Passing Asacol undigested - Nexium the culprit?

[Cat-a-Tonic]

As a lot of you know, I have probable IBD (officially undiagnosed). I'm currently on Asacol for that and have been doing well with it for the most part. I also have severe GERD due to a hiatal hernia and I've failed several meds for that. I am currently on Nexium and Zantac (ranitidine). I previously was on 40 mg Nexium and 150 mg Zantac. I was still having GERD symptoms every day, so my GI recently increased my Zantac to 300 mg. That helped a bit. Then a few weeks ago my GI also increased my Nexium to 80 mg which also helped a bit.

My GERD is still a little wild at times but somewhat better than it was. However, I have noticed that at times I will pass an undigested Asacol tablet in my stool. It's definitely a full tablet - yes, I reached in to the toilet and pulled one out. It is not just a shell, it is full of medicine still. It's kind of squishy, I could squish the tablet between my fingers and the medicine came out, so it's like my body can partway break down the coating of the tablet but not all the way. I believe that has something to do with the pH levels in the stomach/intestines. And the thing is, it's gotten way worse since I've been on the double dose of Nexium. I see undigested Asacol tablets in my stool almost every day now, sometimes multiple times per day. And I've been having more "bad tummy days" lately too so I think there's a correlation. I'm not getting the Asacol I need and my guts aren't happy about that. It's like the extra Nexium makes my pH too low to break down hardly any Asacol tablets, that's my theory anyway.

What would you guys do? I see my GI in a month but I could call him about this sooner if need be. I'm thinking about just going back down to the 40 mg of Nexium and seeing how I do GERD-wise and whether that helps me not pass so much undigested Asacol. Asacol is an expensive med for me too, $75 per month with my insurance (for comparison, I pay $25 for the double dose of Nexium and about $8 for the Zantac). I feel like I'm just flushing money down the toilet, literally, every time I see an undigested Asacol. I'm poor and that stresses me out which is obviously not good for my guts either! So I'm just wondering, has anyone else experienced something like this? If so, what did you do to remedy the situation? Would another ASA med like Pentasa be easier for my system to break down (as I believe those come in capsules as opposed to tablets)?

 

[levi]

I wasn't on Nexium or any similar medication but Asacol did the same thing. My GI told me the medicine was permeating the coating and I was still getting it. I took him a picture and said look, it's a complete pill, I could clean it off and take it again!

I also mashed one and took a pic and all the medicine was still in it.

 

[Cross-stitch gal]

I always passed my asacol pills too when I was taking the drug. Although, I never fished out the pill from the toilet. Doctor told me not to worry about it although I too began seeing it more often.

Ever since I began the pentasa I've never seen any pills in my bm's.

 

[Misty-Eyed]

Have you tried taking asacol a few hours before the nexium? It might give the asacol time to break down slightly before the nexium gets a chance to change your pH levels.

 

[Cat-a-Tonic]

Thanks for the replies! Levi, what did your GI do (if anything) about you passing the Asacol? Are you still on Asacol or have you switched to something else? I like your idea about mashing the Asacol and taking a photo of it, I might do that before my next GI appt in January. At the very least I will tell my GI about it (he usually believes me without requiring any photographic evidence ).

Cross-stitch gal, was that the reason you switched from Asacol to Pentasa? I think I am going to ask my GI about switching to Pentasa. As I've said, I'm technically undiagnosed, but I would wager money that I've got IBD in my terminal ileum (my "pain spot" is in the LRQ right about where the TI is - also, I respond well to Entocort which really only works in the TI area so it seems I must have some sort of involvement there!). My GI said that Asacol would work on the TI and colon, whereas Pentasa would work on the small intestine (including the TI). For some arbitrary reason he prescribed Asacol for me. But it seems to me like whichever one I take, it should work on the spot I need it to. So Pentasa should work for me too (I think).

 

[Cat-a-Tonic]

Michelle, yes, I have tried that too. I take my Nexium first thing in the morning when I get up, and then a few hours later I have a supplement drink and take my Asacol with that. Same situation for my PM dose of Nexium, I take my Asacol with dinner and then take my Nexium and Zantac before bed. My GI explained that Nexium is slow-release so it should continuously work for 24 hours, so it's still in effect even hours later when I take my Asacol.

 

[Misty-Eyed]

Ack what a pain! I'd definitely call your doc. Taking the asacol is effectively pointless in that case and you don't want to spend money on a drug which doesn't work. You don't want to risk getting more ill if there is a way around it!

