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I have a question, in this case not for myself but for a board member of a Dutch bowel disease board (I feel like becoming an expert there on MC, but where did I get that information ... HERE of course). Well two questions
1. is there a relation between MC and stomach problems, like heart burning (is that the same is GERD?) and/or inflammation of/in the stomach? I thought I read here there was, but not 100% sure
2. Is it a problem to take budenofalk together with stomach medication, I thought I read somewhere there was, due to the PH of the stomach and the release of the med. Some stomach medication for GERD can influence the ph of the stomach. The name of the medication this woman is taking is Lansoprazole en Ogastoro
combination stomach medication budenofalk (entocort)
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Harma,
As I understand it, the pain, discomfort, and other symptoms associated with upper-abdominal signs of poor digestion, are usually referred to as "indigestion", or "heart burn", but when reflux, or regurgitation of small amounts of the stomach contents into the esophagus is involved, especially on a recurring basis, it is referred to as gastrointestinal reflux disease, (GERD). I'm not sure that MC causes GERD, or vice versa, but many patients with MC, also have GERD.
It appears that not all of us here have stomach involvement, but many of us do have stomach inflammation, (gastritis), and some of us have problems with gastroparesis, which leads to the symptoms of nausea, and sometimes vomiting, due to slow emptying, or failure of the stomach to empty it's contents. A few of us also seem to have collagenous gastritis, which is probably a special case of collagenous colitis, though it has not been officially classified that way.
Theoretically, one should not take an antacid, or a PPI, while taking an enterically-coated tablet or capsule, that is designed for the treatment of lower digestive system issues, due to the risk of prematurely breaking down the enteric coating, and thereby activating the drug sooner than it was intended to be activated. Some research, however, shows that the risk may not be significant, (at least as far as the benefits of the drug are concerned).
The reason for this is that most enteric coatings are secure, as long as the pH is below 5.5, and I have a hunch that most PPIs are not likely to cause pH excursions greater than this, simply because digestion in the stomach would be very poor, at that relatively high pH level. (A pH of 7.0 is neutral). In fact, even after the coating begins to break down, budesonide is released in a time-dependent fashion, this ensuring that the drug will be well down the small intestine, before any significant amount of the active ingredient becomes available:
So, while taking the two drugs together is not an ideal situation, the fact of the matter is, the Entocort will probably still work pretty much normally. Using a PPI concurrent with using Entocort EC may result in a higher risk of systemic absorption, however, meaning that more than 10 to 15% of the budesonide might be absorbed into the bloodstream, which might possibly increase the risk of developing side effects. I doubt that this would make a huge difference in the risk, however, because of the safety factor built in by the time-release feature.
However, there's a much greater risk from taking Lansoprazole, (or any other PPI). Does she have microscopic colitis? If you do a search, using the key words : Lansoprazole, microscopic colitis, you will find many reports documenting cases of microscopic colitis, caused by the use of Lansoprazole. If she has MC, and if I were in her shoes, I would stop the use of the Lansoprazole, at least long enough to see if it is causing her MC symptoms. Chances are, she might be able to go into remission, by simply stopping the use of Lansoprazole.
If she doesn't have MC now, there is a significant chance that she may develop it at some time in the future, if she continues to take Lansoprazole.
Tex
As I understand it, the pain, discomfort, and other symptoms associated with upper-abdominal signs of poor digestion, are usually referred to as "indigestion", or "heart burn", but when reflux, or regurgitation of small amounts of the stomach contents into the esophagus is involved, especially on a recurring basis, it is referred to as gastrointestinal reflux disease, (GERD). I'm not sure that MC causes GERD, or vice versa, but many patients with MC, also have GERD.
It appears that not all of us here have stomach involvement, but many of us do have stomach inflammation, (gastritis), and some of us have problems with gastroparesis, which leads to the symptoms of nausea, and sometimes vomiting, due to slow emptying, or failure of the stomach to empty it's contents. A few of us also seem to have collagenous gastritis, which is probably a special case of collagenous colitis, though it has not been officially classified that way.
Theoretically, one should not take an antacid, or a PPI, while taking an enterically-coated tablet or capsule, that is designed for the treatment of lower digestive system issues, due to the risk of prematurely breaking down the enteric coating, and thereby activating the drug sooner than it was intended to be activated. Some research, however, shows that the risk may not be significant, (at least as far as the benefits of the drug are concerned).
http://www.drgreene.com/adam/drugs-alte ... budesonideProton pump inhibitors (omeprazole, pantoprazole, rabeprazole): Theoretically, alteration of gastric pH may affect the rate of dissolution of enteric-coated capsules. Administration with omeprazole did not alter kinetics of budesonide capsules.
The reason for this is that most enteric coatings are secure, as long as the pH is below 5.5, and I have a hunch that most PPIs are not likely to cause pH excursions greater than this, simply because digestion in the stomach would be very poor, at that relatively high pH level. (A pH of 7.0 is neutral). In fact, even after the coating begins to break down, budesonide is released in a time-dependent fashion, this ensuring that the drug will be well down the small intestine, before any significant amount of the active ingredient becomes available:
http://www.globalrph.com/corticosteroids.htm#Budesonide__CLINICAL PHARMACOLOGY
Budesonide has a high topical glucocorticosteroid (GCS) activity and a substantial first pass elimination. The formulation contains granules which are coated to protect dissolution in gastric juice, but which dissolve at pH >5.5, ie, normally when the granules reach the duodenum. Thereafter, a matrix of ethylcellulose with budesonide controls the release of the drug into the intestinal lumen in a time-dependent manner.
