Dx of SIBO as a result of acid reducers from use of prednisone?

If you look up the side effects of Kevzara, the first one listed is serious infections, bacterial, fungal or viral so it sounds like it is the Kevzara and not the prednisone or any of the antacid type drugs that you’re taking!! I’m surprised the prescribing provider didn’t come up with this!

@pbk128
I have had blood tests and stool tests and no infection has surfaced yet. That was my first concern. A ct scan scheduled for next week.
Still waiting on one more test but I’m convinced it’s due to the overuse of antacids and possibly sibo which has very complicated testing. Trying to follow a sibo diet. This has really upset my digestive system. Blaming it on the lack of proper gut biome from antacids needed while on prednisone.
Risk of infection is also linked to many prescription medications so it’s an umbrella that they all hide under. My blood counts were fine. Still waiting on answers. See my rheumatologist in August.

Sorry you are dealing with SIBO. I have been there but that was prior to my experience with PMR. I have no doubt that the SIBO was and is a result of PPIs and H2 -blockers (fomatadine). Gastro and family practice doctors throw this around like it is not a powerful drug. It is! It is even sold over the counter in the US. Just crazy. If you have any doubt or have yet to get an exact diagnosis from a Dr about SIBO, you can get a breath test done to confirm. There are natural remedies for SIBO in addition to heavy duty antibiotics. PPIs for more than two weeks (some say 6 weeks) can really do a number on one's digestion.

I totally disagree that this is an effect from Kevzara. Digestive issues even without taking a PPI are notoriously common with long term prednisone treatment. Sounds like some sort of stomach and/or bowel issue is going on and that can be a difficult one to treat and diagnose. I suggest something soothing such as GI-Fortify by Pure Encapsulations in the mean time. Self treatment can be a good way to go while looking into more complex issues such as ulcers, gastritis, different types of IBS, etc with the doctors. Imaging such as you are getting (a CT scan, you mentioned) and an endoscope (and colonoscopy) are worthy procedures to rule out issues that are more sinister and not simply and upset of the microbiome and/or the gut mucosa. Gut lining or mucosa are very susceptible to NSAIDS, of course, but also prednisone. It can take a while to heal the gut but that is the "joy" (??) of PMR, you get to deal with more issues after you have dealt with PMR. Good luck.

@caroljeand
Sounds like this not in the scope of practice of a rheumatologist but rather a GI specialist and a dietitian specialist…have you consulted these specialists? I am sooo sorry you are experiencing this! If you haven’t been referred to the above specialists maybe you shouldn’t wait til August! Good luck!

@petermccarville
Everything you mention is so true. I am following some of the diet for sibo to help minimize the issue (if that is the issue) and space my eating multiple hours apart (not snack) as that seems to feed sibo.
It is hard to find a specialist in Cincinnati that focuses on sibo as a sub specialty. Many chiropractic doctors will treat it with herbal remedies but I would like an honest opinion on the best treatment for me.
In fact I discussed it with my primary care doctor about diagnosis and she said they farm out the testing. Our major health care provider doesn’t even have the means for testing. Our children’s hospital has many gastro doctors that specialize in it but they are all pediatric doctors. I may try to contact them to see if they know of anyone who treats adults.
Thank you for your wise words and thoughts.
Hope to never need prednisone or antacids again!

@pbk128
I have been to the GI doctor and was told I have functional dyspepsia and IBS. He recommended ibgard. Also I told him I was on Kevzara and wanted to be tested for an infection, primarily hpylori. He ordered the test and it came back negative. That was the extent of that visit.
About a week later I was feeling really bad and I went to my primary care doctor. She ordered all the testing
which so far has not indicated anything. If the ct scan this week comes back without any reason for my issues I will be pursing help for sibo.

Just an FYI, I had stomach/intestinal problems and was seeing a gastroenterologist regularly before being put on prednisone for PMR and was tested for SIBO before prednisone as well as during prednisone, and both were negative. On prednisone my WBC was always running around 11 - 12,000 but it wasn't until I went to the ER after 12 hours of vomiting and diarrhea that I was admitted with an intestinal infection and stomach virus with a WBC over 15,000 and was put on two strong IV antibiotics and potassium and discharged 3 days later.

So my point being is that I don't find SIBO tests as reliable. If you can, look back to old labs before you were put on prednisone to find your WBC baseline and then look at you most recent WBC blood test to see if there is a difference, and if so, by how much.

@sloped483
Great input. I will check.
I was aware that the testing wasn’t always conclusive.
I just wonder if everything else is negative do I treat for sibo without testing? Hate taking antibiotics if they aren’t needed, potentially causing more issues.

@sloped483
One of the stool tests was for inflammation and infection so perhaps that concern was addressed. Came back negative.

@caroljeand

I had every GI test imaginable ... stool test, colonoscopy, endoscopy, 2 SIBO tests, camera capsule, CT scans with contrast you drink, CT scans with IV contrast, and yet my then gastroenterologist never checked my bloodwork. They are no longer my gastroenterologist since I was hospitalized last September for a raging infection and a stomach virus that I got at the same time. BTW, I take 20 mg of Pepcid daily.