Undigested pills in toilet

[mzh]

Why would there be undigested pills in the toilet? There is often one in there after flushing. I fished it out of the bowl (yuck!); it was soft, gray, but apparently complete. I only take pills in capsule form so one would think they'd dissolve easier than tablets.

I take Vitamin D3, calcium, leutein, Melissa (lemon balm) at night for sleep, Friendly Flora (a pre and probiotoc), and omeprazole, which I take after giving my GI doc much resistance. I never saw pills before I started the omeprazole so I have to wonder if that's the culprit. The GI doc says it's because I have a short colon. I had that 2 years before the pills in the bowl started.

Does anyone know anything about this? Am I correct in thinking that the omeprazole is the culprit? Yes, I have MC, diagnosed by the same GI doc who prescribed the omeprazole. My endoscopy showed focal Barrett's, which is why he prescribed this.

Marcia

[tex]

Hi Marcia,

Your GI doc is wrong - it's not because you have a short colon. I don't even have a colon, (or a complete ilium, for that matter), I take a lot of pills, vitamins, etc., (16 different pills in all), and I never see any undissolved pills in the output into my ileostomy pouch, (trust me, I couldn't miss them if they were there, because the output from an ileostomy is usually mighty thin).

These days, many pills, especially those used for treating IBDs, or those containing ingredients that might damage the lining of the stomach, have an enteric coating, designed to prevent them from activating in the stomach. They begin to activate, (break down), after the pH of the fecal stream rises to about 6.0 or 7.0, (depending on the type of enteric coating used). In a "normal" gut, (the gut of a healthy individual, free of disease), such coatings will typically allow the pill to proceed to the lower third of the small intestine, (the ileum), and/or the colon, before beginning to break down, and thereby release the active ingredient in the pill. Of course, vitamin and mineral supplements are designed to become available at least as soon as the pill leaves the stomach, because most nutrients are absorbed in the small intestine, so they shouldn't need a retarding coating. Only water and electrolytes are absorbed in the colon - nothing else is absorbed there.

A PPI prevents the parenteral cells of the stomach from producing normal amounts of acid, (IOW, they raise the pH of the stomach). Therefore, if anything, they should enhance the breakdown of enteric-coated pills, and make them break down sooner. A "wild card" in this process, though is the pancreas. If the pancreas is not functioning normally, (and that seems to be true for many of us with MC, at least while our MC is active), it may not provide the bicarbonate needed to raise the pH of the fecal stream to the normal level. In fact, it is known that in some patients with inflammatory bowel disease, a pill with an enteric coating that has a pH rating of 7.0 may never break down, because the pH of their digestive tract may never get that high. Consequently, some of the newer treatments are designed to activate at a pH of 6.0 or 6.5, instead.

Though many GI docs get all bent out of shape when they discover that the pancreas may be inflammed, or otherwise behaving abnormally, the problem virtually always resolves, once our MC symptoms are resolved. Therefore, based on your description, I would have to guess that the omeprazole is probably not the reason why you are finding intact pills in the toilet. However, I can't help but wonder if it might possibly play a part in the inflammation of the pancreas, (IOW, it might be an indirect cause of the unabsorbed pills, because it is documented that the 5-ASA drugs, for example can cause chronic pancreatitis. It is known, for example, that PPIs cause parietal cell hyperplasia and hypertrophy in the stomach, (and IMO, this could also negatively affect the function of the pancreas):

It is likely that the parietal cell hyperplasia and hypertrophy we observe with omeprazole is due to a trophic effect resulting from the hypergastrinemia associated with the hypochlorhydria induced by a PPI. It also provides a physiological basis for the rebound hyperchlorhydria transiently associated with cessation of therapy with a PPI. There is evidence this effect is also observed with other PPIs as well, including lansoprazole.

http://www.hon.ch/OESO/books/Vol_6_Barr ... rt007.html

Tex

[explosive]

I too have been passing pills in whole form for a long time. My doctor has me opening any capsules that I can and taking with applesauce or pudding. My GI said that my colon just emptied too fast. He said things are literally passing straight through me. I am taking at this time:

HCTZ
Topril
Nexium
Potassium
Ferrous Sulfate
Ativan
Lodrane
Cymbalta
Librum
Desryl

And Entocort if it ever comes.

