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MALT Lymphoma

After many years of H.pylori infection a cancer can develop in the stomach. This is particularly common in Latin America and Asia (esp. Japan). It is believed that lifelong inflammation of the stomach lining causes low acidity which then allows carcinogens to be active in the stomach. These then cause stem cells (part of the healing process) to mutate and become cancer cells.

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ML-HELLico_Bacttle
Posts: 26
Joined: Wed Oct 24, 2018 7:32 am

MALT Lymphoma

Post by ML-HELLico_Bacttle »

Dear Helico_expert:

This is my case:
I've been "awarded" with being among the 1% who have a MALT Lymphoma due to H. Pylori.

I had atrophic gastritis + ulcer + H. Pylori + MALT Lymphoma. For who-knows-how-long...
It found in 201705 when I was in post-surgery after having just been removed a 20cm tumor from another rare cancer in the fat under the left kidney. (I'm skinny so I had very little fat, may I add)
Before surgery I made an endoscopy & colonoscopy because I had just found that my father had colon cancer so if I also had it I wanted the surgeons to know before the operation.
Both cancers were found by mere chance because I had absolutely NO SYMPTOMS apart from having gradually been losing weight over the last years.

Since then I have gone through 2 courses of antibiotics:

01 20170806SUN—20170820SUN Triple Therapy: 14+1 days of Cipamox (Amoxicillin) 500mg + Klacid (Clarithromycin) 500mg + Omeprazol 20mg (PPI) + 14-Strain ProBiotic (added by me).

02 20180508TUE—20180517THU Quadruple Therapy: 10 days of Pylera + Omeprazol 20mg (PPI).
By the middle of this course I changed my diet in order to eat the minimum calcium & iron possible to maximize the absorption of the antibiotics. My veggies were reduced to pumpkin, courgette, aubergine & cassava.
On the last days of Pylera I was on my knees, literally.

The ulcer has long been gone & left a scar.
The atrophic gastritis seems to have faded away.
However H. Pylori is still there & with it, on the Fundus, the MALT Lymphoma.

Soon, at the institute where I'm being treated at, there will be a multidisciplinary group meeting to discuss my case.
The menace of Radiation Therapy becomes closer. I am genetically prone to cancer in the stomach so if I undergo radiotherapy ANYTHING can happen… So I am willing to try EVERYTHING & now seems to be my last chance.

- - - - - - -- - -- -- ---- ---- ------------- -- - - - --

These were my first questions & answers that had been posted on another forum:

by ML-HELLico_Bacttle » Sun Oct 28, 2018 1:14 am
Before any introduction about my particularly rare & difficult case I'd like to post my first question:
Can H. Pylori be completely unreachable if it's already too deep into the stomach lining?

by Helico_expert » Sun Oct 28, 2018 3:45 am
The antibiotics will be absorbed by your body and flow in the blood. Every cell in your body will need nutrient from the blood and hence then antibiotics will reach every single cells. There is no hiding place for H. pylori in the body.

by ML-HELLico_Bacttle » Sun Oct 28, 2018 11:42 am
Ok, so if blood circulates all over the stomach lining: shouldn't Lymphocytes B be able to reach & handle these bacteria?

by Helico_expert » Mon Oct 29, 2018 3:15 pm
This is another reason why H. pylori is so successful. It has the ability to mask itself from the immune cells. The T and B cells are not able to get rid of it. B cells can generate antibodies against it and yet it survived. Hence, it is very difficult for vaccine to work.

- - - - - - -- - -- -- ---- ---- ------------- -- - - - --

My new question is:
I suppose you're not saying that the immune cells don't see H. Pylori otherwise I wouldn't have a MALT Lymphoma exactly where the bacteria is.
What exactly is the process that makes a MALT Lymphoma? Is it an accumulation of frustrated Lymphocytes that got ill because they can't deal with the enemy?
I must also add that my Lymphocyte count has been negative but not so much as last year before the antibiotic courses.
Last edited by ML-HELLico_Bacttle on Fri Dec 21, 2018 7:22 am, edited 1 time in total.

Helico_expert
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Re: MALT Lymphoma

Post by Helico_expert »

Hi, thanks for sharing your story. I wish you all the best to your treatment.

Nobody knows how H. pylori lead to MALT lymphoma. My guess is because of inflammation. As H. pylori needs to extract nutrient from the gastric cells. The gastric cells are sending signals to the immune cells to gather and fight off the pathogen. However, when the immune cells arrive, they cannot see the pathogen. So all the immune cells gathered there get stressed and starting to kill off everything. I believe the immune cells are trying to get rid of the pathogen by causing "mass destruction".

