How About Gastroentestinal Issues? Slow Motility Anyone?

[Kris4444]

I have been diagnosed with severe colonic inertia which means really bad constipation. I was on every laxative known to man both prescription and over the counter and have had every test you can imagine to find out what the cause is. Finally a new GI doctor started me on Pristiq which is an SNRI but seems to help with the constipation as the gut creates it's own seratonin and other hormones. Who knew?

Since starting this drug though I ended up with severe diarrhea and hospitalized for 6 days. They did a sigmoidoscopy with biopsies and found I had microscopic colitis which just makes NO SENSE considering I've been dealing with constipation for years!

I haven't had another bout with the MC and I am still taking the Pristiq and Miralax. The Pristiq may be adding to my high NE levels. I have tried stopping the Pristiq but the constipation came back really bad and I had to use a bowel prep and enemas to get going again.

Does anyone else have GI issues? I wonder how much the gut plays a role in this whole thing??

[Christy_D]

GI issues are common with dysautonomia. My son had gastropareisis, but his last test came back fine. Whether it is still fine I wouldn't know. He is very severely constipated and doctors never seem to care much, they just ask what we do for it. He will go 2 weeks without a bm when he doesn't take either a stool softener or laxative. Even laxatives take longer than they should. Some he just won't take because of the cramping. His softner/lax. of choice these days is Perdiem. He didn't like Miralax, plus it works by pulling liquid from the body and I figured that might dehydrate a little.

[Aimes]

I have also had a lot of GI issues and just this morning read an article about the role mast cells play in digestion and how SSRIs might help. The article focuses on depression which is obviously not the cause of our issues but I still found it interesting. http://www.medicalnewstoday.com/releases/134119.php

The Effect Of Fluoxetine On Mast Cell

Main Category: Biology / Biochemistry

Also Included In: GastroIntestinal / Gastroenterology

Article Date: 30 Dec 2008 - 1:00 PDT

Mast cells are now recognized as "granular cells of the connective tissue", whose activation exacerbates allergic immune responses and as key players in the establishment of innate immunity as well as modulators of adaptive immune responses. The role of mast cells in the gastrointestinal mucosa is not only to react to antigens, but also to actively regulate the barrier and transport properties of the intestinal epithelium. In clinical studies, it has become clear that psychological factors, especially anxiety and depression, play an important role in gastrointestinal diseases by precipitating exacerbation of symptoms. Fluoxetine hydrochloride (fluoxetine) is a kind of selective serotonin reuptake inhibitors (SSRIs), which belong to a class of antidepressants used in the treatment of depression and anxiety disorders.

The research team led by He-Shen Luo, from the Renmin Hospital of Wuhan University of China, investigated the effects of fluoxetine on mast cell morphology and rMCP-1 expression in gastric antrum in a rat model of depression. This will be published on December 7, 2008 in the World Journal of Gastroenterology.

A Sprague-Dawley rat model of chronic stress-induced depression was established. Fifty experimental rats were randomly divided into the five groups: normal control group, fluoxetine + normal control group, depressed model group, saline + depressed model group, and fluoxetine + depressed model group. Laser scanning confocal microscopy (LSCM) immunofluorecence and RT-PCR techniques were used to investigate rMCP-1 expression in gastric antrum. Mast cell morphology was observed under transmission electron microscopy.

They found that depression induced mast cell proliferation, activation, and granule hyperplasia. Compared with the normal control group, the average immunofluorescence intensity of gastric antrum rMCP-1 significantly increased in depressed model group (37.4 ± 7.7 vs 24.5 ± 5.6, P < 0.01) or saline + depressed model group (39.9 ± 5.0 vs 24.5 ± 5.6, P < 0.01), while there was no significant difference between fluoxetine + normal control group (23.1 ± 3.4) or fluoxetine + depressed model group (26.1 ± 3.6) and normal control group. The average level of rMCP-1mRNA of gastric antrum significantly increased in depressed model group (0.759 ± 0.357 vs 0.476 ± 0.029, P < 0.01) or saline + depressed model group (0.781 ± 0.451 vs 0.476 ± 0.029, P < 0.01 ), while no significant difference was found between fluoxetine + normal control group(0.460 ± 0.027) or fluoxetine + depressed model group (0.488 ± 0.030) and normal control group. Fluoxetine showed partial inhibitive effects on mast cell ultrastructural alterations and de-regulated rMCP-1 expression in gastric antrum of the depressed rat model.

These findings will conduce to understand that chronic heterotypic stress may induce the immune responses in gastric mucosa. Treatment with fluoxetine can ameliorate pathological changes in gastric antrum of depressed rat model, suggesting that SSRIs are an effective therapeutic agent for some gastroduodenal diseases caused by psychological factors.

