Positive biopsy in March → no specific treatment → Negative stool test November

[Vitebs47]

Hi everyone! I did an endoscopy in March, which showed gastritis and the presence of bile in the stomach, also express biopsy with ++ as the result. I was prescribed PPIs, which made me burp and bloated like crazy, 100x worse then before, so I dropped them after 4-5 days and "recovered" within a week to the initial symptoms (a bit bloated, I also have low WBC for reasons still unknown). My doc at the time told me not to eradicate h.pilori as she did not consider ++ to be worth treating with antibiotics. A couple days ago I saw another doc who told me to make a full stool test and a h.pilori antigen test, the latter being negative this time. I was a bit shocked as I had not taken any medications (except garlic which is considered by some as an antibiotic). Have just done another stool antigen test at another lab and will get the results soon. In the meantime, what can all that mean? False positive/negative biopsy/stool test or can the infection just resolve on its own? Thanks!

Edit: the second antigen stool test is also negative. I'm at a loss...

[Helico_expert]

Interesting. So did you ever get a positive result of H. pylori? how was it confirmed? There are very rare cases where PPI alone get rid of H. pylori. Perhaps you are very lucky.

[Vitebs47]

Interesting. So did you ever get a positive result of H. pylori? how was it confirmed? There are very rare cases where PPI alone get rid of H. pylori. Perhaps you are very lucky.

Hi! First, thanks very much for your time! I did get a positive biopsy result in March 2020. It was some kind of 'express test' during my gastroscopy which measures the amount of h.pylori on the scale of + (low) to +++ (high). Mine was ++, which is supposed to mean a moderate number. Anyway, they found gastritis, I was prescribed PPIs after that, but could not take them for more than 5 days as they made me burp and extremely bloated with a heavy sensation in the stomach. Of course, I'd had the same symptoms prior to taking them, but the PPIs made my condition 100x worse. I guess I just can have low stomach acid instead of high. A couple days ago I saw another doc who told me to do a stool antigen test to confirm a have h. pylori along with a full stool analysis. My initial thought was - what do you need it for? Of course, it will show I'm positive, my h.pylori was confirmed with a biopsy and no eradication treatment was done! Just a waste of money. To my astonishment, it came back negative (the full stool test showed some digestion issues, though). I did another one yesterday at another lab, and it was also negative.

As for now, I can see 3 possibilities:
1) False-positive express biopsy test (can that happen at all? I mean, they are literally taking a part of your stomach lining for the test).
2) H.pylori somehow died during the several months in-between or its number is too low to be detectable in stool. I don't think that 5 days of taking PPIs could have eradicated the bacterium.
3) Two false-negative consecutive stool antigen tests at different labs.

[Helico_expert]

It's rare to get a false positive from biopsy. "++" two pluses is almost 99.9% accurate.
it's usually more common to get false negative from biopsy because the bacteria load is so low, the pathologist accidentally missed it.
Then again, the inflammation will give the pathologist a hint to look harder.

it's more likely to get false negative from stool test because IF your stomach is indeed not acidic, then H. pylori will not grow well. and the bacterial load is too low for stool test to pick up.

two consecutive negative antigen test from different lab is also almost confirm that you are clear of H. pylori. perhaps you can get a blood test now, ask for the titre of antibody against H. pylori. then measure again 3 months later. if the antibody is dropping, then it will be true that you are free of H. pylori.

alternatively, you can get another endoscopy 6-12 months later. to see if your inflammation condition improved.

[Vitebs47]

Thanks! I will do the test tomorrow and check what level of IgG I have.

[Vitebs47]

Hi! The mystery continues
My igG test showed 10.5. According to my lab, less than 5 means negative, more than 15 is positive, while I'm stuck somewhere in between in the "f...k knows" zone

[Helico_expert]

That will be your baseline. You can test again in a few months time and see if it drops.
a drop will indicate free of H. pylori
being constant or rise value will indicate presence of H. pylori.

But since it is in the indeterminant zone, your chance of being free of H. pylori is high.

[Vitebs47]

Hi! I've just done the same tests at the same lab: 1) stool antigen 2) blood igG. Not too early, how do you think? Awaiting the results in a few days. Thank so much for your helpful advice!

[Helico_expert]

look forward to seeing your test result.

[Vitebs47]

Hi! The new results are as follows:
stool antigen - negative
blood igG - 6.12 (still equivocal as between 5 and 15) - down from 10.6 two months ago.
Can I consider the bug gone?