As you can see, H. pylori doesnt directly cause disease. It is the immune cells that cause the disease. As the immune cells destroy the gastric cells, the mucous become thinner; stomach acid can now digest the stomach wall; hence ulcer is formed.

As the immune cells destroy all the cell structure. the cells division is too slow in repairing the damage. stem cells from other regions are attracted to help fix the damage. When the intestinal stem cells arrive, it becomes intestinal metaplasia, that's the beginning of stomach abnormality. As the stem cells continue to evolve to adapt to the gastric environment, sometimes it turns into cancer cells.

So if the hypothesis is true, then by taming the immune cells can probably reduce the risk of chronic inflammation disease.

ML-HELLico_Bacttle
Posts: 26
Joined: Wed Oct 24, 2018 7:32 am

Re: MALT Lymphoma

Post by ML-HELLico_Bacttle »

Dear Helico_expert:

I always wonder whether you are a specific single person or one of the team which varies according to forum/subject.
Thank you so much because no one ever provided me with an explanation about it before. I'm trusting it's accurate because it surely makes sense.

I don't know if there is a connection but I have always been anxious & worried & always reacted to bad things with all weapons. I used to have Asthma when I was a kid and maybe it was an over-reaction to house dust acarus. I also wonder if H. Pylori was not protecting me from Asthma yet. This leads me to the question: is H. Pylori essential to the body?

So the whitish stain that they see on my Fundus is a gathering of intestinal cells that couldn't adapt to stomach acidity?
I thought they were white blood cells, specially lymphocytes.
If I understood your explanation right it supports my belief that radiation not only will not solve the problem as it can create a new one. MALT Lymphoma seems like a sort of autoimmune. My immune cells will always respond the same way to the stomach cells calling so the only solution seems to eradicate H. Pylori there if that is possible...
What I was told by the Onco-Hematologist was that radiotherapy could get rid of the lymphoma & that MAYBE there wouldn't be another clone that responded the same way. I don't exactly know what he meant by clone…

So there is no scientific way to make H. Pylori visible to T & B Cells yet...
What exactly do you mean by "taming the immune cells"? How?
Do you think that it is actually good that my immunity is on the lower side because if it was higher the reaction to such invisible-bacteria would cause a worse/faster damage?

And my most important & urgent question:
is there anything that can create an environment in the stomach that is hostile to H. Pylori?

Helico_expert
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Joined: Wed Mar 02, 2011 7:20 am

Re: MALT Lymphoma

Post by Helico_expert »

We have a team of people answering the post in the forum. But I am the most active one.

There is no way to create a "hostile" environment for H. pylori.

When patients become symptomatic, especially MALT or cancer, there is no good H. pylori. All H. pylori should be eradicated.

I am not sure which whitish stain you meant from your histology slide. perhaps you meant the globlet cells, which is a marker for intestinal metaplasia.

the lymphocytes are dark purple color, cells with a big nucleus.

The following link will give you more insight into how H. pylori "tame" the immune response.
https://www.ncbi.nlm.nih.gov/books/NBK2443/
Do you think that it is actually good that my immunity is on the lower side because if it was higher the reaction to such invisible-bacteria would cause a worse/faster damage?
In theory yes, but I think you will have to find out from your Oncologist.

Lastly, it is best to have H. pylori eradicated. Ask your doctor when is the best time you can take antibiotics to get rid of H. pylori.

ML-HELLico_Bacttle
Posts: 26
Joined: Wed Oct 24, 2018 7:32 am

Re: MALT Lymphoma

Post by ML-HELLico_Bacttle »

Dear Helico_expert:

I will read your article attentively.

My oncologist just smiles every time I ask him a question & says he doesn't know or that it is not his specialty.
I have no one else science-formed to talk to about this so I really appreciate your answers.

I didn't mean any histology slide. The whitish zone I referred to is what is seen on my Fundus via endoscopy.
I've always been led to believe it was accumulation of lymphocytes. I thought white cells were… white. Pus is whitish…
There's something I didn't understand on your previous email: why would intestinal cells be called to reinforce the stomach walls instead of the body making more stomach cells?

It's curious that you say when "patients become symptomatic, especially MALT" because I had no symptoms at all…
This is why it is SO important that we don't just rely on our idea that we feel 0K but do the right check ups.
I found this by plain chance!

