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Extremely low stomach acid

After first line treatment, various "second line" treatments can be used. The policy for H.pylori is: Make sure the infection is real (breath test for follow-up). Always give a high dose of PPI (acid blocker) when using amoxicillin. In the second treatment, give a different drug in place of clarithromycin.

Moderators: Toni, barjammar, luci2010, Ondek-Expert, kkimura

Chonibashi12
Posts: 20
Joined: Thu Feb 20, 2020 6:59 am

Re: Extremely low stomach acid

Post by Chonibashi12 »

Hello Helico Expert,

My last treatment was:

Omeprazole 20mg 3 times a day
Levofloxacin 500mg twice a day
Amoxicillin 1g three times a day
Bismuth 350mg three times a day

I did not feel better during the treatment at all I just had nausea from the side effects of levofloxacin. The only treatment that made me feel good was the first with clarithromycin, my appetite went up.

For the culture it’s only 50% luck, and I have used all the drugs. But I will take the culture test nevertheless.

I think it’s the end for me sadly, do you have any words to make me feel better?

Helico_expert
Site Admin
Posts: 3751
Joined: Wed Mar 02, 2011 7:20 am

Re: Extremely low stomach acid

Post by Helico_expert »

So you have not tried rifabutin. Perhaps you should try the following regime.

Rabeprazole 20mg (TID)
Bismuth 350mg (TID)
Amoxicillin 1g (TID)
Rifabutin 150mg (BID)

The reason rabeprazole is better than omeprazole is because when omeprazole is made, it contain two configurations, the L type and the R type. Only the L type is functional. therefore, when you take 20mg of omeprazole, only 10mg is the actual active ingredient.
Then, scientist figured that out and invented esomeprazole where the R type is removed, and therefore more expensive.

another reason for choosing rabeprazole is because everyone metabolised the PPI differently. especially when you have this functional CYP2C19 gene, you have fast metabolism against PPI, especially against omeprazole. Therefore, the effective dose is further reduced. People who has fast metabolic rate against omeprazole should take double the dose. Rabeprazole is not affected by metabolic rate. Therefore it is a better choice than other PPI.

Acid suppressant is very crucial when it comes to HP eradication. The better you neutralize the stomach acid, the higher cure rate you'll get. There is a new PPI, vonoprazan, released last year. It is the best PPI ever because it is the only PPI that can push stomach acid to almost neutral for long period of time. When that happened, clinical trials already shown that vonoprazan and amoxicillin alone can give HP cure rate of over 90%.

Chonibashi12
Posts: 20
Joined: Thu Feb 20, 2020 6:59 am

Re: Extremely low stomach acid

Post by Chonibashi12 »

Dear Helico Expert,

Once again thank you for your reply, I will undertake the culture once the lockdown is lifted, and I will discuss with my doctor the Rifabutin regimen you have given.

Thank you

Chonibashi12
Posts: 20
Joined: Thu Feb 20, 2020 6:59 am

Re: Extremely low stomach acid

Post by Chonibashi12 »

Dear Helico Expert,

I want to ask a question that has been killing me to death, maybe your excellent knowledge in H pylori can answer it for me.

On my first treatment with H pylori my appetite went up, no discomfort when eating, regular stool consistency, now this is 100% down to acid secretion during the treatment (correct me if I’m wrong).

When I stopped the treatment everything went back to as it was, extremely low stomach acid, cannot eat or digest anything at all.

1. Where did all that acid go after stopping the treatment, how it can disappear all of a sudden?

This is something really crazy that H pylori can do.


Thank you Helico Expert

Helico_expert
Site Admin
Posts: 3751
Joined: Wed Mar 02, 2011 7:20 am

Re: Extremely low stomach acid

Post by Helico_expert »

have you checked if you still have H. pylori? The guideline says, one month after treatment, patients need to get follow up test to find out if they still habe H. pylori.

in most cases, H. pylori "destroys" the acid secretion mechanism, so when a treatment is given, H. pylori number gets down and the acid secretion starts to gradually return and appetite gets better.

if 1% of resistant H. pylori survived through the treatment, it will gradually build up an army and return with all the symptoms. So it is important to find out if you still have H. pylori.

if your treatment is successful, then you'll have to talk to your doctor about symptomatic treatment. find out what you meant by "low acid". perhaps you meant you felt that food is always in the stomach, always feel fullness. Then maybe it is due to slower motility to push the food down from stomach into intestine. There are treatments to improve motility.