So, while taking the two drugs together is not an ideal situation, the fact of the matter is, the Entocort will probably still work pretty much normally. Using a PPI concurrent with using Entocort EC may result in a higher risk of systemic absorption, however, meaning that more than 10 to 15% of the budesonide might be absorbed into the bloodstream, which might possibly increase the risk of developing side effects. I doubt that this would make a huge difference in the risk, however, because of the safety factor built in by the time-release feature.
However, there's a much greater risk from taking Lansoprazole, (or any other PPI). Does she have microscopic colitis? If you do a search, using the key words : Lansoprazole, microscopic colitis, you will find many reports documenting cases of microscopic colitis, caused by the use of Lansoprazole. If she has MC, and if I were in her shoes, I would stop the use of the Lansoprazole, at least long enough to see if it is causing her MC symptoms. Chances are, she might be able to go into remission, by simply stopping the use of Lansoprazole.
If she doesn't have MC now, there is a significant chance that she may develop it at some time in the future, if she continues to take Lansoprazole.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I just read her earlier messages, in earlier stage she suspected a relationship between her stomach medication and her diarrhea. But of course her doctor told her "no no that is not possible". So she even made the connection her self, earlier and the dr didn't do is home work. It looks like her complaints started after she started with Lansoprazole. I hope they will go away after she quit them. Again thank you, also on her behave.
harma
harma
Harma,
Even if she does not automatically go into remission, after stopping the Lansoprazole, she will need to avoid it in the future, since it will always cause inflammation for her, if it was the original trigger for her MC. If remission doesn't come within a week or so, she may need to change her diet, but you know how to help her with that, if she needs to do so.
You're very welcome,
Tex
Even if she does not automatically go into remission, after stopping the Lansoprazole, she will need to avoid it in the future, since it will always cause inflammation for her, if it was the original trigger for her MC. If remission doesn't come within a week or so, she may need to change her diet, but you know how to help her with that, if she needs to do so.
You're very welcome,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I will try another time to convince her another to join this message board. I know already a lot about MC, but there is still a lot to learn. Most things I know consider me. Things that are different from my situation I have to admit I don't put much attention to it. Just a quick look and I thing okay, good to know and that's it.
Hello Tex a while ago I asked a question here (in this topic) about the combination Lansoprazole and CC for a woman with CC and this medication a dutch/belgium message board. First she was very happy to hear their might be a solution for her CC. She quitted the stomach medication about a week ago and I just in read in her latest message that 80% of her bowel problems are gone. So, so far so good!! On her behave thank you very much. I think we together did a good job!!
Although she is very angry with her doctor, why didn't he know and even worse why didn't he listened to her (earlier she made the connection herself between the Lansoprazole and MC, the problems started (out of the blue) just after she started taking that meds).
harma
Although she is very angry with her doctor, why didn't he know and even worse why didn't he listened to her (earlier she made the connection herself between the Lansoprazole and MC, the problems started (out of the blue) just after she started taking that meds).
harma
Hi Harma,
That's good news. Yep, we make a good team, but you did all the work.
Thanks for the update. I hope she continues to improve.
Doctors are strange creatures. They're intelligent, and they realize that according to statistics, drugs have side effects, and there are risks in using them. For some strange reason, however, they can't seem to recognize the fact that those statistics actually apply to their own patients. They consider adverse drug reactions to be rare events, (so they don't expect that to happen to their own patients). Also, they seem to feel that since they prescribed the drugs personally, any patients under their care are exempt from any risk of adverse events from those drugs. I don't believe that they intentionally ignore the risks, but I have a theory that, subconsciously, those doctors feel that if a patient has an adverse reaction to a drug that they prescribed, that's somehow a negative reflection on them, and so the doctors are overly-defensive about such events, and they tend to try to ignore the risks, since bad reactions are "rare" events, (in their minds).
This all goes back to their medical school training, where they are taught that, “When you hear hoofbeats, think horses, not zebras.” IOW, expect to see common diseases, not rare ones. Unfortunately, because of that training, most doctors automatically rule our any diagnosis option they believe to be "rare", and they don't even consider that it might be a possibility.
As a general rule, most doctors grossly underestimate the risks of adverse reactions from drugs that they prescribe. Their career depends on prescribing drugs, so they tend to believe that those drugs have "magical" healing power, and can do no harm.
Their patients know better, of course, but many doctors don't put much trust in what their patients say, since their patients are not "trained professionals", such as themselves, (IOW, they have a deity complex).
Tex
That's good news. Yep, we make a good team, but you did all the work.
Thanks for the update. I hope she continues to improve.Doctors are strange creatures. They're intelligent, and they realize that according to statistics, drugs have side effects, and there are risks in using them. For some strange reason, however, they can't seem to recognize the fact that those statistics actually apply to their own patients. They consider adverse drug reactions to be rare events, (so they don't expect that to happen to their own patients). Also, they seem to feel that since they prescribed the drugs personally, any patients under their care are exempt from any risk of adverse events from those drugs. I don't believe that they intentionally ignore the risks, but I have a theory that, subconsciously, those doctors feel that if a patient has an adverse reaction to a drug that they prescribed, that's somehow a negative reflection on them, and so the doctors are overly-defensive about such events, and they tend to try to ignore the risks, since bad reactions are "rare" events, (in their minds).
This all goes back to their medical school training, where they are taught that, “When you hear hoofbeats, think horses, not zebras.” IOW, expect to see common diseases, not rare ones. Unfortunately, because of that training, most doctors automatically rule our any diagnosis option they believe to be "rare", and they don't even consider that it might be a possibility.
As a general rule, most doctors grossly underestimate the risks of adverse reactions from drugs that they prescribe. Their career depends on prescribing drugs, so they tend to believe that those drugs have "magical" healing power, and can do no harm.
Their patients know better, of course, but many doctors don't put much trust in what their patients say, since their patients are not "trained professionals", such as themselves, (IOW, they have a deity complex). Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.