meal because it has got to get you through the night. Ideally, no food after 7 pm, no supper or snacks, no food or milk at all until breakfast the next day. You will feel hunger in the fasting periods, but you will not starve, and this is doing you good!, You must NOT respond to the hunger - only with water or black tea. This is CRITICAL. Unless you are in a very healthy GI state, a mid-morning or afternoon snack interrupts your set meal digestion, causing acidity, SIBO, and driving premature advancement of food into your colon resulting in putrid fart gases mentioned below. Importantly, when you are feeling better, do not resort to your old ways, you are still recovering as you villi repair and become more efficient, and you need to make a life-style change to have this level of discipline in your eating and continue with it. It takes a few weeks at least, and you need to persevere with this. Failing on this will undermine all of your other good works. In a couple of weeks, you should be able to be getting off the low FODMAP diet, and begin mixing back in the higher FODMAPs. However, if you feel that this is not enough and symptoms are returning then just back off on the high FODMAPs for a while, and go for the wheat free options. Some people recommend longer fasting periods, but for me the regular program above is sufficient.

If your farts really stink like something died in your guts, then this is because partially undigested proteins are making it through to your large intestine and the amino acids lysine and arginine are being metabolized by bacteria into cadaverine and putrescine which are the compounds that give the smell to rotting flesh! – do not worry that you yourself are rotting, this is just temporary, but it shows that you really need to sort your digestion out.

The third aspect of IBS is enzyme insufficiency, or rather insufficient time for your enzymes to act on the food in your small intestines due to fast gut motility, typical of IBS-D. Digestive enzyme supplements are usually plant-based enzymes which work in a wider pH range than your own enzymes, and so can get to work on the food while it’s in your stomach and also during transit through your small intestine, and boosting your own pancreatic enzymes. In this case, not only are you ensuring you have sufficient enzymes working on your food, but also gaining extra time for effective enzyme action. I would suggest to try some multi-component digestive enzyme supplements, and take these with at least two meals a day, particularly your heaviest meals. You want them to contain at least amylases, proteases, lipases (for starches, proteins and fats respectively), but they can also contain other enzymes such as cellulase (for tough vegetables) and betaine HCl. Enzyme production can decrease as you get older, and is also affected by stress/anxiety, vitamins, and the health of your guts. You want to be sure that undigested food does not get to your large intestine where the bad bacteria will go to town on it. Using enzymes for IBS-D can help to avoid inflammation and bloating, and can help you to break out of the IBS cycle.

The fourth aspect of IBS is that some food additives are quite simply toxic for you and cause direct inflammation of the colon, allergic reaction of the colon, or they are laxatives that give you diarrhoea that you didn’t realise you were eating. These are to be considered separate to the usual SIBO and mechanism that you are dealing with above:

1.) Try to seek out and eliminate “trans-fats”. These cause direct inflammation of the colon, and you will be more sensitive than most people and this confuses what is causing you trouble. Chips, hash browns, butter, doughnuts, popcorn and things cooked in cheap or old frying oil as you find in many restaurants and commercial products can give you colon pain directly through inflammation. It can take up to three or four days to recover from this inflammation, but trans-fats are bad for you in a miriad of ways (cardio-vascular and diabetes), not only by inflammation of the colon. There is evidence that as cooking oil is re-used that the trans-fats (and other compounds) increase. So, if you want fried food as a treat, do it at home with good oil at a low temperature, and use it only once. Ideally, starches should only be boiled, rather than fried.

2.) E407, or “Carrageenan” – is a food additive derived from a red seaweed, which is only present in small quantities as a thickener, but even at low levels it has been shown to be “highly inflammatory to the digestive tract” and associated with IBS, colitis and other GI diseases. There is loads of literature and objections to this substance on the internet. It is present in cheap Crème Caramels, and many other dairy and meat products. After weeks of good health, just one of these products knocks me out for 24 hours with colon bloating and pain. I have found this by trial and error several times. Food tests show that even the food grade carrageenan contains between 2 and 25% of the non-approved “degraded” carrageenan, which is colon damaging and carcinogenic. Some food agencies now prohibit this additive altogether, and it may be responsible for a lot of IBS cases. It might be found in chocolate milk, cottage cheese, cream, crème caramel, ice cream, almond milk, diary alternatives, such as vegan cheeses or non-dairy desserts, coconut milk, creamers, hemp milk, rice milk, soy milk, and particularly processed meat. It is used extensively in cheap meats and is even injected into beef joints – so always get organic or local butcher fresh good quality meat!). It may be labelled as E407 or Carrageenan, but if you’ve got IBS, consider it as highly toxic for you.