Chonibashi12
Posts: 20
Joined: Thu Feb 20, 2020 6:59 am

Re: Extremely low stomach acid

Post by Chonibashi12 »

Dear Helico Expert, I report after 2 months of hell and suffering since your last comment.

1. So far I have gone through 4 treatments of H pylori. My symptom is extremely low stomach acid (hypochlohydria), intestinal gas, burping, loss of appetite (never feel hungry). Bloating, substantial weight loss.

2. So since your last comment I decided to just give myself a small break of all the antibiotic treatments.

Just a few days ago I went to see a new gastroenterologist to start my new treatment of Rifabutin based quadruple therapy, however first he recommended endoscopy, upon doing this he found erosions as well as 1 raised bump like gastric erosion. So he decided to take biopsy for histology.

Today the results came back and the biopsy results showed a high number of abnormal eosinophilic cells in the biopsy, My gastroenterologist now wants to take biopsy in the healthy parts of my stomach to further investigate.

I understand that those people who experience low stomach acid with H pylori infection have increased risk of gastric cancer as H pylori can change the acid secreting cells.

I hope I have given enough information here for you to give me your knowledge and understanding of this please.

Thank you once again

Chonibashi12
Posts: 20
Joined: Thu Feb 20, 2020 6:59 am

Re: Extremely low stomach acid

Post by Chonibashi12 »

Hello Helico expert hope you are well,

Just a question: is it true that it can take a very long time for acid levels to raise in patients with hypochlohydria and for some it can be partial?

Thank you

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barjammar
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Posts: 144
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Location: Perth Australia
Contact:

Re: Extremely low stomach acid

Post by barjammar »

I can't add much to Helico Expert, the advice is good. Also, you seem to have a thorough GI specialist who is working on the problem. If Hp has been eradicated, low acidity is always accompanied by atrophy or extensive metaplasia of the upper half (acid secreting mucosa /corpus mucosa), and I doubt that it can return to normal no matter what happens.
But acidity is hard to measure without a formal acid secretion test (these aren't done much any more but are research tests). If the corpus biopsy shows plenty of parietal cells, I suggest that the low acidity is just artefact. The gastric juice is sometimes diluted with saliva or even bile reflux when endoscopy is going on. You only need a small number of parietal cells functioning to maintain acidity below 3 in the stomach, which is the level which kills bacteria and keeps the stomach clean.
If there are no parietal cells, or very very few, then even if Hp is eliminated, a cancer risk remains and yearly checking would be worthwhile.
If acidity is really low and gastric atrophy is present, then breath tests for Hp might give a false positive result. Add a second and third test. These would be a biopsy (no PPI/Nexium for 14 days), culture, stool antigen, and serology at 6 and 12 months to look for a falling titre or even a negative result after some time.
I'll discuss this with Helico Expert.
Barry Marshall
Check the link below for information on hard-to-treat cases. Then search the forums for questions and answers similar to yours.
docs/200808%20stenstrom%20Hp%20Treatment.pdf

PyloriSte
Posts: 14
Joined: Sat Jun 27, 2020 3:51 am

Re: Extremely low stomach acid

Post by PyloriSte »

Why don't you try supplements to help the antibiotic treatments, turmeric, mastic gum, allicinmax, cranberry extract, siberian pine tree nut oil, kefir, manuka honey.

jes21
Posts: 1
Joined: Tue Jun 30, 2020 7:04 pm

Re: Extremely low stomach acid

Post by jes21 »

Low stomach acid is a trigger for poor digestive activity. Because food and nutrients can't be broken down, they sit in the stomach and cause bacteria to build up. The main symptoms from this process are gas and bloating.

Chronic stress may decrease production of stomach acid. Vitamin deficiency. Deficiency of zinc or B vitamins may also lead to low stomach acid. These deficiencies may be caused by inadequate dietary intake or by nutrient loss from stress, smoking, or alcohol consumption.

Regards:
Jes21...........
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