Heartburn: question for Gabes and Tex

[ingridj]

Hi to all
I am still regularly reading and appreciating the information on this site. Thanks to everyone who gives of their time to this!
Towards the end of September I posted that I was experiencing uncomfortable heartburn.
At that time I was on 9mg of entocort and avoiding
Gluten, dairy , soy. I have tolerated entocort fairly well. However I am now tapering, down to one tablet
every second day but recently the heartburn has become much worse. I was not following advice of smaller meals more frequently but am now doing that. Is it the entocort that is possibly causing the heartburn? I thought not, as the dosage has decreased, but perhaps this is a cumulative effect?
I think I read on a previous post from Gabes that increased D3 helped her? I know magnesium is a must. I am using a spray and Epsom salts in my bath as I am very wary of trying any magnesium orally. Do you think I should risk trying mag glycinate 100mg perhaps twice a day? My instinct is not to do this but the heartburn is really impacting me daily now.

I lay down at the gym this morning and had to get up and leave as the pain was so intense. Once I’d walked around a bit, it subsided. Am making sure to sleep on my left side! Any advice you can give me would by much appreciated.
Thanks
Regards
Ingrid

[tex]

Even though budesonide is designed to act locally in the gut, it still provides meaningful anti-inflammatory suppression in the upper GI tract, so when the dose is tapered, subclinical esophagitis or gastritis may appear (or reappear). In other words, acid exposure that was previously tolerated may now cause symptoms, So that heartburn sometimes appears even though acid production hasn’t increased. This is because budesonide may have been masking acid sensitivity (not preventing acid secretion) by suppressing mast cell activation. As budesonide is tapered, mast cells tend to be reactivated In the digestive system, including in the upper GI tract. This is a perplexing problem, but I'm guessing that it's probably somewhat common among MC patients.

My best guess for possible solutions include:

• Slower tapering of budesonide (You may be doing this already — Did you stay at each stage for at least 10 days to 2 weeks?)
  H2 blockers (famotidine, nizatidine)
  Mast cell stabilization practices such as avoiding alcohol, stress, and high histamine foods)
  Ordinary type I antihistamines may help (cetirizine, loratadine, fexofenadine)
  And of course, magnesium, quercetin, and vitamin C may help

If none of this helps, it may be necessary for you to ask your doctor to assess you for eosinophilic or lymphocytic esophagitis.

Tex

[ingridj]

Thank you Tex. Yes I have been doing a slow taper and am also alternating the entocort with Loratadine. I have an appointment with a gastroenterologist mid January. Hopefully he can advise.
To me it seemed to be linked to the entocort but I couldn’t understand why.. as the dose was decreasing. Your explanation makes sense.
Regards
Ingrid

[tex]

If you're going to see a gastroenterologist, a prescription for oral cromolyn sodium, Or ketotifen would probably be the most beneficial, Because it would stabilize mast cell activity and prevent mediator release. Over here in the US, those prescriptions are unavailable, but if you're in Europe, they should be available (at least in some countries).

Tex

[ingridj]

Thank you Tex. I’m in South Africa. Googled both of them. Does not look like they are readily available but I will certainly ask.
Regards
Ingrid

[Gabes-Apg]

early in my MC healing journey i ended up with hiatus hernia, could not bend down to tie up runners without bad pain and near vomitting.

it was a combo of contributors

what fixed it

- B6 via P5P and magnesium moderate bile acid if you have excess it will calm it
- magnesium and Vit D3 healed the hiatus hernia in about 4 months. (the GI wanted to do surgery)
- H2 antihistamines as suggested by tex while i worked on fixing the nutrient deficiencies

enjoy meal time, don't eat in a hurry etc, dont eat when stressed. gentle walk after dinner will help digestion (5-10 mins)
make sure you eat at least 2 hours before bed time. I have my main meal in the middle of the day.

be patient, things will take a while to work. Months not weeks.