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Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

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Steve H.
Posts: 17
Joined: Thu Apr 26, 2018 1:45 am

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Steve H. »

Greetings Helico Expert and The Helico Team,

Thanks a lot for your efforts and the support that you provide to the people around the world facing this awful bug known as H. Pylori and the issues and complications related.

In continuation of my earlier posts, I would like to update you on the recent happenings. This update along with your worthy advices and replies would help other forum members in getting a better understanding, if they are in a similar situation. Below is the detailed history or recap to provide you with a better understanding of the matter, I realize it is lengthy but it will help me in elaborating the history.
--------
In 2006, I started having acidity, pain right under the rib cage in the middle and heart burn, the primary care physician tried some medications like Gaviscon and Omeprazole, my symptoms would get better but once I stopped the medicine the symptoms would re-appear. So, I went to a top rated GI in November, 2007 and he advised an upper GI endoscopy.

Endoscopy - November, 2007:
Post procedure diagnosis: Gastritis, Duodenitis, Gapping lower esophageal sphincter and reflex esophagitis.
Observation:
Oropharynx - Normal
Esophagus - Mild distal esophagitis
GEJ: @ 38 cm. Gapping lower esophageal sphincter
Stomach:
Body - Mild pangastric erythema
Deodenum:
First Part – Mild erythema. Two tiny 1 mm erosions anteriorly.
Biopsy Report:
Antral - Gastric mucosa showing intact architecture. Mild chronic inflammation is identified in lamina propia. Helicobacter like organisms are identified. No evidence of metaplasia or dysplasia is seen.
Body of stomach – Two fragments of gastric mucosa showing specialized type of gastric mucosa showing mild chronic inflammation in the lamina propia. Helicobacter like organisms are identified. No evidence of metaplasia or dysplasia is seen.
Diagnosis: Antrum and body of stomach: Mild chronic helicobacter pylori associated gastritis.
Treatment: Antibiotic regime for 10 days, Amoxicillin 1000mg once a day + Ciprofloxacin 500mg and Esomeprazole 20mg twice a day, after the initial regime Esomeprazole 40mg for two weeks and then 20mg for two weeks recommended.
I started feeling better but no test was done to check for H. Pylori eradication.
---------
After a few years, I started having the acidity and reflux again, I had a stool test done which showed that I had giardia lamblia, so I visited the GI again in May, 2014, another Upper GI endoscopy was done.

Endoscopy - October, 2014:
Post procedure report stated: Hiatal Hernia, Pangastric erythema,
Observations:
All normal but GEJ - Z line@35 cm, Hiatus at 37 cm: small hiatal hernia
Stomach observations: showed Fundus, Body, Antrum with Mild pangastric erythema.
Biopsy report of Distal Duodenum stated:
Duodenal mucosal fragments showing mild chronic Duodenitis. The villi are reasonably tall. No increase in intraepithelial lymphocyte noted. No granuloma or giardia lamblia seen. There is no evidence of malignancy.
Biopsy report of Antrum stated:
Gastric antral mucosal fragments showing non-specific changes. No activity noted. No Helicobacter pylori organisms are seen. There is no evidence of granuloma or malignancy.
Treatment offered: Esomeperazole 20 mg and Gaviscon if needed.
---------
In February 2018, I went for a complete medical and wanted to know where I stand with Hiatal Hernia so I went back to the GI again, I told him at times there were symptoms of GERD so we decided to go for another upper GI endoscopy.