 

[Cross-stitch gal]

Cross-stitch gal, was that the reason you switched from Asacol to Pentasa? I think I am going to ask my GI about switching to Pentasa. As I've said, I'm technically undiagnosed, but I would wager money that I've got IBD in my terminal ileum (my "pain spot" is in the LRQ right about where the TI is - also, I respond well to Entocort which really only works in the TI area so it seems I must have some sort of involvement there!). My GI said that Asacol would work on the TI and colon, whereas Pentasa would work on the small intestine (including the TI). For some arbitrary reason he prescribed Asacol for me. But it seems to me like whichever one I take, it should work on the spot I need it to. So Pentasa should work for me too (I think).

The regular GI that prescribed asacol for me wouldn't listen to me. She agreed that the drug wasn't working anymore yet I was still on it. The only other thing she wanted to do is put me on really strong drugs like injections. I finally got a second opinion who listened to me and agreed to try pentasa to see if it'd work for me before opting to try that strong of drug. It's been working well for me too. Although, I've begun flaring again recently. But, have to admit that for awhile the asacol did work for me and had been on it for a few years.

 

[Cross-stitch gal]

Forgot to say that the last time I was tested they said that it looked like my inflammation was more in my small intestine. From what I've read, the pentasa is more geared to treat this area.

 

[Cat-a-Tonic]

Cross-stitch gal, I wonder if Asacol just fails after awhile for some of us then? I've been on it for over a year now and have done pretty well for the most part, and I'm still in remission. It seems like too much to be a coincidence that this happened right when I started on a double dose of Nexium, but who knows.

Michelle, I will call my GI, but he usually makes me wait until appointments for bigger issues such as this one. So I suspect I will have to wait until the end of January for my appointment to get these questions answered. I think in the meantime I'm going to try going back down to taking a single dose of Nexium daily and see if the Asacol issue resolves or stays the same. It'll be an interesting little experiment and will either prove or disprove my theory about Nexium making my pH too out of whack.

If worse comes to worse, my GI has offered to refer me to a surgeon to get my hiatal hernia fixed, which should in turn make my GERD much better. In that case I might not even need any GERD meds and could concentrate solely on treating the IBD. But I am so leary of surgery so I'm not sure that's the route I want to take!

 

[Cross-stitch gal]

I believe that after a few years drugs do stop working as well. I originally was diagnosed with UC and at that time was put on Sulfasalazine. After being on that for a few years I was told that that wasn't working for me anymore and was changed to Asacol.

My dad has been on many different drugs for his sleep disorder and when I was a kid he also had depression. I can't tell you how many drugs he's been on, but I can tell you that once he's been on one for awhile it'll stop working too. I think it's just a common thing for medications.

 

[Misty-Eyed]

I guess it depends on how bad you feel your GERD is and how much your life would improve by having the surgery.

I'm assuming you don't have IBD nurses? Here if you have problems you can call them and they can either advise or ask your GI on your behalf to try and sort things out. Such a useful way doing things and saves getting an appointment if you feel it's not a large enough issue.

Hope your experiment works!!

 

[Cat-a-Tonic]

Michelle, no, no IBD nurses like what you guys have in the UK - my GI has a nurse but she's more like a secretary than anything else. When I call her, I just pass messages along for her to give to my GI and then she calls me back later with a response from my GI. This is why I'm thinking I'm going to have to wait until my appointment to get any kind of real answers. My GI is super busy all the time, he's only in the clinic 2 mornings a week, the rest of the time he's at the hospital performing scopes and stuff like that. So it's really hard to get ahold of him which is why his nurse acts as the messenger. I can email him but he takes forever to respond to those too, he has told me several times not to even bother emailing, that it's faster to go through the nurse. So yeah, either way I'm not likely to get answers until my appointment unfortunately.

My GERD is bad, really bad. I had a pH impedance test recently which found that my GERD is in the 95th percentile (100% is the worst of the worst so 95% is very bad!). During that 24 hour test, I had something like 48 separate episodes of reflux, and the longest single episode lasted for 5 hours. So yeah, it's bad! I told myself I was going to try every med before I opted for surgery but I am starting to re-think that plan. My GI advised me at my last appointment that if I decide to go for surgery, that I would need at least one more test first (apparently I need my esophageal motility tested - if it's normal then I can have surgery, but if it's abnormal then surgery would actually just make things worse). So, my thought right now is that I will ask for that esophageal motility test at my next appointment. At least then I'll know if I'm a good surgical candidate or not and can decide on things from there.

