Gastritis anyone?

[Joshman]

Hi everyone.

I've been a Type2 diabetic for about 6 years now, controlled by 3 Metformin's a day. Overall control is good. About the same length of time I've been taking Omeprazole for acid reflux / gastritis. All seemed to be going well until a few months ago when I started getting really bad stomach cramps, bloating, wind and needing to go to the toilet 3 or 4 times a day. I haven't lost my appetite exactly but I never feel hungry anymore, never get those hunger pangs. I'm eating less than I would normally, sometimes I can go without eating all day.

Blood tests showed I had a slight iron deficiency and I've been given iron supplements to take. Stool sample came back normal. I recently had an Endoscopy and Colonoscopy and all appeared normal in my stomach and bowels. So the iron deficiency remains unexplained. I did notice several weeks ago that when I stopped taking Omeprazole, the stomach problems settled down. However then, after a couple of days, the gastritis would flare up, causing pains and burning sensations in the chest. It quite often feels like I'm about to have a heart attack!

As if that wasn't enough, my blood pressure had been creeping up over the past year and was no longer in the "normal" range using Losartan Potassium alone, which I'd used for years. The GP added Amlodopine tablets which bought the blood pressure down. However in the last few months my heart has been racing, quite often over 100 bpm even at resting. ECGs and other tests showed my heart was fine and I was given 1.5mg of Bisoprolol a day to bring the heart rate down. It's now at about 75 bpm.

I seem to have zero energy these days, any kind of mild activity has me breathing quite hard. If I push myself further, I get an upset stomach. I'm just exhausted by it all and it's really getting me down.

I'm currently waiting to see the consultant again but my appointment isn't until December! I just wondered if anyone else has had similar symptoms and what was the remedy? Is the gastritis, iron deficiency and increased heart rate all linked together?

Thanks

 

[ButtterflyLady]

Is it possible you have developed delayed stomach emptying? This causes many of the gastrointestinal symptoms you describe, including reflux.

Are you on 20mg of omeprazole? I am on 40mg - any less than that and I get terrible reflux attacks that feel like I'm having a heart attack. I would recommend continuing to take it as prescribed.

Another possibility that springs to mind is obstructive sleep apnoea, which is linked to T2, reflux, high BP and some heart problems.

When you say your T2 is well controlled by 3 metformin a day, what are your BG and HbA1c levels like?

I think you should ask your GP to refer you to a gastroenterologist. If your December appointment is with an endocrinologist, I'm not sure how much they could do in relation to these other problems.

I worry about your breathlessness/exercise intolerance, which seems to suggest heart issues? Or asthma? What does your GP say about it?

 

[Indy51]

Metformin is known for causing malabsorption over time. I recently read of someone in the UK who'd been taking it for several years and had been offered testing for B12 and iron by their GP. I believe PPI drugs can also cause malabsorption issues.

I only took metformin SR for 6 months, but within that time my ferritin levels plummeted and I had bad gastritis - when I had an endoscopy my stomach lining was found to be inflamed and bleeding. So I stopped taking it, had a course of 5 ferritin shots and my ferritin levels returned to normal. At the time the gastroenterologist prescribed Nexium which I had weaned myself off when first going LCHF - within 3 days I had a recurrence of all the bloating and upper GI discomfort that I used to suffer with, so stopped it cold turkey and my gastritis pains went away without taking it as the stomach lining healed being metformin free.

My worry re the breathlessness is that you may still have silent reflux and be inhaling stomach contents which can also cause other issues like scarring of the lungs and pneumonia.

I'd definitely advise you to have further investigations.

One of the best things I ever did for my digestion was to stop eating grains and adopt a low carb diet. I'd never have been able to wean myself off Nexium without that step and would have still been in upper GI misery.

 

[Joshman]

Thanks for your replies guys....

I've been on 40mg Omeprazole for several years now and up until earlier this year the gastritis was well controlled. Now because of all the stomach problems, I'll only take one 20mg tablet every 2 to 3 days and I won't usually eat anything after 6pm. I did wonder if long term use of Omeprazole had led to me having low stomach acid. When I first stoppped the Omeprazole, it was over a week before symptoms of acid reflux returned.

I have been seeing a Gastroenterologist. She wanted me to have a Endoscopy, Colonoscopy and a CT Scan, all of which i had last week. From the Endoscopy and Colonoscopy they didn't see any signs of bleeding. I'm due to see the Gastroenterologist in December, I'd hoped it'd be sooner than that. She said if the above tests were all fine then maybe they'd do tests to measure my stomach acid.

My B12 levels are normal but my iron levels are low, although at this stage it's not so low as to be classed as anemia.

I'm due to have my next diabetic review at the end of this week but the past few years my HbA1c levels have been between 5.3 and 6.0.

I have discussed my breathlessness with the GP and he sent me for an ECG which was fine and a "Stress Test" where they put you on a treadmill and monitor you for about 10 minutes whilst they make it go faster. Apart from breathing heavily, that went fine too.
Trouble is now that the Gastroenterologist is involved the GP's happy to take a back seat until they've carried out all their investigations.

I'll ask about delayed stomach emptying, silent reflux and malabsorption caused by metformin next time I see her.

 

[ButtterflyLady]

Thanks for your replies guys....