Endoscopy - March, 2018:
Post procedure result stated: small hiatus hernia/Mild esophagitis with ragged Z line/Mild gastric erythermia.
Observations:
Esophagus - Mild distal esophagitis with one linear erosion
GEJ - Ragged Z line @37 cm, Hiatus at 39 cm: small hiatus hernia
Stomach - Fundus: normal, Body: Mild erythema seen, and Antrum: Mild erythema seen.
Biopsy report stated: Antrum.
The lamina propia shows moderate inflammation comprising of lymphocytes and plasma cells with focal neutrophils. Helicobacter pylori-like organisms are also noted. There are multiple foci of intestinal metaplasia. There is no evidence of granuloma or malignancy.
Diagnosis:
Antrum:- Moderate chronic focal active Helicobacter pylori associated gastritis.
Intestinal metaplasia is also seen.
Treatment offered:
Amoxicillin 1 gm + Clarithromycin 500 mg + Esomeperazole 40 mg and Bismuth Subcitrate (120 mg - Two Tablets each time), all medicines were to be taken twice a day for 14 days, followed by Esomeperazole 40 mg once a day for a month. I also used Mastic gum and Manuka honey.
Eradication Test:
I finished the treatment and stopped taking Esomeperazole, Mastic gum and Manuka honey, like 15 days after I finished the antibiotics. A month after I stopped taking PPI, I went for a Urea Breath Test (UBT) with C13, the result stated: DOB= -0.22 Negative-, which was a big relief for me. Two months after the UBT test, I had a H. Pylori Antigen (stool) test done and it was also negative. The test was done with Rapid Immunoassay method.
---------
After the testing I had some good days and some bad days throughout the year. During this period, I also tried several herbal remedies and treatments which gave some relief at times. In order to check on Intestinal Metaplasia I was advised by the doctor to get an endoscopy after a year so I had it done in the last week of July.

Endoscopy - July 2019:
Pre-procedure diagnosis - Ragged Z-line and Intestinal Metaplasia / Surveillance EGD
Post-procedure diagnosis – Whitish patches throughout Esophagus (? Eosinophillic Esophagitis) / Gaping LES / Ragged Z-line
Observations:
Oropharynx – Normal
Esophagus – Small whitish patches (exudates) seen throughout esophagus. Multiple biopsies taken for histopathalogy analysis. Intermittent feline pattern contractions of mucosa.
GEJ - @ 38 cm, Gapping lower sphincter and ragged Z-line seen.
Stomach - All normal. Antrum Mild erythema seen. Biopsies taken.

Biopsy Report: The specimen was received in formalin in 2 containers. Container 1 coded as "Antrum" consisting of four grey white tissue pieces and container 2 coded as "White patches in esophagus" consisting of four grey white tissue pieces. (Note: Total of eight tissue samples were taken, I guess to check thoroughly).

Deodenum - Fragments of specialized and non-specialized gastric mucosa with mild chronic focally active gastritis Helicobacter Pylori organism. No evidence of Intestinal Metaplasia or Dysplasia.
White patches in Esophagus – Superficial strips of squamous mucosa with mild congestion, scattered neutrophils and lymphocytes. Significant number of eosinophils are not seen in the epithelium. Scanty amount of lamina propia seen with few inflammatory cells and fibrosis. Negative for dysplasia.

I had a CBC test done after the endoscopy which showed all normal but eosinophils were 10.5 which was high but I was told that they could be high because I suffer from allergic rhinitis.

In reply to one of the earlier asked question by me on this forum you said that it is hard to get re-infected with H. Pylori but it has infected me again, even though I am extremely keen on hygiene. My wife has also been tested negative for H. Pylori in stool antigen test. So, I have had H. Pylori third time and I wonder why and what could be the reason, could it be something that I eat regularly.

In the follow up appointment after the endoscopy, my doctor told me that since it is mild chronic focally active gastritis Helicobacter Pylori organism, I should not worry about it. When I told him that I am worried, he said in that case I should take 14 days regime once again that is, Amoxicillin 1 gm + Levofloxacin 500 mg + Pantoprazole 40 mg and Bismuth Subcitrate (120 mg - Two Tablets each time), all medicines are to be taken twice a day for 14 days, followed by Pantoprazole 40 mg once a day for a month, only change from last regime is Levofloxacin instead of Clarithromycin and Pantoprazole instead of Esomeperazole.

I was glad to hear when the doctor told me that intestinal metaplasia is no more there and has reversed, also there was no mention of Hiatal Hernia, so I asked him if the Hiatal Hernia is also gone and he said it never goes back. Also, I have requested the pathologist to do a immuno stain to highlight Helicobacter as I am unable to understand what it means when the report says H. Pylori like organism seen.
Also, I wanted to get your advice on the medication, opinion and some explanation of the situation.