 

[Misty-Eyed]

I would be worried about developing barrett's esophagus with GERD that bad. My dad has it and he has to have a scope every year to look for cancer If you can do something to prevent all the better! I think getting the mobility test is a good idea. At least then if surgery isn't a possibility you can forget about it.

Don't you just love how life is so straightforward?? Ugh

 

[Cat-a-Tonic]

I was worried about Barrett's esophagus too but I guess I'm okay for now. I had an upper endoscopy last month and my GI says my esophagus looks just fine aside from the hiatal hernia. No sign of Barrett's whatsoever. And my GI said that Barrett's takes years to develop so I should be okay for awhile, which was another reason I was not rushing to get the surgery done. I'm sorry to hear your dad has Barrett's, it sounds pretty awful.

 

[PVail]

Hi Cat
Look ive had similar issues to the original post here. I was having very bad GERD and it was driving me mad . I went to a health food store and was told to take Wheat grass. This was in capsule form and this would lower the acidic level and reduce the Gerd. So I take Asacol for the IBD and Amitryptiline for the pain. The Asacol as i know only breaks down at a ph of 7. This is localised at the Ti and the anus only. Now taking the Wheat Grass really worked for the Gerd but it drastically reduced the effectiveness of the Asacol as it changed the ph level in my digestive tract.I started to pass whole tablets . I put up with it for a week or so to calm the Gerd and then had to stop as i was going downhill so to say with the IBD.
I took a serious look at my diet and I have managed to nearly get rid of the Gerd by cutting certain foods and eating long before i sleep .
hope this helps.
Peter

 

[levi]

Cat-a-Tonic, when I showed that to my GI he relented and said I wasn't getting the meds and switched me to Apriso.

Due to knowing now I have Crohn's and the Apriso wasn't helping I'm not on Pentasa, but that's another story, the Asacol for sure wasn't doing anything.

 

[Misty-Eyed]

I was worried about Barrett's esophagus too but I guess I'm okay for now. I had an upper endoscopy last month and my GI says my esophagus looks just fine aside from the hiatal hernia. No sign of Barrett's whatsoever. And my GI said that Barrett's takes years to develop so I should be okay for awhile, which was another reason I was not rushing to get the surgery done. I'm sorry to hear your dad has Barrett's, it sounds pretty awful.

Yeah I think my dad got it after years and years of bad acid reflux although I think he has a hiatus hernia too. To be honest, I don't think it is that awful. He hardly ever gets the reflux now he takes omeprazole before bed every night and he's used to the scopes that he doesn't even get sedated anymore!

How's the experimenting going?

 

[Cat-a-Tonic]

Michelle, the experimenting is going well so far - I did see one undigested Asacol in my stool yesterday, but I believe that's the only one I've seen so far since I started my little experiment. My GERD doesn't feel worse being on a lower dose of Nexium either - if anything, I feel a bit better. My stomach feels better and I haven't had a bad tummy day since going back down to the single dose of Nexium. So I'm sticking with the single dose of Nexium probably at least until my GI appointment. Will talk with my GI then and see what his thoughts are.

Peter, I've tried dietary changes, not eating before bed, eating small meals, etc. None of that helps much with the GERD. The pH impedance test that I had indicated that I reflux about 60% of the time when I'm lying down, regardless of if I've eaten etc. It's even worse when I work out - I can't have anything but water and antacids in my stomach when I exercise (if I even drink something like a sports drink I very quickly get to the point of vomiting), but even with just water in my stomach, I reflux a LOT when I work out. Like sometimes I have to stop and let my stomach contents settle back down and talk myself out of vomiting - and it's just water! I love working out so I have learned to just deal with the reflux that comes with it. But yeah, even with dietary changes, I still reflux a lot of the time, regardless of what is in my stomach.

 

[Cross-stitch gal]

Glad to hear the experiments are going good so far. Hopefully you'll start feeling somewhat better soon. Take care. Xxxxx

 

[Cat-a-Tonic]

Just an update on this - it's been about a month now that I've been taking a single dose of Nexium instead of the double dose. I still sometimes pass undigested Asacol, but not nearly as frequently as when I was on the double Nexium. My GERD hasn't gotten worse on the single dose of Nexium so I am thinking I will stick with this for awhile. I see my GI in about 10 days so of course I'll discuss this with him, and I do want to get his thoughts on switching me to Pentasa. But so far, so good!

 

[PVail]

Hi Cat .
Look ive been reading the Forum Wiki Information on Asacol. There are two links on that page . The second one really goes into detail about effectiveness and how a where it works . it also has some usefull drawings of where it works in the GI tract compared to Pentasa. thought this might be helpfull.
Peter