Notes:

Reference: Chen ZH, Xiao L, Chen JH, Luo HS, Wang GH, Huang YL, Wang XP. Effects of fluoxetine on mast cell morphology and protease-1 expression in gastric antrum in a rat model of depression. World J Gastroenterol 2008; 14(45): 6993-6998 http://www.wjgnet.com/1007-9327/14/6993.asp

[looneymom]

For constipation, have you tried using magnesium citrate. The citrate is what helps the magnesium asorb into the body. A naturalpath doctor started our son on this and it really helps. Start with a low dose and add more each day until it works for you. When you are regular, you can back off the dose. My son's magnesium levels were in range when he started this but I learned from this doctor, just because my son was at the starting range, this was not the range that was helping his body function. The more literature I read on POTS, I am learning that the middle or 75% of the range for certain vitamins and supplements is the better range for POTS patients.

[Kris4444]

I'm sorry for your son. I know what he goes through and its awful. Miralax works ok for me. I'm a big water drinker as you need to be when you are dealing with constipation.

Great article! Makes me feel better about insisting my doctors look into mast cell as a possible cause of what I'm dealing with.

Magnesium citrate does NOTHING for me other than make my insides gurgle and make me feel worse. I've tried it several times. My constipation was so bad that I had to do a weekly bowel prep (like you would do for a colonoscopy).

[cupcakemomma5]

Also ask the doctors if the microscopic colitis or during that procedure if they found ganglion nerve ending. Ask about hirschprungs disease (it affects the nerve endings in your intestine/colon....

Just. A thought...

[Kris4444]

Nothing like that came up in the report and my doctor hasn't mentioned anything like that since. That happened in August and I've never had an ordeal like that before in my life and not since (thank God) so I have no idea what caused that and can only hope that it won't happen again.

I still don't know how you go from severe constipation to severe diarrhea in a heartbeat and then get diagnosed with and IBD for diarrhea? Just weird like everything else I am going through.

[Gerrik1]

Major GI issues here. I even had a colostomy for 6 months after my bowels blew open in me. I have terrible constipation trouble and really have to watch. I take Fiber gummies everyday andstool softeners. And eat a high fiber diet ans naturally drink all my water.

[Guest mattgreen]

Gerrik - What exactly happened to your bowels? It sounds horrifying

[Gerrik1]

@mattgreen - I've had scopes before and they found nothing but all of the sudden one Sunday I woke-up to severe Lower left abdominal pain. Went to hospital and after testing they said I has a Diviticuousis that had ruptured. And my interstines had opened up. The cut out the opened up area and sewed me back up and within 1 week I blew apar again at incision site. So with in 1 week I had major surgury in the same area 2 times and the 2nd time a colostomy for 6 months. Never had a diviticui before or after and they told me the ruptured one was the only one I had.

But now I really have to watch not to get constipated.

[Kris4444]

My GI issues have gotten increasingly worse since starting clonidine. I am having severe left sided (colon) pain for the last few days. I have been taking Miralax 3 times day with no relief. I've tried Librax for the colon pain and 800 mgs of prescription Motrin several times a day and it isn't letting up.

Part of me wants to go to the ER but I have done that many times before and they don't do much other than take an x-ray, declare that I'm terribly constipated, offer me drugs that will make the constipation worse but help with the pain and send me home.

Does anyone else have these types of issues? Is there anything you do that eases the pain when it gets like this? The heating pad just isn't cuting it and I don't want to break down and take a tramadol but it might come down to that.

Sorry for being a whiner but I just needed to vent.

[corina]

Kris you aren't a whiner, it must be awful. I'm sorry I can't be of much help to you, just offer some support. Really hope you will feel better soon!

[Dizzysillyak]

I used to have constipation all the time until I started using Natural Calm, mag citrate, every day. I've tried everything else, more oil, fiber, miralax, etc etc but this is the only thing that helped.

It took awhile for me to feel good on this but now I'm good. I need to put it into really warm but not hot water too. It just gets absorbed better this way.

I saw that you'd tried this but maybe it was the brand of mag citrate you were using or maybe you didn't give it long enough. I wouldn't expect you to feel good on this at first but overtime IMHO, your body should adjust to it. Start with a 1/4 of a tsp then increase if needed.

Diet too plays a role for me too. If I eat too much meat or dried beans, my constipation is worse and I need to take Natural Calm 2 - 3 times during the day to get things started again. This always upsets my intestines for a few days until I get whatever I ate out of me.

