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Multiple treatments

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AMERC
Posts: 111
Joined: Mon Dec 07, 2020 5:23 am

Multiple treatments

Post by AMERC »

After 3 treatments for H Pylori over 2.5 years I think I may be finally free of the bug! fingers crossed

History
June 2020 - acidity symptoms started
Oct 2020 - 1st Endoscopy - No inflammation only Helicobacter via CLO test. 7 days amoxicillin, clarithromycin and pantoprazole treatment
Jan 2021 - no improvement so did another 7 days treatment with Metronidazole amoxicillin and Omeprazole
Jan 2021 - Ultrasound and CT scan show all ok for liver, pancreas and gall bladder and kidneys
March 2021 - Stool test negative for Helicobacter
May 2021 - Stool test negative for Helicobacter
July 21 to Dec 21 - minimal symptoms
Jan 22 - Symptoms returned'
Feb 22 - Stool test negative for Helicobacter
Jul 22 - Breath test negative for Helicobacter
Sep 22 - 2nd Endoscopy - Mild Chronic Gastritis and helicobacter seen in Histology

Oct 22- Did 14 days treatment with amoxicillin, Levofloxacin and Dexilant
Nov 22 - March 23 - Symptoms on and off and sometimes very instense
March 23 - 3rd Endoscopy - No Helicobacter seen in Histology only Mild Chronic Inactive Gastritis and LAX LES. No other issues found.
March 23 - CLO test negative and breath test also negative for Helicobacter

Hopefully I am free of Helicobacter but my questions are:

Is the Mild Chronic Inactive Gastritis caused by Helicobacter?
What does inactive mean?
Can the inactive chronic gastritis cause so much pain and discomfort? Mainly pain in the upper middle abdominal especially on empty stomach
Can Chronic Inactive Gastritis ever heal and stomach return to normal?
Can on and off use of PPI contribute to gastritis?
How to people manager similar condition?

Much Appreciate your thoughts

Helico_expert
Site Admin
Posts: 4600
Joined: Wed Mar 02, 2011 7:20 am

Re: Multiple treatments

Post by Helico_expert »

hi,

I am glad that your latest endoscopy showed negative of H. pylori.

"inactive" means the immune cells are not aggressive anymore. They are in the process of retreating. However, the retreat may be slow, depending on individual's immune system.

The immune cells do occupy space and can irritate surrounding cells. So depending on the amount of immune cells, they may still trigger symptoms.

Unfortunately we do not fully understand how to speed up the retreat of immune cells. But in most cases, the would eventually be gone and back to normal.

PPI will not contribute to gastritis.

you can try probiotics, herbs, or even vitamin C to help improve the condition.

AMERC
Posts: 111
Joined: Mon Dec 07, 2020 5:23 am

Re: Multiple treatments

Post by AMERC »

Thanks

Will being on PPI for say 6 to 12 months help in the healing the chronic inactive gastritis?

Can long term stress aggrevate gastritis and slow down the healing process ?

Helico_expert
Site Admin
Posts: 4600
Joined: Wed Mar 02, 2011 7:20 am

Re: Multiple treatments

Post by Helico_expert »

this is a very hard question.
Because we dont know what causes your gastritis after HP eradication.
it could be because the mucous producing cells are killed during H. pylori infection, therefore, there is less mucous protection against acid. So the gastritis could due to the acid. If that's the case, your PPI will buy time for your mucous producing cells to recover.

Then, another reason could be due to auto-immune disease. This has not been proven, but we suspect that H. pylori mimic our cells to avoid been killed by our own immune cells. So perhaps the immune cells accidentally recognised some of the protein H. pylori learnt from us and start attacking our own cells that is producing the protein. So we think that explain why some people cannot get rid of the gastritis even after HP eradication.

Plotun
Posts: 59
Joined: Sun Sep 27, 2020 2:48 am

Re: Multiple treatments

Post by Plotun »

Mild chronic gastritis doesn't cause symptoms. Likely, your symptoms aren't caused by H. Pylori. Maybe you got functional dyspepsia or even IBS. Go find an experienced GI and request Amitriptyline or Sulpiride, antispamodics and follow low FODMAP 6 months.

