Bile Acids and Collagenous Colitis

[Gabes-Apg]

A h2 blocker is a much safer option, especially if you plan on doing Vit D3, mag etc.
It won't take long for the vitd3 and mag to help, 6-10weeks...

[Joseph7179]

Thank you again for the advice.. I really do not know what to do with this GERD and nausea, that is off and on each day. Maybe I should call him again and ask the question if there is another solution to this. I have been taking Vitamin D3 at 5000 for a year or so. i am also taking endocort at this time for a flair that began July 3 and seems to be well managed at the moment. This protonix could kick off a major event, I fear, and my last state might be worse than my first. I have had LC for 15 years but have managed it with GF diet and no dairy, and have been in remission for a year until July 3 when it started again.

Any advice is welcome.

[tex]

If you've been taking 5,000 IU of vitamin D for a year or so, your vitamin D level shouldn't be low. Of course that doesn't mean that a little more might not help, but that makes me wonder if magnesium deficiency might be more likely to be the problem than vitamin D, at this point.

Many of us have found that an ordinary over-the-counter H1 antihistamine can resolve nausea problems when excess histamine is the source of the problem, and it may help with the GERD, also. Some of us use Allegra or Claritin Redi-tabs (regular Claritin contains dairy). Some members here use Benedryl at bedtime, and it even helps with sleeping, because it's a first generation antihistamine, meaning that it causes drowsiness, so it's best to avoid taking Benedryl during the day.

If the normal dose seems to help, but doesn't quite do the job, it's possible to use up to to 4 times the labeled dosage (allergists use 4x labeled dosage treatments for treating chronic urticaria, so we know that it's safe at that level — I can provide a medical reference for that if you want). Some members here find that a non-drowsy antihistamine (such as allegra or Claritin Redi-tab) in the morning, and Benedryl at night works well for them, for example.

If you've been dealing with LC for 15 years, and successfully controlling your symptoms by diet, that makes me wonder if you may have developed a sensitivity to another food or food ingredient, such as soy or eggs. Sometimes we have food sensitivities that don't cause us to react until we finally manage to purge our body of all the gluten antibodies (which can take a long time) and then our immune system pays more attention to any secondary sensitivities that may be present, and begins to react to them. Based on EnteroLab test results, it appears that almost as many members here are sensitive to soy (and most legumes) as there are members who are sensitive to dairy. And quite a few of us are sensitive to eggs, also. We have to be detectives to track down the problem sometimes, because we all seem to be different.

You're probably aware that avoiding eating for several hours before bedtime is very helpful, especially for retraining our lower esophageal sphinctor. And avoiding foods known to cause reflux problems at all times is usually necessary for treating a GERD problem. Examples of such foods include chocolate, alcohol, coffee, tomatoes, peppermint, etc. Definitely avoid them for several hours before bedtime, because they can almost guarantee reflux problems.

One very important trick to help prevent GERD/reflux issues is to never lie on your right side, because that position places much of the stomach higher than the lower esophageal sphinctor (LES), which will allow acidic stomach contents to backflow into the esophagus if the LES fails to clench tightly enough at all times. This is very important, because taking any antacid or H2 blocker (or PPI) will lower your stomach acidity, and research shows that the weaker the stomach acidity on the backside of the LES, the less tightly it will clench. IOW, the stronger the stomach acid, the more tightly the LES will clench to hold back the acid. The reason why I advise against PPIs, is because they are known to weaken the clenching strength of the LES, and it can take months to rebuild the strength of the LES after a PPI is discontinued. That makes it very difficult to wean off a PPI, because weaning off them will actually cause the very problem that they are prescribed to treat.

The only time that I ever had a serious reflux problem in my life is when I was recovering from surgery, and the doctor in charge insisted that I take a PPI each day, while in the hospital. As best I can recall, I only took a PPI for 3 days, but it took me many months to get rid of the reflux problem after that. That's when I learned to never sleep on my right side.

Some people find that elevating the head of their bed a few inches by placing those legs on blocks, can help to prevent GERD/reflux problems, also.

You're most welcome.

Tex

[Joseph7179]

Tex,
Thanks so much for the information and the helpful hints. I will try them all. i will you know how it is going and what seems to work. This has been a great resource.

[Joseph7179]

Tex,

Just a question about Allegra. I got the 24 hour kind 180 mg. I take it in the morning. I also got magnesium 400 mg. I also take it in the morning with am aware of what not to take it with. Can I up the dosage of the Allegra?

Most of my nausea seems to be in the early morning but comes and goes during the day. the reflux (or burning in mu upper abdomen) is less of a problem except about 2 hours after eating. I am avoiding al the trigger foods gluten and dairy and refined sugar.

If you have any comments, I would find them most welcome.