Glycerin suppositories and enemas work for me too if I'm in too much pain. I just get the Fleet brand of suppositories and store brand saline laxatives. I haven't had to use anything but the mag citrate in several months now tho. kow .. I suspect it's because I backed off eating so much meat.

tc .. d

[Kris4444]

Thanks Corina.

Dizzy when I use the magnesium citrate I've use the whole bottle in 1 sittingand it never works. I've been on every laxative you can imagine from prescription to over the counter. The only thing that was working is an SNRI called Pristiq. Now that we've started the clonidine the constipation is back. It's so frustrating.

I've tried magnesium supplements and they don't work for me either.

[Dizzysillyak]

Hugs. I feel so bad for you because I've been here too. Don't even ask me how I got over the barium solution I had to drink once for a gi test. I ruled out thoughts of calling 911 due to embarrassment. Suffice to say it felt like it had turned into concrete inside my colon ...

I had to use saline enemas with a little oil in them for several years until I got the hang of taking Natural calm daily, watching my diet for too much meat or dried beans and using suppositories when needed.

At the risk of beating a dead horse, Natural Calm, mag citrate, is a powder that you add to warm water and you can only get from a health food store or online. It works for me when the others didn't. I don't know why. But even then, it has to be really warm for it to work for me. Cold or room temp won't work ...

I hope you find something that works for you. tc ... D

[Racer]

I just deal with my regular once a week, since anything that makes me go more frequently causes a whole new problem! : (

[Kris4444]

I wish I had a "weekly" lol. Oh the things we go through!

Looks like I'm going to have to wean off the clonidine.

[Racer]

I wish I had a "weekly" lol. Oh the things we go through!.

Ohh! Looks like I am doing good then

Seriously though, sorry you are having such trouble!

[Kris4444]

Lol. Yes, I'd be thrilled with a weekly! Good for you! Geez the things we talk about huh? Haha.

[Racer]

Lol. Yes, I'd be thrilled with a weekly! Good for you! Geez the things we talk about huh? Haha.

If my coworkers knew the messages I type on this phone at work!

[Christy_D]

Hate to say it, but my son would love to go weekly as well!

[Kris4444]

I'm sorry he's going through this Christy, it's miserable.

[Racer]

Hate to say it, but my son would love to go weekly as well!

Sorry your son has trouble. I guess I am lucky. I didnt realize how much trouble some people have with it.

Taking miralax cures any issue I might have with constipation, but anything short of constipation, and I have trouble making it to the bathroom in time. I guess I was vague because this is embarrassing.

[blueskies]

Yes, I had total constipation for many years and used to use extreme measures to have a bowel movement. In the past year or so my bowels have started to work again. Not my old 'normally'' but enough for me to be comfortable. Sometimes my bowel stops but some movicol will get it going again and I'm able to start going without having to take it for long -- which is a good thing because I am intolerant to movicol and get nasty side effects. I had all the tests and have seem 3 gi docs over the years and didn't get much help. virtually none.

I'm hoping my bowels are returning to normal. I did go through a period of 6 years when I really couldn't sweat and now I'm sweating like a horse all the time. I don't like this but it's better than not sweating. I'm hoping I'm seeing a somewhat similar story with my bowels.'

My thoughts are with you. it seems like Nothing is worse when it comes to the bowels is complete constipation in my opinion. At least for me. Complete constipation was painful and had me in tears more times than I can remember. I've experienced dumping (although not often) and I would prefer that or diarrhea to the difficulties of keeping my bowels working. I'm also keeping my fingers crossed that my bowels don't just stop again completely for years again. I never want to experience total bowel inertia again.

I'm depressed but not near as much as I was when completely constipated. One of the reasons I don't take medication for depression is that they will stop my bowels among other adverse reactions.

Symptoms do change - morph -- at least in my case. Now if only my migraines would back off.

blue

[Kris4444]

Thanks blue! Believe it or not, I take an SNRI not for depression but for my bowels! Your gut makes it's own seratonin and when you have chronic issues with the gut those levels can become depleated. I went from being constipated and taking laxatives 7 times a day and doing a bowel prep every Friday after work, to getting off all laxatives (except the miralax) because of taking the SNRI.

The GI doctor that I see said he pulled out the "big guns" and hoped they would work. It was working really well. At first I had a hard time with the side effects (headache and sweating) but we played with the dosage until we found what was comfortable. Unfortunately since starting the clonidine, I am back to square one with the consitpation which has me pretty discouraged.

I do wonder if my high NE levels are from the SNRI and if the flushing is worse because of it. We are looking further into things still, I'm not ready to give up and neither is my rheumy who has been AWESOME about helping us track this thing down until we get it right.