AMERC
Posts: 111
Joined: Mon Dec 07, 2020 5:23 am

Re: Multiple treatments

Post by AMERC »

It appears that mild chronic inactive gastritis can cause symptoms for a long time after eradication according to this report:

https://www.mypathologyreport.ca/diagno ... 20appetite.

I have been taking Amitriptyline 10mg for a year now. Doesn't help with pain but helps me sleep better.

@Helico Expert

So in my case I think what we know for sure is that H Pylori was there but has now been eradicated . Three different tests (UBT, COL and Histology) all returned negative in Mar 23.

Mild Chronic Inactive Gastritis was seen in Endoscopy in Sep 22 and again in Mar 23 despite being mostly on PPI during this time.

I managed to control my symptoms without PPI for a month to get these tests done and whole of April 23 I fasted in Ramadan with just one 20mg Pantoprazole at night.

But since then as I am now eating 3 times a day the symptoms have returned and now have to increase the dose to 40mg a day

my questions are:

1. Has H Pylori messed up my natural acid secretion system such that any change in diet or stress the stomach produces too much acid which then prevents the chronic gastritis from healing? I can sometimes go for weeks without any major digestive symptoms but it always come back if I had something to eat or go through a stressful period at work. When symptoms starts it usually takes a couple of weeks, with the help of PPI and Gaviscon, to cam down

2. Have you seen in people with Mild Chronic Gastritis persisting for a long term post successful helicobacter eradication?

3. Other than PPI what can I use to protect my damaged stomach lining from acid? Are there any medication that would provide quoting for the stomach? Would stomach emptying medication help?

4. How long does it take for Mild Chronic Gastritis to develop into IM or more serious condition.

5. How do people with Ulcer heal their stomach?

Helico_expert
Site Admin
Posts: 4600
Joined: Wed Mar 02, 2011 7:20 am

Re: Multiple treatments

Post by Helico_expert »

With all the tests done, I think you are really negative of H. pylori.

The only way to tell if the ulcer healed is by endoscopy.
Continue PPI is a good way to control the gastric symptoms.

It is possible that H. pylori may lead to some "auto immune" diseases that lead to having long term gastric symptoms.
The mechanism is unclear. Perhaps H. pylori left "something" behind after its eradication and it continues to cause trouble.

From our experience, most patients do get better eventually. But some of them take slightly longer (months to years).

******************************************
1. We dont know if it's because you lack of mucous to protect you from acid or you have too much acid. However, if PPI works, you should keep taking it.

2. yes. it's not common. but some patients do take a long time to gradually recover.

3. I think PPI or H2 blockers or gasviscon are all good. Pick one that you find most suitable to yourself.

4. tough question. It may or may not progress to IM. It's very subjective. But if your acid is strong, then less likely you'll get IM.

5. continue PPI for a month or longer until the ulcer is healed.

AMERC
Posts: 111
Joined: Mon Dec 07, 2020 5:23 am

Re: Multiple treatments

Post by AMERC »

Thanks HelicoExpert

My concern is that between the endoscopy in September 22 (which showed helicobacter and mild chronic gastritis) and endoscopy in March 23 (which showed no helicobacter but chronic inactive gastritis) I have been on PPI expect for 15 days before the second endoscopy and despite PPI use for nearly 5 months the gastritis has not healed. So not sure other than providing temporary relief PPI are doing the job of healing the inflammation.

What is your views on Sucraflate or Gastrofait or similar medication that provides quoting for the stomach inflammation?

Is there any surgery options if PPI fails to heal the gastritis to prevent the gastritis progressing to a more severe stage?

AMERC
Posts: 111
Joined: Mon Dec 07, 2020 5:23 am

Re: Multiple treatments

Post by AMERC »

BTW I don't have ulcer. Just mild chronic gastritis. I am worried that if mild chronic inactive gastritis does not heal is the next stage and ulcer?

Plotun
Posts: 59
Joined: Sun Sep 27, 2020 2:48 am

Re: Multiple treatments

Post by Plotun »

There's nothing to heal because your stomach lining is intact and healthy. Mild chronic gastritis is just pathological finding when in fact nothing is wrong with your stomach during visual endoscopy. Your symptoms are not because of chronic mild gastritis for sure.

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