When I had my small bowel follow through I drank the chalky contrast and they would take picutres as the contrast would pass through. They said it could take anywhere from 4-8 hours for it to travel through the bowel. I had to go to the restroom with d right after drinking it and 20 minutes later I was passing it. They had to get me on the table fast. They didn't believe me at first until they saw it for themselves. Does anyone else pass stuff this fast or is there something else going on. Sometimes when it is at its worst I start with dinner on my plate and end with it in the toilett.
Sharon

[Mags]

It happened to me all the time until I put myself on an extremely high-protein diet. Pills would come out intact, food would come out intact. I have trouble digesting meat because I have had c. diff., so I use a gluten, dairy, soy free vegan shake. I'm certainly not a vegan, but it does provide a complete protein, and I do three shakes a day, instead of the one recommended. I blend it with lactose-free whole milk. If you are sensitive to casein, this would not work, but any rice, almond, hemp, or other milk would be fine.

Norman is a regular visitor around here. I am unable to take steroids, so I have to do the best I can with diet. I only use Lomotil when I must, and cholestyramine when I flare.

I must stress that this is only my opinion and only my experience. I also take 40mg of omeprazole per day.

I get my shakes (called Vegan Proteins+) from [url]genuinehealth.com[/url] .

I've only started completely eliminating gluten since I've been on this board. I'm hoping that it will finally do the trick!!!

However, Tex is a fountain of advice and good judgement. I just posted because of the lack of Entocort...

Good luck!!!

Mags

[klhale]

that happened to me when I was taking Asacol....red whole pills would empty right into the toilet...very weird. Needless to say, Asacol did not help me at all. I have never had this happen since that time.

It must be a rejection by the colon.

Try taking one pill a day and see if you can isolate which pill is causing the problem.


karen

[tex]

It's somewhat common for members to report Asacol ending up intact in the bowl. Of course, the rapid transit plays a part, since the breaking down of enteric coatings is also a time-dependent process. The problem is reported so often in connection with PPIs that I wonder if there might be a "backlash" effect because of the PPI. IOW, because of the PPI, the pH of the chyme, as it enters the small intestine, is significantly higher than it would otherwise be, (though still acidic), so the pancreas does not detect a normal need for buffer, and as a result, it may not add sufficient buffer to the chime, causing the pH to remain too low for the proper breakdown of enteric-coated pills. I'm not aware of any research that has investigated this theory, but there seems to be a connection, and this would provide a logical explanation for what happens in so many cases. Normally, Asacol should become activated before it reaches the colon.

The point is, if the pills remain intact, it is either because they are not allowed enough time to break down, (due to rapid transit), or the pH of the entire GI tract is too low, (implying a malfunction of the pancreas), or a combination of the two possibilities.

Tex

[mzh]

The responses are so helpful; they actually helped me remember more stuff too. Tex, I feel like I'm in college when I read your posts. Thanks so much for the details.

I've been on Entocort -- my lifesaver -- off and on since 2005. (I'm off right now.) I can't tolerate the regular dose of 3 pills a day. I do well on 1 pill every 4 days. At the moment I'm on day 9 of no Entocort. The only addition to account for this wonderful event is Friendly Flora, a pre and probiotic which gives me pretty normal BMs. I splurged and had breaded shrimp yestersday so I had one round of D today. I'm not celiac, just gluten sensitive.

I also have fast transit time except for the upper esophagus, which is slow and spasms some. Barium will start coming out in an hour but it takes several hours to be completely gone.

The GI doc gave me Zenpep, a pancreatic enzyme. It seemed to help for a few days but then it didn't; I still needed Entocort to give me normal BMs. (Is Norman diarrhea?) The Zenpep gave me awfully stinky gas too so I stopped that.

Sharon, I was thinking about just opening up the caps. The omerprazole is time-released so I can't open that one up but I can stop it and see if the pill stops showing up. Karen, I like your idea of taking one pill a day but I bet it's the omeprazole in the bowl sincde it's the only timed-release one. I have to wonder if it's doing anything.

Marcia

[tex]

Marcia,

Many years ago, someone on the forum mistyped "normal", as "norman", and the name stuck as a substitute name for a normal BM. You can see a listing of abbreviations and substitutions sometimes used on this forum, at the following link:

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=845

If the omeprazole is the one that is passing through intact, then that would explain why the pH of your intestines might be abnormally low. That's a classic Catch-22 situation, if I ever saw one. The omeprazole is prescribed to raise the pH level of your stomach and intestines, but it doesn't work, because the pH level of your intestines is to low to allow it to activate. Someone wasn't thinking clearly when they designed the encapsulation.