I've been on 40mg Omeprazole for several years now and up until earlier this year the gastritis was well controlled. Now because of all the stomach problems, I'll only take one 20mg tablet every 2 to 3 days and I won't usually eat anything after 6pm. I did wonder if long term use of Omeprazole had led to me having low stomach acid. When I first stoppped the Omeprazole, it was over a week before symptoms of acid reflux returned.

I have been seeing a Gastroenterologist. She wanted me to have a Endoscopy, Colonoscopy and a CT Scan, all of which i had last week. From the Endoscopy and Colonoscopy they didn't see any signs of bleeding. I'm due to see the Gastroenterologist in December, I'd hoped it'd be sooner than that. She said if the above tests were all fine then maybe they'd do tests to measure my stomach acid.

My B12 levels are normal but my iron levels are low, although at this stage it's not so low as to be classed as anemia.

I'm due to have my next diabetic review at the end of this week but the past few years my HbA1c levels have been between 5.3 and 6.0.

I have discussed my breathlessness with the GP and he sent me for an ECG which was fine and a "Stress Test" where they put you on a treadmill and monitor you for about 10 minutes whilst they make it go faster. Apart from breathing heavily, that went fine too.
Trouble is now that the Gastroenterologist is involved the GP's happy to take a back seat until they've carried out all their investigations.

I'll ask about delayed stomach emptying, silent reflux and malabsorption caused by metformin next time I see her.

I'm not sure why you have reduced your omeprazole. It works by reducing your stomach acid down to something like 1% of what it was. If you stop taking it, then acid levels rise and people usually get reflux and dyspepsia symptoms back as a result.

My understanding is that gastritis is an acute inflammation that may be visible on endoscopy, and dyspepsia is the term used to describe ongoing stomach pain/discomfort that doesn't appear to have a visible/structural cause. I have had dyspepsia and reflux for nearly 20 years (regardless of whether I eat gluten or carbs) and it's controlled by omeprazole. I also have delayed gastric emptying, which is controlled by domperidone, but I understand this drug is no longer approved in the UK. An alternative is ondansetron, which is an anti-nausea drug.

 

[Joshman]

I stopped taking the Omeprazole because it was messing with my stomach quite badly, it was causing painful cramps, bloating, diarrhoea. When I stopped taking it the symptoms settled down. Unfortunately that meant the gastritis would flare up again.
I had ECGs, blood tests etc a couple of days ago and they didn't find any problems with my heart. So I'm beginning to think my stomach acid levels may be too low. From what I've been reading, I have some of the main symptoms of low stomach acid, including the stomach pains, the iron deficiency, shortness of breath, zero energy etc.

 

[hankjam]

I stopped taking the Omeprazole because it was messing with my stomach quite badly, it was causing painful cramps, bloating, diarrhoea. When I stopped taking it the symptoms settled down. Unfortunately that meant the gastritis would flare up again.
I had ECGs, blood tests etc a couple of days ago and they didn't find any problems with my heart. So I'm beginning to think my stomach acid levels may be too low. From what I've been reading, I have some of the main symptoms of low stomach acid, including the stomach pains, the iron deficiency, shortness of breath, zero energy etc.

My GP suggested I take Omeprazole and I got it from the Pharmacy. Reading the data sheet put me right off.... it stated "don;t take for more than 12 months" and yet it seems to be handed out like sweeties.... I put it in the bin.

 

[Indy51]

I stopped taking the Omeprazole because it was messing with my stomach quite badly, it was causing painful cramps, bloating, diarrhoea. When I stopped taking it the symptoms settled down. Unfortunately that meant the gastritis would flare up again.
I had ECGs, blood tests etc a couple of days ago and they didn't find any problems with my heart. So I'm beginning to think my stomach acid levels may be too low. From what I've been reading, I have some of the main symptoms of low stomach acid, including the stomach pains, the iron deficiency, shortness of breath, zero energy etc.

Your reactions to the drug sound very similar to mine, especially the bloating (for me it is all above waist level).

Chris Kresser has a free e-book on curing GERD and following the advice helped me a lot. The biggest thing was removing the fermentable carbs from my diet, especially wheat. The FODMAPS diet can help in this regard. I then tried pancreatic/digestive enzymes - you can get them with Betaine HCL or take that separately to help boost acid. Some people also find apple cider vinegar or lemon juice prior to eating can help. I'm including a link to his e-book. Also Norm Robillard's book.

http://chriskresser.com/heartburn/
http://www.amazon.com/Heartburn-Dig...qid=1441496365&sr=8-1&keywords=norm+robillard

FODMAPs diet:
http://www.med.monash.edu/cecs/gastro/fodmap/

I always have a bottle of digestive enzymes in the house and take one if I get even a hint of reflux after eating. I also have Zantac on hand for times when a simple antacid doesn't work. Though mostly these days I don't need to use anything.

I hope you can sort it out

 

[ButtterflyLady]

I stopped taking the Omeprazole because it was messing with my stomach quite badly, it was causing painful cramps, bloating, diarrhoea. When I stopped taking it the symptoms settled down. Unfortunately that meant the gastritis would flare up again.
I had ECGs, blood tests etc a couple of days ago and they didn't find any problems with my heart. So I'm beginning to think my stomach acid levels may be too low. From what I've been reading, I have some of the main symptoms of low stomach acid, including the stomach pains, the iron deficiency, shortness of breath, zero energy etc.

Have you tried ranitidine/zantac?