1. What is the difference between the treatment regime with Levofloxacin / Pantoprazole and Clarithromycin / Esomeperazole?
2. Do you think that four tissue samples taken was enough to be sure that intestinal metaplasia has reversed? and When should I get another endoscopy to check if intestinal metaplasia is not back?
3. Can Hiatal Hernia be reversed or heal on its own, or with some other exercises?
4. Is there a need for a diet plan, if yes, what diet plan should I follow?
5. Is there a supplement that I should take to help with gastritis and inflammation?

I have not started taking the treatment regime prescribed yet and I would appreciate your prompt reply and advice.
Once again, I thank you for your time and kindness. May God Bless you all for all the good you are doing for humanity.

Kind Regards and Best Wishes

Stay Blessed.

Helico_expert
Site Admin
Posts: 3639
Joined: Wed Mar 02, 2011 7:20 am

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Helico_expert »

Hi, thanks for sharing your detail report.

Esomeprazole, pantoprazole, omeprazole, rabeprazole, etc.. these are PPI.
PPI is to reduce the acid secretion.

Levofloxacin, clarithromycin, amoxicillin, metronidazole, tetracyline, etc.. these are antibiotics.

To kill H. pylori, you need one effective PPI and two antibiotics (triple therapy). sometimes, due to antibiotic resistant, you need three antibiotics (Quadruple therapy).

When doctor take a biopsy from your stomach for histology examination, the biopsy is only a very small part of the whole stomach. If the doctor did not pick the metaplasia part, then histology will not show. 4 biopsy samples is good enough for now. taking too much will make you very uncomfortable.

Hiatal Hernia is harder to heal. depending on the severity, most people wont feel it.

There is no special diet plan to follow. Eat whatever you feel good.

Maria.b
Posts: 46
Joined: Wed Apr 25, 2018 2:50 pm

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Maria.b »

Sorry to jump post but does this bacteria seem to spread quicker in hot countries as so many are suffering where i live or have been treated for it and yet its not really known of in the uk

Steve H.
Posts: 17
Joined: Thu Apr 26, 2018 1:45 am

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Steve H. »

Helico_expert wrote:
Fri Aug 23, 2019 11:09 pm
Hi, thanks for sharing your detail report.

Esomeprazole, pantoprazole, omeprazole, rabeprazole, etc.. these are PPI.
PPI is to reduce the acid secretion.

Levofloxacin, clarithromycin, amoxicillin, metronidazole, tetracyline, etc.. these are antibiotics.

To kill H. pylori, you need one effective PPI and two antibiotics (triple therapy). sometimes, due to antibiotic resistant, you need three antibiotics (Quadruple therapy).

When doctor take a biopsy from your stomach for histology examination, the biopsy is only a very small part of the whole stomach. If the doctor did not pick the metaplasia part, then histology will not show. 4 biopsy samples is good enough for now. taking too much will make you very uncomfortable.

Hiatal Hernia is harder to heal. depending on the severity, most people wont feel it.

There is no special diet plan to follow. Eat whatever you feel good.
Thanks Helico Expert for your valued advises and information.

1. In reply to one of the earlier asked question by me on this forum you said that it is hard to get re-infected with H. Pylori but it has infected me third time around, even though I am extremely keen on hygiene. My wife has also been tested negative for H. Pylori in stool antigen test. So, I have had H. Pylori for third time and I wonder why and what could be the reason, could it be something that I eat or drink regularly, and what should I do for completely eradication.

2. Prescribed medication, that is,Amoxicillin 1 gm + Levofloxacin 500 mg + Pantoprazole 40 mg and Bismuth Subcitrate (120 mg - Two Tablets each time), all medicines are to be taken twice a day for 14 days. The only change from last regime is Levofloxacin instead of Clarithromycin and Pantoprazole instead of Esomeperazole. So, will that work better or what? And should I start taking it even though the biopsy report said "specialized and non-specialized gastric mucosa with mild chronic focally active gastritis Helicobacter Pylori organism."

3. You said that when the doctor take a biopsy from your stomach for histology examination, the biopsy is only a very small part of the whole stomach. If the doctor did not pick the metaplasia part, then histology will not show, so does that mean that one can never be 100% sure that intestinal metaplasia has reversed?

Thanks once again.