You stress how important it is to eradicate H. Pylori but: is this possible?
I've recently come across a post by someone who was on the 7th course of antibiotics...
Do you believe that antibiotics are the only solution?
Besides what I already took what would you recommend?
And what do you mean by "the best time you can take antibiotics"? The best time of the day?… With or without food?… Doctors follow the drug's leaflet.

Is there ANYTHING ELSE I can do, daily?

Ever since the new menace of radiotherapy my anxiety has skyrocketed. I haven't been able to sleep enough. I'm in a constant state of alert.
This is ridiculous but: does radiation at least kill H. Pylori?

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

Re: MALT Lymphoma

Post by Helico_expert »

the whitish thing you saw from endoscopy is most probably just bubbles. nothing important.

you can can sometimes see redness in the stomach. That is a sign of inflammation. But for better understanding of the degree of inflammation, you need to do histology.
why would intestinal cells be called to reinforce the stomach walls instead of the body making more stomach cells?
this is just a theory. but it's a good one.
because the cell death is too much faster than cell regeneration. So stem cells are recruited to aid the repair.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404024/
It's curious that you say when "patients become symptomatic, especially MALT" because I had no symptoms at all…
When infected with H. pylori, there are 3 outcomes
1. acid level goes up -> stomach ulcer. This happen to maybe 10% of the population
2. acid level stay the same -> asymptomatic. This happen to most people.
3. acid level goes down -> asymptomatic. but this increase chance of stomach cancer. This happen to maybe 1% of the population.
You stress how important it is to eradicate H. Pylori but: is this possible?
Yes. Among the most difficult antibiotic resistant cases, we have a cure rate of 95%.
https://onlinelibrary.wiley.com/doi/ful ... /apt.12089
Do you believe that antibiotics are the only solution?
Yes. Antibiotic is the only solution.
Besides what I already took what would you recommend?
You need to ask your doctor who understands your medical history.
And what do you mean by "the best time you can take antibiotics"? The best time of the day?… With or without food?… Doctors follow the drug's leaflet.
I assume you are currently taking some medication or treatment. Hence I think you should ask your doctor when is it most suitable to treat H. pylori.
with or without food is fine.
Is there ANYTHING ELSE I can do, daily?
Stay positive. Try not to think too much about it.
This is ridiculous but: does radiation at least kill H. Pylori?
Good question. My guess is no.

ML-HELLico_Bacttle
Posts: 26
Joined: Wed Oct 24, 2018 7:32 am

Re: MALT Lymphoma

Post by ML-HELLico_Bacttle »

Dear Helico_expert:

The whitish area is not something I saw. It is always mentioned by the Gastroenterologist performing the endoscopy as possibly being, or not, the MALT Lymphoma.
Yes, the stomach (& duodenum) is always biopsied.

I have heard someone on YouTube, who had a stomach lymphoma, referring stem cell transfusion.
If that is an option I was never told about.

Of the 3 outcomes you mentioned it's a little confusing for me to know which one I fit in…:
I already had an ulcer (outcome 1) when all of this was discovered. I had no symptoms (outcome 2 and 3). According to the B12 deficiency (& probably others) and the homemade tests I've done (Sodium Bicarbonate, Betaine Hydrochloride) I must have really low stomach acid (outcome 3). In late July I had an accident with a fruit-juice water kefir which gave me food poisoning and when I forced vomiting I noticed that it didn't burn my throat as hard as the last time I had thrown up many years ago. And there's the MALT Lymphoma (outcome 3).

I've been taking Betaine Hydrochloride to restore my stomach acid but I'm not sure if the wall is already thick enough. The endoscopy still found some red zones of inflammation. So maybe I should continue to try to strengthen the stomach wall mucus.

Speaking of acidity:
I have read people AND specialists saying that H. Pylori cannot survive in a less acidic environment.
Is this true?
From what I know H. Pylori has the ability to coat itself from the stomach acidity which is very different from assuming it prefers low pH. Moreover: the sources of H. Pylori contamination are not that acidic.

No, I'm not taking any new medication or treatment yet; the multidisciplinary group will tell me their decision next week.
In the meantime, without much hope in conventional medicine & facing the menace of radiation, I have started taking certain supplements but I don't want to upset you with these references.

