PPIs help with pouchitis

Steve, I think a number of people here have had the same observation as you. Certainly worth looking into if you are having chronic pouchitis symptoms. Just one word of caution if you intend to stay on it long term. B-12 deficiency is associated with chronic PPI and/or antacid use. This is because stomach acid is necessary for the absorption of B-12 further down the GI tract.

Basically, this just means getting tested for deficiency every year or so.

Jan

More good news regarding antacids, PPIs, and H(2) inhibitors. Another study confirming that modifying the acidity in the gut helps prevent pouchitis.

Note the study very specifically states that sporadic use does not help - you have to be consistent with it.

This find has helped me tremendously since I first commented on it back in March. My daughter, also, seems to be keeping her chronic, acute pouchitis in order in part due to a daily regimen of Prilosec (we also take sulfasalazine for different reasons - hers for pouchitis).

Steve

Forgot the link to the newer study:

http://www.ncbi.nlm.nih.gov/pubmed/23532599

Steve,

This is fabulous news for you! What milligrams are you on? I know it is a prescription but do you think the OTC PPI would be beneficial? I am always on the look-out for some relief from this finicky pouch of mine.

Donna

Steve, I think this is really great news that the use of PPIs has improved your function. However, the study you cited is quite small, so should not be considered the end of the story. In particular, is my concern (that I failed to mention before) is that chronic PPI use can be associated with C. difficile infections in susceptible people. Apparently, stomach acid is also needed to suppress that bad boy too.

So, it probably is not a good idea for everyone to be on PPIs hoping to never get pouchitis, particularly for long term use. But, something to discuss with your doctor. In particular, if you are at risk for or had prior infections with C. difficile, then something to carefully consider.

I remember the days when they left people on Reglan for years. Turns out it is associated with causing irreversible neurological damage similar to Parkinson's. Happened to my step-mom.

http://www.ncbi.nlm.nih.gov/pubmed/23927671

http://www.ncbi.nlm.nih.gov/pubmed/23010681

Jan

I wish I could take PPIs. Thanks to having c.diff I can't anymore. Only Zantac on occasion since I have gastritis and some almost cancer ulcers in my esophogus. I never noticed a difference being in Perscription strength previcid for a year. shen says Zantac is the only safe one to take here and there for c.diff avoidance. My local GI has said the same.

Man Jan Reglan is evil! I was in the hospital from allergic reaction and they gave me reglan. I had dystonia symptoms. Horrible experience. Freaked my hisband out big time.

I guess you were lucky to find your intolerance right away. My step mom thought she absolutely HAD to take it or she would cease to function. She was on it for 20 years. Then came the tremors, wooden gait, lip smacking, the whole nine yards. I marched her in to her neurologist, and right off the bat, he caught the Reglan issue. Stopping it helped some, for a while, but the symptoms returned and worsened with time. They say that perhaps susceptible people were destined to possibly get Parkinson's anyway, like perhaps this is a trigger. But, yikes...

Jan

I have taken a prescription strength PPI for over 10 years including the 2.75 with my j-pouch. I'm pm Omeprazole (Prilosec). I've had c.diff with my colon and with my j-pouch but I'm still going to take the PPI for my GERD. I tried to taper off of it not to long a ago but got sick. I take s.boularii daily for c.diff prevention. I hate taking a something to counter act another, it can drive one nuts but it happens

Tapering off Nexium (a PPI like Prilosec) was a nightmare for me. The rebound reflux was much worse than the original GERD, and proved temporary (though it felt like I barely survived it). I'm doing it again, but this time I'm replacing the PPI with Zantac, and it seems to be working. Zantac is easy to stop, if the underlying GERD is mild enough to permit stopping.

Jan, could a b-12 supplement be helpful if you are taking a H-2 blocker such as pepcid?

Steve, thanks for this thread.

I was told by a doctor that PPIs can worsen SIBO.

What's SIBO?
Thanks

Taking B-12 only helps prevent B-12 deficiency. It does not affect the issue with SIBO.

SIBO is small bowel bacterial overgrowth.

Jan

Thanks Jan. I meant could a b-12 supplement be enough to counteract the effects of the h-2 blocker maybe making you b-12 deficient? My daughter is trying a low dose, 5mg, of pepcid and is feeling better pain wise, although we don't understand why, but who cares if she can reduce her pain. So I told her to pick up a b-12 supplement to take along with it. She has never been b-12 deficient before and we don't know if she is now either, she has only been trying the pepcid for a few days.