[tex]

That is the version of Allegra that I use. As far as I am aware, it should be safe to use Allegra at up to 4 times the recommended label dose, if needed. It probably would work best to spread out the dosage during the day, rather than to take more than 1 tablet at a time, because I find that the 24-hour tablets are not effective for me, for a full day.

Here's my reference on the safety of increasing the dosage. Medscape is one of the few websites that many/most doctors trust and use. They make this recommendation for treating urticaria, and if that dosage is safe for treating urticaria, then it should be safe for treating other mast cell issues, also. FWIW, IMO the nausea that is associated with MC is mast cell-related, and not due to some unrelated issue, but bear in mind that this is an assumption, and not proven fact (since as far as the official medical description of LC is concerned, nausea is not even officially recognized as a symptom of the disease, despite the fact that nausesa is/was a prominent symptom for many of us here).

Most cases of simple acute urticaria can be treated with H1 antihistamine agents.[38] In cases of severe or persistent urticaria, H2 antihistamines may be added and are probably additive to the effect of H1 antihistamines if given simultaneously intravenously.[33] This combination may also be effective orally in a small percentage of patients with chronic urticaria.[6] If the patient with chronic urticaria is refractory to nonsedating antihistamines, doses up to 4 times the recommended maximal dose may be effective.[6] If maximum doses of nonsedating antihistamines are not effective, other therapies should be tried.[39, 40]

Note that since they specify "nonsedating" antihistamines, this recommendation may not apply to Benadryl, or any other first-generation H1 antihistamines. Here's a link to that Medscape article (you may have to register in order to access the article, but registration is free and easy):

http://emedicine.medscape.com/article/762917-medication

Here is a link to reference 6 in that quote:

http://www.ga2len.net/464D9d01.pdf

Ginger (the spice) is often recommended as a home treatment for nausea, and some members here who have tried it say that it works for them, so that may be another option for you.

Please be aware that some of us (including me) have found that if we take certain antihistamines for an extended period (many weeks or months), we may have a rebound effect when we discontinue taking it if we don't wean off it. IOW, if we are using it to control a rash or itching, for example, when we stop using it we may experience itching due to the discontinuation of the treatment (rather than from a rash or other physical source of itching). Weaning off it slowly seems to resolve the problem.

I have no idea at what point in a treatment program this may become a problem, because we are all different, and we tend to have different responses to medications. So far members have reported this effect from Allegra and Zyrtec. It's still unknown whether other popular antihistamines can have the same effect. It's possible that only some of us are susceptible to this effect. Here's a link to a recent discussion about this topic:

antihistamine warning

As usual, even though these medications have been available for years, medical researchers are way behind on this issue, and I'm not aware of any official double-blind, random, medical trials that have been conducted to evaluate this problem, but hopefully, some day a research team may get around to verifying this effect and quantifying the issues involved. Sadly, FDA regulations do not require that drug companies report such findings, even if they occur in the trials that are used to prove the effectiveness of products submitted for FDA approval. Apparently the FDA believes in the old "Caveat Emptor" slogan.

I hope that this will help to relieve your symptoms.

Tex

[Joseph7179]

Tex,

One more question as I have a doctor appointment this week.

I have had off and on,tenderness or soreness on the outside or around the rib cage on both sides. it usually comes with a flair of LC. i am having that now but am in the process of tapering the Entocort from 3 to 2 day.

The Allegra seems to help a great deal wight he nausea and I have started on Magnesium 400 mg a day.

I hope to ask the doctor about potential mast cell issues wight he LC but don't know if he is acquainted with this issue.

Thanks for the help.

[tex]

I can only guess about the sensitivity around the rib cage, but I would guess that the tenderness might be due to costochondritis. Costochondritis is not considered to be a serious issue, but it's also caused by inflammation, so it's certainly possible for it to be associated with MC. A few other members here have reported being diagnosed with it. Here's a link with some information about it, but your GP should certainly be familiar with it also, and he should be able to offer some suggestions for treatment, if it's causing a significant amount of discomfort.

http://www.patient.co.uk/health/costochondritis

In case you haven't seen this, here are links to some short articles describing how mast cell issues are associated with MC:

What are mast cells?

How are mast cells associated with microscopic colitis?

How do I know if mast cells are causing problems for me?

How are mast cell issues treated?

Unfortunately, only a handful of GI specialists and allergists in this country (and in the world) are familiar with the types of mast cell disorders that are associated with MC, and all of them were trained under the guidance of Dr. Maria Castells, at the Brigham and Women's Hospital in Boston. Dr. Castell's group is also the leading source of information on treating systemic mastocytosis, a very serous mast cell disorder. If your doctor should happen to be knowledgeable about mast cells disorders, and how they are associated with MC, we would very much like to add his name to our list here.

Tex