In the same category is carboxy methyl cellulose (CMC) which is more widely used in the food industry, but has similar toxicology in animal studies, giving inflammation of the colon. However, the jury is still out on CMC to its impact on humans.

I’ll also mention here mono-sodium glutamate (MSG). Clinical trials and several scientific articles connect MSG with IBS, so given the option to avoid it you should avoid it.

Also, NICE advises against the use of Aloe Vera for IBS - although I would say for the hydration of skin burns it is miraculous, so get a tube of the pure plant gel for your medicine cabinet for minor burns.

3.) E338, E339, E340, E341, E450, E451 and E452, are phosphates, diphosphates or polyphosphates as different salts. Natural phosphates are essential for life, and your body is full of organically bound phosphates, however, free ionic phosphates have several problems. Firstly, they are laxatives and will give you diarrhoea (sodium phosphate was once used to prepare patients for colonoscopies!). Secondly, they are associated with cardiovascular disease and accelerated aging. Since the 1990’s we are now exposed to twice the amount of added phosphate in foods, and this is bad. There are calls to have added phosphate labelled on products as a health warning. Particular culprits are mass produced sausages and processed ham and chicken slices (and other meats), some cheeses, and cola (both diet and normal). Always buy ham “on the bone”, which usually has no phosphate added. Personally, all phosphate additives make me ill.

4.) Aspartame and other sweeteners definitely have a negative role to play in IBS for many people. As with the other toxins above, your ability to cope with them varies on a spectrum. If you look at some of the work of K.J. Mielke, many of these additives can be allergens or “pseudoallergens” and with time you can develop a reaction to them. The best sweetener for IBS is normal table sugar (sucrose), otherwise, it’s “Stevia” which is quite a new plant based sweetener and seems to be safe for IBS.

You must remember that there are many different causes of IBS, and one person’s solution may not be another’s - because of the allergies that you may or may not have developed, plus all other factors in play.

The fifth major topic in treating IBS, is adrenalin control. The GI tract is very sensitive to adrenalin. A friend of mine says that “adrenalin not used by your muscles goes to your guts” and there may be some truth to this. If you have a busy life, you are probably not coasting along on a bed of feathers, and you probably not aware of your almost constantly high adrenalin levels – that is until you start actively lowering them. Crucially, what does work, is hard exercise to burn up your adrenalin and stop it interfering with the nervous system of your guts – and this is a powerful effect. My advice is to do something every day, whatever you can manage in your busy life, it will all help. It will improve your gut motility, general health, bone strength, relieve tiredness, help you sleep better, improve your mental agility and help get your anxiety under control. To many people, exercise may seem like a waste of time, but it is equivalent to spending a bit of time sharpening an axe – it is not wasted time, but time very well spent in servicing your whole body and mind.

Closely related to this (and maybe actually more important is serotonin), which is a controlling hormone for your bowel, and is the target of low-dose anti-depressants used for IBS treatment that are used to raise your levels of it by inhibiting its destruction. Exercise increases your serotonin levels, but there are also two other surprising ways to do this: 1.) avoid hostility and increase your agreeableness!, 2.) bright light, i.e. get outside in the daylight as much as possible and avoid dim lighting indoors.

Other points...

IBS-D can be characterized as having excessively fast gut motility or excessive peristalsis, while IBS-C is where the motility and peristalsis is slower than normal. If it’s too fast, then your enzymes don’t have enough time to work on the food, and for you to absorb the nutrients, giving IBS-D. Coffee (both caffeinated and de-caff.) stimulate peristalsis of the intestines and so this is negative for IBS-D, but positive for IBS-C. Tea, snacks, spicy foods, black pepper and hot peppers also stimulate peristalsis. The general advice given for IBS is to cut down on tea/coffee stimulants, no more than 3 cups a day is the NICE guidance, but this entirely depends on whether you are IBS-D, IBS-C or a mixture of both. If you have IBS-D, you should try cutting tea/coffee out altogether, and for IBS-C you could try drinking more! You then realise that you can “tune” your gut peristalsis by how much tea or coffee you should drink in a day. The half-life for excretion of caffeine from your body is between 5 and 15 hours depending on your health. So, it can take about three days to remove it all from your body to know how you would really perform without it. For IBS-D, this is worth doing, and then re-introduce it by one cup per day (starting with tea), and then do not exceed what you determine is the optimum for you. You may only tolerate one cup per day, or none. This is important, because even if your enzyme levels are good, and you take supplements, if your gut peristalsis (motility) is too fast you will drive undigested food to your colon causing all of the usual symptoms.

Be aware that, caffeine also “drives” anxiety, a “nice cup of tea” won’t necessary calm you down, but may actually make you more agitated.