As far as boy's mom's Dr saying it can worsen SIBO, could that be helped with probiotics and FODMAP diet? She is not back on FODMAP yet (suppose to help SIBO, although she has never been diagnosed with it) since she is still on the post surgical diet but plans on getting back to it within a month and that may even help where she might not need the H-2 blocker. But she does take probiotics.

Thank you!

It takes quite a long time to become B12 deficient, and it's easy to fix (e.g. with an injection). If you're trying to juggle a lot of things, it really is okay to put off worrying about the B12 issue with PPIs for a while. Imagine the unnecessary nuisance of a bellyache caused by the B12 supplement.

Some side effects of some meds need to be expected and managed in anticipation of their arrival, but most can be dealt with if they show up.

Thanks Scott.

Yeah, it takes 3-7 years to become deficient. Plus, you don't even know if she would be affected. It is a risk, not a certainty. So, unless she isn't eating any animal products, I wouldn't worry about it. And here is why:
If her ability to absorb B-12 is blocked, it would be the same for supplements, and she'd need injections. B-12 from animal based foods is the most bioavailable (useful for the body).

Jan

Thanks Jan! Good to know.

My nutritionist has me taking B-12 under my tongue because it is absorbed better than if swallowed.

What are the signs of small bowel bacterial overgrowth? Is this one more thing we should all be looking out for?

SIBO and pouchitis have similar symptoms.

I get extremely bad gas and movement. Stool that is really stinky is a sign. And guut gurgles.

Yes essentially, if you have pouchitis symptoms without evidence of pouch inflammation, then it is either small bowel bacterial overgrowth or irritable pouch syndrome (or both!).

I'm not sure it is something to watch for or worry about. It is just to be in the differential diagnosis if you have pouchitis symptoms that are persistent after standard pouchitis treatment.

Jan

I have IPS and pouchitis that goes away when treated plus a terrific GI so I'm not borrowing trouble.

It is interesting to know.

Thanks ladies

My son has symptoms of pouchitis frequency, urgency and incontinence, especially at night. However it is not especially inflamed like it would be with pouchitis - so I assumed SIBO -- but how do we distinuish with IPS and is that treated differently? Thank you.

Bacterial overgrowth responds to antibiotics. IPS, not so much. For IPS the treatment is the same as IBS: antispasmodics, low dose tricyclic antidepressants, fiber supplements, probiotics, etc.

Jan

I'm having good luck with decreasing gas and bloating using the FODMAP diet thus far (also taking Culturelle). Not that it'll fix issues when things are raging, but might help con't to decrease symptoms once things are better. I already know I'm lactose intolerant; this is just helping even more. Just a thought, for those who'd rather try a dietary change first vs. automatically reaching for meds.

Rachaelraven - I don't know what FODMAP stands for I've tried at least 3 dozen diets the last 2 decades, maybe I've already tried it. If not what's one more? Please tell me what the acronym stands for and I'll look it up.
Thanks

Hi Marie,
My daughter was trying FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) prior to this last surgery and will try it again after a few more weeks. It seemed to help with her bloating, but for now it's a post op diet for her.

Here are a few links.
http://shepherdworks.com.au/di...tion/low-fodmap-diet

http://www.webmd.com/ibs/featu...ight-diet-ibs?page=2

Best to you.

Thanks for the links Beckysmom, I know I have not been on this one!

1st time heard SIBO. If ulcers always seem to be in part left when connecting j-pouch. instead of pouchitis/could it be SIBO. Is it wrong to say the inflammation is not given a name when tested but doctors inflammation by name according to where the problem exist? I was taken/chewing antacid/seems to help consistency of stool(also indigestion) to come out better. Seems for one thing it is the reason for calcium deposit on breast/cause me to have further testing but ended up just calcium deposit. wander if it could also contribute to why so many issues. also told to eat several meals instead of big ones for j-pouch/downfall/had three cavaties between teeth. teeth cleaner explained unless brush teeth each time. six times???? well we have all heard dang if I do dang if I don't. Also do the GI know about this in j-pouch or another certain type doc?