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Re: Diagnosed with h pylori

Posted: Tue Aug 13, 2019 10:09 am
by Helico_expert
the sour taste is probably due to acid reflux. it's not necessary because of presence of H. pylori. It could be because of stopping PPI too quickly. You can imagine when a pipe is blocked.. and suddenly the blockage is removed. the water is going to burst out. So this is what happen to stopping PPI too quickly. you can start taking some ranitidine to control the symptoms. ranitidine will not affect the breath test. you can take ranitidine until the night before breath test.

Re: Diagnosed with h pylori

Posted: Fri Aug 16, 2019 3:38 pm
by Helico123
Hi,
I had a bit of research about intestinal metaplasia (IM) and reviewing some of the studies has been done about its prevalence and relevance with cancer. Most published paper and retrospective studies concluded that IM is irreversible and even eradication of h pylori cant stop its progression but slow down its progression. Considering the fact that 50 to 60 per cent of the world population is being infected with H pylori and only some of them will develop gastritis and few of patient with gastritis will end up to IM, can we really attribute incidence of IM to H pylori? I think there are many risk factors contributing to IM.
Also, in one study investigating the progression of IM after H pylori treatment, there was not a significant difference in IM worsening between still H pylori positive and negative patient in follow up endoscopy after h pylori treatment.
My question is if eradication of H pylori would not stop the progression of IM, what is the the benefit of eradication?
With regard to my biopsy , what would happen to my IM after H pylori eradication ( assuming it is not reversible), Would it progress further or extend to larger area?

I attached just one sample paper published among many which I read regarding the management of IM.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312926/

Re: Diagnosed with h pylori

Posted: Sat Aug 17, 2019 10:01 am
by Helico_expert
I think first you need to understand that H. pylori is the root of the problem. Its presence attract inflammations and leads to massive damage to the stomach cells.

As you aged, your repair mechanism become weaken, stem cells are then recruited to do the repair job. Intestinal stem cells reach stomach quickly and start replacing the damaged stomach cells. Hence, the progression of IM.

If you do not kill of H. pylori, the damage will continue and IM will get worse.

However, since the IM does not produce mucous, they are sometimes killed by the stomach acid, and then the neighbouring stomach cell can do cell replication and fix the damage.

In the situation when the acid producing cells are also killed by the inflammation and replaced by intestinal stem cells, then the acid production reduced, and the IM stays.

As the IM continue to evolve, trying to make stomach more intestine like, plus the lack of acid, carcinogen from diet and other bacteria accumulate, then it can progress to cancer.

So in summary,
Yes, eradicating H. pylori is a must.
We should eradicate H. pylori before IM (before you get any symptoms).
There is always a chance for the reverse of IM. But, depending on the severity, an annual endoscopy is recommended to monitor the progress of IM.

Re: Diagnosed with h pylori

Posted: Sat Aug 17, 2019 2:12 pm
by Maria.b
Hi helico expert i have just read yr post on intestinal metaplasia i have been asking drs and google for over a yr and unless im thick never really understood why im occurs in some people and other are fine this explanation is fantastic and yr knowledge is amazing thanku so much u really are a great help to the community xXxX

Re: Diagnosed with h pylori

Posted: Sat Aug 17, 2019 4:11 pm
by Helico123
Thanks for the information. So for my case, I could still be optimistic to get my IM regressed since I had just focal IM and mild atrophy and some of my acid-secreting glands are intact, right?
Could you please advise if taking vitamin c supplement is helpful in the healing process?
Thanks for all your useful information and advice.

Re: Diagnosed with h pylori

Posted: Sat Aug 17, 2019 5:05 pm
by Helico_expert
Yes, we should always be optimistic.
Yes, Vit C can prevent cancer.

https://journals.plos.org/plosone/artic ... ne.0116060
Conclusion
This meta-analysis clearly demonstrated that low doses of vitamins can significantly reduce the risk of GC, especially vitamin A, vitamin C, vitamin E.

Re: Diagnosed with h pylori

Posted: Tue Aug 20, 2019 7:25 am
by Helico123
Hi,
According to your explanation, the IM does not produce mucous, And can be killed by the stomach acid, and then the neighbouring stomach cell can do cell replication and fix the damage. If I understand right, acidic environment of stomach is good for healing of IM. I wonder whether taking ppl which reduce stomach acid prevent IM healing after H pylori eradication?

Thanks

Re: Diagnosed with h pylori

Posted: Tue Aug 20, 2019 2:16 pm
by Helico_expert
The sour taste is probably acid reflux. You can take some ranitidine to neutralise the acid.
you can continue ranitidine until the night before breath test.

having acid reflux doesnt mean you still have H. pylori. Some people just take longer to heal.

Re: Diagnosed with h pylori

Posted: Wed Aug 21, 2019 10:14 am
by newpylori
Helico123 wrote:
Tue Aug 20, 2019 7:25 am
Hi,
According to your explanation, the IM does not produce mucous, And can be killed by the stomach acid, and then the neighbouring stomach cell can do cell replication and fix the damage. If I understand right, acidic environment of stomach is good for healing of IM. I wonder whether taking ppl which reduce stomach acid prevent IM healing after H pylori eradication?

Thanks
An interesting question... As one diagnosed with IM request helico expert please help us understand.

Re: Diagnosed with h pylori

Posted: Wed Aug 21, 2019 10:34 pm
by Helico_expert
Hi,
According to your explanation, the IM does not produce mucous, And can be killed by the stomach acid, and then the neighbouring stomach cell can do cell replication and fix the damage. If I understand right, acidic environment of stomach is good for healing of IM. I wonder whether taking ppl which reduce stomach acid prevent IM healing after H pylori eradication?
I guess it's a catch 22. we need the acid to kill off bad bacteria or denature carcinogens. In the same time, we dont want acid to cause reflux and causes esophageal and oral cancer.

Here are some points.
Patients with atrophic gastritis, produce less acid, higher risk of gastric cancer.
The acid killing of IM is an unproven theory.
However, there are articles out there about long term PPI increasing gastric cancer rate.
Nevertheless, those patients who took long term PPI and developed gastric cancer, usually are those who were infected with H. pylori before.


https://gut.bmj.com/content/67/1/28

download/file.php?mode=view&id=64&sid=c ... 1fe670ca8f


As you can see from this table, you can interpret "with prior HP therapy" as patients who had H. pylori before.
and you can see that the categories where patients uses PPI without prior HP therapy are all low risk of gastric cancer.

In conclusion, I think the chance of long term PPI causing stomach cancer is lower than not taking PPI and develop other throat and mouth complication. Therefore, if PPI can control the reflux symptoms, patients should continue PPI. Meanwhile, patients with IM, should go for annual endoscopy follow up.