Tex

[mzh]

Hi again,

Sorry to have been missing from the thread, but I had nasal surgery on 1/20 and am feeling like I can come back to gut issues instead of thinking about nose issues. LOL

The amazing thing is that I have no gut issues at this time! I started taking Friendly Flora (a wonderful pre and probiotic supplement from Procaps Labs) back in December. Apparently it has kicked in and I've had normal BMs since about January 8! The surgery required that I take clarithromycin for 10 days. I usually get severe diarrhea 2 days after taking most antibiotics but this time I had no issues except a bad taste in the mouth. I didn't take the omeprazole b/c there was a possibility of an interaction with the antibiotic. (Actually, clarithromycin and omeprazole is a good combo for treating H Pylori but since I don't have the later, I took a break from the omeprazole.) I went back on it yesterday so we'll see if there is anything in the toilet soon. If the bms are normal they may be buried in the stool and still whole. I dunno; time will tell. All I can say is, it's great to have Norman without having to take Entocort.

[mzh]

I don't know if anyone is still following this thread but I wanted to report on the Friendly Flora pre/probiotic I've been taking since mid to late December. I haven't had any Entocort since Jan 8 and my bowels have been good up to last Friday, Feb 25th. The loose bowels started again so I restarted the Friendly Flora that day. (I had stopped them for a couple of weeks to see if they were still necessary.) It's Sunday and for the first time I noticed the dreaded half-dissolved pill in the toilet b/c I was loose again. It's a tab, not the capsule; I bought the wrong kind. So, after 8 weeks of 95% "norman" <G> things are loose again. I hope the Friendly Flora will normalize things again soon. If not, I have Entocort on hand. Ah, it was a good month and a half!

I was wondering if Zegerid with the bicarbonate added would be better for digesting the omeprazole. Thoughts and experiences are welcomed!

[TooManyHats]

I have no way of telling if the Lialda is dissolving. There is no way to differentiate anything in the toilet, it's all watery. I'm now supplementing with Immodium; 2 at a time.

[Gloria]

Hmm. From January 8 (the day you stopped taking Entocort) to February 25 was almost 7 weeks. You might also want to consider that Entocort had finally gotten out of your system and is the reason for your D.

I've gone 55 days without being on Entocort, and on the 56th day, the D would come back with a vengence. It's been the board's experience that we can't assume that we are in remission without Entocort until 56 days have passed without D.

Something to ponder. I hope the Friendly Flora helps you again.

Gloria

[mzh]

Wow, no kidding. I had no idea 56 was the magic number. I'm not anywhere near that but then I can only tolerate 1 or 2 pills at a time. Otherwise it's burning anus time. Perhaps my reduced dose reduced the remission time. Yikes!

Thanks for the heads up, Gloria. Why don't the doctors tell us this.... Off to find threads on this.

Arlene, the omeprazole sits in the bottom of the toilet after the flush. It doesn't flush away with the watery stuff.

Marcia

[tex]

Marcia,

From your original post in this thread:

I never saw pills before I started the omeprazole so I have to wonder if that's the culprit.

I hesitated to bring this up initially, because of your Barrett's symptoms, but it's possible that you may be reacting to the omeprazole. Omeprazole is documented to cause MC, in some cases, after extended use. If the drug is causing you to have an MC flare, (drug-induced MC), then obviously this could be the cause of the whole pills in the toilet, because rapid transit can also cause encapsulated pills to fail to activate. It's possible that you may have developed a sensitivity to the omeprazole, so that after all the budesonide, (in the Entocort), cleared your system, then the omeprazole began to cause symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/19142168

Why don't the doctors tell us this....

Because the doctors are not aware of it, and since it hasn't been officially researched and scientifically proven, I'm sure that they will argue that it is totally worthless misinformation. We have found it to be quite accurate, though.

The omeprazole may not be your problem, though, if it is not being activated before passing out of your system. Of course, it takes a few weeks for all of the residual omeprazole to clear your system, also, so you might be reacting to a residual supply.

Tex

[TooManyHats]

Oh, Tex, I wish you had been in that exam room when I tried to tell my doctor that.