There is a lot of support for L-glutamine to help with repair of your small-intestinal lining; this means buying 500g of the bodybuilder powder type and having a couple of tea-spoons of this a day - one before breakfast and one just before you go to bed, and you can have this in a light cordial drink. I don’t think this is a permanent requirement, but I think can help you recover more quickly from long term issues.

I am not a fan of pro-biotics, I have never found that they actually do anything for me, although some people may disagree. However, I have had more success with pre-biotics, which is basically food for your large intestine good bacteria. This helps to strengthen the lining of your colon, and further improve your resilience to potential trigger foods and inflammation. Again, I would only use these periodically for a few weeks to help you back to a good state which you can then manage with the other good behaviours. It’s not that they do you any harm, just another thing to shop for. The pre-biotics can give a noticeable improvement in your GI comfort and performance, but don’t depend on them alone. You cannot get away with having poorly digested food in your large intestine.

I should add that although I eat bread and milk now in moderation, I am still cautious about high FODMAP fruits and tend to avoid them. The FODMAP fruit list is complicated, but an easy way to remember it is like this: "fleshy", juicy fruits are bad, i.e. (nectarines, peaches, apricots, pears, apples, plums, dates etc), but segmented fruits (oranges, mandarins etc.) and all berries are generally OK, as you are not likely to eat lots of them. Best of all is bananas which you can eat loads of. (Microwave three of them until they are mushy and put a couple of fried eggs and cheese on them is my favourite weekend breakfast!). For efficient fructose adsorption, you need glucose to be present with it in a 1:1 ratio. No enzyme will help you with your fructose adsorption from fruits with excess fructose, but what can help is trying to balance the fructose with an excess glucose fruit like banana. Bananas, figs, kiwis and pineapples have an excess of glucose over fructose, and so you can balance fruits with excess fructose. If you try using pure glucose powder, this will not travel slowly in your guts and you’ll still be left with excess fructose later on, so it is better to use bananas for the slow release of glucose to accompany the fructose. So you can experiment with this by making a fruit salad mainly composed of bananas, and small amounts of other fruits. However, be aware, that the problem with “fleshy” fruits (e.g. nectarines) is not only fructose ratio, but rather the polyols that they also contain, which can still make you ill.

I should also mention hormone changes in women can be connected with IBS, affecting the brain-gut nervous system, but being male I have no personal experience in this. Similarly, hypnosis is actually recommended by NICE as the best alternative therapy, again trying to get a grip on the nervous dysfunction. I have tried this, but for me I was just being very relaxed with your eyes shut for half an hour. However, like other therapies it concentrates on repeatedly putting lots of positive thoughts in your mind, and strategies for dealing with negativity, so I’d say it is a good complement for your psychology and anxiety, although it will not address organic issues like SIBO. But, as an example of your sub-conscious on your guts, if you have IBS-D, try taking yourself off camping for a few days in a “proper” tent. The change of living environment will slow down your gut motility into emergency mode as your mind tells your body to get everything it can from the food you eat in case you don’t have any in the future. Camping also removes you from your usual daily anxieties, and gets you more active.

Dealing with Flare-ups

First thing is, fix your SIBO as described above. If you still have SIBO symptoms, oregano oil capsules are very good, it is bactericidal, anti-inflammatory and can help with acute SIBO problems. It is not “gassy” as you may find with peppermint oil. Take some digestive enzymes, to ensure your digestion is complete. Fixing your SIBO has got to be your priority.

If you are on top of your SIBO, then a bowel toxin might hit you 5 to 8 hours later as the food gets to your large intestine. The first line of attack in this case is ibuprofen which is far more effective than paracetamol for bowel pain, and I find that 200 mg alone is enough. Second, a couple of 10 mg Buscopan will stop the cramps. If you have IBS, always have available in advance some linseed (seeds) and natural aniseed (Star Anise), and when you are bad make the following tea: in a saucepan, add 1 teaspoon of linseed, ½ to 1 anise star, 1 teaspoon of sugar, a squirt of lemon juice (bottled is fine), and one mug full of water. Boil to simmer, with stirring, for 3 to 5 minutes, then sieve off the hot liquid back into the mug. This is a very effective remedy that I have used countless times, and it really does help. The reason that it helps (anecdotally) is that the “gooey” linseed extract coats the intestinal lining. There may be some truth to this, as some propose that the mechanism of bowel inflammation is a chemical attack on the mucus lining of the intestine which then allows food particles be exposed to the more delicate tissues underneath, causing inflammation. The linseed goo would provide a temporary replacement to the mucus lining, preventing further inflammation. In fact, NICE recommends oats and linseed for daily consumption for IBS patients.

A few references…

“Treatment and Management of SIBO — Taking a Dietary Approach Can Control Intestinal Fermentation and Inflammation, by Aglaée Jacob, MS, RD; Today’s Dietitian; December 2012, Vol. 14 No. 12 P. 16”.