Steve H.
Posts: 17
Joined: Thu Apr 26, 2018 1:45 am

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Steve H. »

Maria.b wrote:
Sat Aug 24, 2019 1:45 am
Sorry to jump post but does this bacteria seem to spread quicker in hot countries as so many are suffering where i live or have been treated for it and yet its not really known of in the uk
I think you are right, the prevalence is higher in hot countries but it also does not seem to be much lower in cold countries. The Helico team should be able to shed light on this.

Helico_expert
Site Admin
Posts: 3639
Joined: Wed Mar 02, 2011 7:20 am

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Helico_expert »

hmmm... spreading faster in Hot country? probably not true.

Indonesia and Malaysia are pretty hot, they are the only two countries I know, originally free of H. pylori. All the H. pylori in those countries are introduced by migrants like Chinese and Indian. The local people is free of H. pylori.

In respond to Steve's question about reinfection, it is true that H. pylori doesnt spread easily. Your three times "reinfection" is most probably due to antibiotic resistant and treatment failure. When you took the medications, 99% of the H. pylori is killed, and you feel better. However, after a while, the 1% survival build up the number and strike you again. You thought you got reinfected, but it's actually a treatment failure that did not kill them off 100%. Hence it is important to get a follow up breath test after each treatment to make sure there is no more H. pylori left.

Steve H.
Posts: 17
Joined: Thu Apr 26, 2018 1:45 am

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Steve H. »

Helico_expert wrote:
Sun Aug 25, 2019 10:08 am
In respond to Steve's question about reinfection, it is true that H. pylori doesnt spread easily. Your three times "reinfection" is most probably due to antibiotic resistant and treatment failure. When you took the medications, 99% of the H. pylori is killed, and you feel better. However, after a while, the 1% survival build up the number and strike you again. You thought you got reinfected, but it's actually a treatment failure that did not kill them off 100%. Hence it is important to get a follow up breath test after each treatment to make sure there is no more H. pylori left.
Thanks Helico Expert,

Initially I got infected with H. Pylori in 2007 and after the 10 days treatment, in the next endoscopy and biopsy result done in 2014, H. Pylori was not found but last time it was in March, 2018 when I went for a endoscopy to check on Hiatal Hernia that I found out that I was infected with H. Pylori for the second time. Second time after the treatment with Amoxicillin 1 gm + Clarithromycin 500 mg + Esomeperazole 40 mg and Bismuth Subcitrate (120 mg - Two Tablets each time), all medicines were to be taken twice a day for 14 days. To test for eradication I went for a Urea Breath Test (UBT) with C13, the result stated: DOB= -0.22 Negative-, which was a big relief for me. Two months after the UBT test just to make sure, I had a H. Pylori Antigen (stool) test done and it was also negative. The test was done with Rapid Immunoassay method. So, I got the test done and reported it to you as well and you also said that "Yes. Based on that two tests, I believe your HP has been eradicated, each of those tests has over 90% accuracy" and "Breath or Stool test are good to confirm HP eradication." So I did get the follow up test. I feel the re-infection has to do with the bacteria in saliva or oral as I had two root canals in the past where the bacteria could be trapped and causing the re-infection.
What do you think???????

I also asked you in my post last year that "The biopsy report from 2018 says "Helicobacter pylori-like organisms also noted", what does that really mean? Can it be something similar to H. Pylori (like another type of Helicobacter organism) and not actually H.Pylori?" Your reply was "It's probably some bacteria from the saliva. But let's find out from your next endoscopy and histology report. If in doubt, you can ask the pathologist to do immuno stain to highlight Helicobacter." I asked the pathologist to do an immunostain to highlight helicobacter and she said "we have to tell her the markers we are testing for" so I request you to please advise which markers should we use for immunostaining?????????

Suppose, if I find out after getting immuno stain done and find out that it is some other type of Helicobacter that is infecting me, will this prescribed treatment regime also work on the eradicating it or will it be some other treatment????????

Also, kindly advice on the treatment regime prescribed by the doctor to me this time around. He has prescribed Amoxicillin 1 gm + Levofloxacin 500 mg + Pantoprazole 40 mg and Bismuth Subcitrate (120 mg - Two Tablets each time), all medicines are to be taken twice a day for 14 days. My question is should I take this medication regime even though the report says "specialized and non-specialized gastric mucosa with mild chronic focally active gastritis Helicobacter Pylori organism?" Will the prescribed treatment regime work or is it better than the last treatment with Clarithromycin????????

