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Ask the GP: Could heartburn pills be causing my upset stomach?

Doctors are at a loss to explain my chronic diarrhoea
Doctors are at a loss to explain my chronic diarrhoea Doctors are at a loss to explain my chronic diarrhoea

Q: I HAVE chronic diarrhoea and doctors seem to be at a loss to explain it. I take ranitidine and lansoprazole for acid reflux – could this combination be the cause?

KC

A: IT SEEMS you’ve found the answer that has evaded your doctors, although I can’t think how they missed it: it is listed as a potential side-effect for each of these drugs. I would recommend that you stop taking the pills and see what happens.

Give it two to four weeks after stopping them to see if the diarrhoea resolves. If it does, then reintroduce one of the drugs (perhaps the lansoprazole, as this is the most effective at suppressing the production of stomach acid, which causes acid reflux). If the diarrhoea does not return, then reintroduce the ranitidine and, once again, await the outcome.

I suggest you inform your GP that you’re doing this, but the worst that can happen is the acid reflux symptoms recurring.

If, after a period of time off both drugs, the diarrhoea persists, then there must be another cause. If you are in good general health, stable in weight, and you are not passing blood, it would be all too easy to conclude that you have a form of irritable bowel syndrome.

However, there is a hidden cause of chronic diarrhoea that requires biopsies of the colon’s lining to confirm the diagnosis. This is called microscopic colitis, an unexplained inflammation of the bowel lining, which frequently goes undiagnosed. If your diarrhoea persists, talk to your GP about a referral to a gastroenterologist for a colonoscopy.

This disorder has few other symptoms and its cause is not fully understood. Treatment would involve a course of inflammatory bowel disease medication, which has been shown to be effective.

Q: AGED two, I had a metal splinter removed from my eye. Aged 23, I was punched in the same eye and later developed a cataract, since removed. At 27, I was diagnosed with glaucoma in the eye, which I now successfully treat with drops – but which incident was the cause?

AC

A: For the benefit of other readers, let me explain a little about glaucoma. This disease of the optic nerve is essentially caused by a build-up of pressure within the eye – but this occurs in different ways.

The most common type of glaucoma is open-angle, in which there is progressive loss of peripheral sight leading to tunnel vision and, if untreated, eventually blindness. Often associated with age, open-angle glaucoma usually occurs as the drainage channels between the cornea (the clear bit at the front of the eye) and the iris gradually narrow and block, meaning fluid in the eye, called the aqueous humour, cannot drain away. This leads to increased pressure, which can damage the optic nerve.

A less common type is angle-closure glaucoma, where drainage channels become blocked suddenly due to the shape of the eye or an injury, meaning there is not enough room for the normal flow of fluid.

The main symptom is severe pain and it requires urgent action – without immediate treatment it could lead to permanent blindness.

Either form of glaucoma may develop due to inflammation caused by trauma (or other conditions).

Yours is a complicated story and I discussed it with an expert ophthalmic colleague, Peter Ivins.

His opinion is that it is impossible to say with certainty if the glaucoma is the result of the splinter, or the blow to your eye.

In theory, the angle between the cornea and the iris could have been compromised by the splinter, or during the operation to retrieve it.

The blow to the eye is another undoubted potential cause of both the cataract and the glaucoma.

My guess is that the first injury started you on the path to developing glaucoma, though it is impossible to be definitive after this passage of time. The good news is that the treatment is working and your sight is intact.

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