DizzyDoll36 profile image
DizzyDoll36 in reply to Stuart24

Hi - I have had the symptoms you described many times but was told once it was dyspepsia. Not sure if I should take an anti acid, perhaps I don’t have enough acid to process food! I don’t want to take Omeprazole, is there a safe alternative?

Stuart24 profile image
Stuart24 in reply to DizzyDoll36

Omeprazole is very highly prescribed and is generally considered safe. Ranitidine is an alternative.

Not all gastritis causes acid in the mouth or throat sometimes it can just be in the stomach at the top of your tummy and even feel like there is so much pressure in this area. It can cause dreadful pain under the breast and radiate to the back. I have had it several times with excruciating pain in my middle back and even when trying to sleep it wakes me up and I can't sleep on one side or even on my back as the pain radiates down my arm. I tried omeprazole and it made me dizzy really bad after just 6 days I then ended up going for a treadmill test to check for angina and they wouldn't let me do it as they said I had a heart murmur which could possibly be a faulty heart valve. I immediately went to my doctors and got an urgent referral to a heart surgeon. I was telling my neighbour who asked me was I on omeprazole and I said yes. She then told me she thought it was the most evil drug ever made as she had had so many problems from it and had friends who had all kinds of problems with it from heart murmurs hair loss in the shower every day split second black outs crashing cars into front of the house when pulling in the driveway at home.

I looked at the side effects in the pamphlet and it come up with all the side effects I was having and even some it says are very rare. I stopped taking them and it took me two weeks to get back to normal by which time I had an appointment with a heart surgeon and for a heart scan and ECG.

By the time I had had those done and seen the surgeon he said my heart was perfect and I didn't have any murmur now but I definitely had one when I first went to the hospital. It turns out omeprazole gave me a temporary heart murmur and I did feel faint often almost collapsing at times and my hair was coming out every morning in the shower. Now I just take gaviscon or what my consultant for ibs put me on which is called kolanticon gel which is especially good for ibs sufferers. It's a white liquid which you take every four hours and it has an antacid an antispasmodic and something called simeticone which helps with trapped wind that can also be the cause of back and tummy pain. The simeticone collects all the bubbles of gas together to help it pass out your body easier. Kolanticon also reduces bloating and helps with gastritis. Kolanticon is not prescription only so you can buy it from the pharmacy/chemist or you can get a script for it.. my consultant for ibs is reported to be the world's no1 expert on ibs. His name is professor Peter Whorewell of Manchester university hospital. He has done research for many years and he heads the only NHS bowel hypnotherapy treatment centre. He treats patients from all over the UK some even by Skype. He has also written books which you can buy and he prescribes different medicines depending on your type of ibs. Like I said I am currently on kolanticon and nortriptyline which helps with the pain and nerve pain and helps me sleep and it reduces anxiety . I am also possibly going to try a new anti biotic that the professor along with others has developed that doesn't pass through the small bowel so it m&s more effective at treating the gut. I am also considering and may be offered fecal transplant (bacteriotherapy) which is basically someone else's poo being transplanted in my bowels. The poo is tested from a healthy person who also has a healthy gut. It's then inserted with a tube or it is dried and put into capsules that dissolve when they reach the bowels. Sounds gross but it's just like taking any medication in capsule form and if it works I would try anything.

That sounds really interesting. I’ve never heard of that drug before. I’m in the Midlands. Wonder if your consultant is doing clinical trials.

I have IBS-D and gastritis.

Lizzy88 profile image
Lizzy88 in reply to Leemccluskey

Thank you for that in depth information! It has really helped! Do you get any nauseous when you have these attacks and afterwards

How long can you stay on Kolanticon? I’d like to get off the ranitidine that I take - 150mg twice daily.

I was told Ranitidine becomes mostly ineffective after a few months. So it may not actually be doing much for you. I was also told it can play havoc with liver enzymes as it did with me. My doctor said my liver enzymes were raised and she was puzzled. I then said to her I had read in the side effects of Ranitidine that it can give abnormal liver enzyme results and she said "well spotted!" and then she said it's better to come off them and go onto something like Gaviscon for a while.

As far as I know you can take Kolanticon Gel as long as you want. It says on my prescription take 1 to 4 x 5ml teaspoons every four hours when required and doesnt state any amount of times like say paracetamol which says take two tablets every four hours but maximum 8 tablets a day(24 hours)

Thanks for that info. I haven’t needed to try the Kolanticon gel as yet. Also I’ve warned myself off ranitidine a couple of weeks ago and my tummy seems pretty ok. I need to sleep sitting up quite often but other than that - all good!

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