I have not started taking this medication and I am waiting for your advice and feedback before I start taking the prescribed medication.

Thanks & Stay Blessed
Last edited by Steve H. on Sun Aug 25, 2019 5:42 pm, edited 1 time in total.

Helico_expert
Site Admin
Posts: 3639
Joined: Wed Mar 02, 2011 7:20 am

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Helico_expert »

Looks like you are very "lucky" of continuously being genuinely reinfected. I wonder why.

Helicobacter pylori-like organism usually refer to H. heilmannii, where it's slightly fatter. H. heilmannii is usually found in domestic animals. So I wonder if you keep any pets?

who else living with you under the same room all these years? have they checked for H. pylori infection?

since it's a genuine reinfection, you can take the same medication for eradication. If your doctor believes that it's genuine infection of Helicobacter, regardless if it is pylori or heilmannii, you should get treatment.

Steve H.
Posts: 17
Joined: Thu Apr 26, 2018 1:45 am

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Steve H. »

Helico_expert wrote:
Sun Aug 25, 2019 5:41 pm
Looks like you are very "lucky" of continuously being genuinely reinfected. I wonder why.

Helicobacter pylori-like organism usually refer to H. heilmannii, where it's slightly fatter. H. heilmannii is usually found in domestic animals. So I wonder if you keep any pets?

who else living with you under the same room all these years? have they checked for H. pylori infection?

since it's a genuine reinfection, you can take the same medication for eradication. If your doctor believes that it's genuine infection of Helicobacter, regardless if it is pylori or heilmannii, you should get treatment.
LUCKY !!!!!!!!!! for continuously being genuinely reinfected?????? :) Trust me Helico Expert, I would rather be unlucky and not be ever infected with H. Pylori, I pray myself and everyone else to be free from H. Pylori for ever. Amen.

Currently, No pets in the house, I used to have a Labrador and three German Shepards between 2005 and 2011. I do get fresh milk from a nearby farm.

I live with my wife and 4 young kids aged 12 to 2 years, my wife has tested negative for H.Pylori in stool antigen test.

H. Heilmannii, So what is the treatment for that? Is it the same as H.Pylori??????

I asked the pathologist to do an immunostain to highlight helicobacter and she said that "we have to tell her the markers we are testing for" therefore I request you to please advise as to which markers should the pathologist use for immunostaining?????????

In my earlier asked question you said that "when the doctor takes a biopsy from your stomach for histology examination, the biopsy is only a very small part of the whole stomach. If the doctor did not pick the metaplasia part, then histology will not show", so does that mean that one can never be 100% sure that intestinal metaplasia has reversed??????????

Thanks.
Last edited by Steve H. on Sun Aug 25, 2019 7:45 pm, edited 1 time in total.

Helico123
Posts: 30
Joined: Wed Jun 12, 2019 4:25 pm

Re: Questions about H.Pylori, Testing, Diet, Intestinal Metaplasia and Hiatal Hernia

Post by Helico123 »

Helico_expert wrote:
Sun Aug 25, 2019 5:41 pm
Looks like you are very "lucky" of continuously being genuinely reinfected. I wonder why.

Helicobacter pylori-like organism usually refer to H. heilmannii, where it's slightly fatter. H. heilmannii is usually found in domestic animals. So I wonder if you keep any pets?

who else living with you under the same room all these years? have they checked for H. pylori infection?

since it's a genuine reinfection, you can take the same medication for eradication. If your doctor believes that it's genuine infection of Helicobacter, regardless if it is pylori or heilmannii, you should get treatment.
Sorry for jumping into your topic, my histology report after endoscopy also shown helicobactor-like organisms.
before reading this post, I have thought that I was certainly infected with H pylori.
When they report as helicobactor-organism, does that mean the pathologist was not 100 % sure that which type of helicobacter bacteria it was?

If someone infected with h pylori, do they clearly specify and mention in the histology report as H pylori? Or they just report any type including h pylori just as helicobacter-like organism?

It would be interesting if I was not infected with H pylori. Can helicobactor heilmanni cause intestinal metaplasia too?

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