Is this it?:
"For the in‐house primary quadruple therapy, with Proton pump inhibitor, Amoxicillin, Rifabutin and Ciprofloxacin (PARC), H. pylori was successfully eradicated in 95.2% of patients."
…Despite the 4.8% chances of not working… I also seem to have made it to 1% of the population…
I haven't done Rifabutin yet… If they don't propose this to me: can you assist people overseas?

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

Re: MALT Lymphoma

Post by Helico_expert »

I think you are in good hand. So let's wait for your panel's decision next week.

H. pylori can survive in acidic environment, however the optimum growth pH is still neutral.
You know why the stomach is not self digesting? it's because our stomach secret a layer of mucous to block the acid touching the gastric wall.
H. pylori likes to live under the mucous layer, where pH is neutral and lots of nutrient from gastric wall.

H. pylori has the ability to turn on or off the urease enzyme that produce ammonia, that is used to neutralise the acid. when there is acid, ammonia is produced. when there is no acid, ammonia is not produced.

rifabutin is normally reserved for tuberculosis infection. I am sure your doctors have access to it. alternatively, can try tetracycline and furazolidone.

ML-HELLico_Bacttle
Posts: 26
Joined: Wed Oct 24, 2018 7:32 am

Re: MALT Lymphoma

Post by ML-HELLico_Bacttle »

Dear Helico_expert:

This is the biggest irony:
Over the last year I have read so many comments of people in such a miserable state because of H. Pylori…
And, yet, here I am, symptomless but in a much greater danger than all of them…

I DID have reflux / heartburn… on the last decade of the previous century!…
I thought it was normal… My doctor probably would too. Who knew about H. Pylori in the 1990s?!...
My theory, and please do tell me your opinion, is that back my H. Pylori was still on the surface of my stomach walls but starting to bore its way into the mucous membrane of my stomach.
Back then I also used to have terrible bad breath when I didn't eat.
Because the stomach was longing for food there was acid being produced & therefore H. Pylori produced ammonia.
Because my father is a diabetic my mother was always afraid that my breath meant that my blood sugar levels were abnormal.
They never were...
Some years later I remember a work colleague of mine pointing out how thin my arms were.
I thought it meant that I lacked some workout. However his job was also at a computer, he did no special physical exercise & yet he had more body muscle than me. In fact, just about any other guy seemed to have, even without sports.

Am I wrong to assume that all these people suffering from H. Pylori still have it working on the surface of their gastric walls?

You might not agree with this but cabbage juice and potato juice apparently help to rebuild the stomach's mucosa.
I took it for several weeks to heal my ulcer & it did — if it wasn't the antibiotic's entire doing, you'd probably add.
However, according to what you say, I might have also helped H. Pylori shelter from stomach acid…

Some years ago I had an abscess above a tooth & it was late Friday so that meant no dentistry support.
I was in so much inflammation that I just followed my instinct and improvised with whatever I had in the kitchen.
I poured a bit of Olive Oil & crushed some Garlic with Oregano into it; put it in my mouth & tried to swish it into the gum/cheek.
After a few minutes I started to feel a MAJOR RELIEF.

Recently I was surprised with a major wisdom tooth cavity.
It was affecting my ear, my mandibular nerve and a tonsils lymph node, which in my case was quite concerning.
I would only have an appointment at the dentist in 2 weeks. He was booked.
So once more I turned myself to Garlic & after some minutes of making the infected tooth chew on a bit of it & swish its paste around it the inflammation I had suffered with for days was gone!

I can say for sure that Garlic saved me twice because I took nothing else.

My point with this is:
Garlic is, without a doubt, a VERY POWERFUL antibiotic.
It happens that I have eaten garlic daily for years now.
I guess this proves how resistant H. Pylori is or how well shielded it is...

Thank you for your suggestions.
Tetracycline is in Pylera, which didn't work.
I believe Rifabutin or Furazolidone are rescue therapy & might have the worse side effects but… I rather not google about it…

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

Re: MALT Lymphoma

Post by Helico_expert »

it's a bit unfortunate that Pylera didnt work on you. Do check with your doctor if he knows any laboratory that is able to culture H. pylori. I think it will be more efficient to have susceptibility test done than trying different antibiotics blindly.

I agree that garlic has strong anti-bacterial effect. In laboratory, garlic can kill H. pylori. But not in the stomach. I believe the mucous has shielded H. pylori from all the food.
Am I wrong to assume that all these people suffering from H. Pylori still have it working on the surface of their gastric walls?
All you need to know is, all H. pylori causes inflammation in the stomach. The inflammation, depending on the severity, lead to different symptoms.

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