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Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Wed Dec 11, 2019 11:51 am
by ankiwo72
Helico_expert wrote:
Wed Dec 11, 2019 8:36 am
“Active inflammation if neutrophils in glandular or surface epithelial layer, presence of active inflammation after eradication therapy is sign of treatment failure.
Yes. It is unfortunately true. Your H. pylori load is probably very little, hence not detected by other UBT.
I think we need to review all the antibiotics you have taken and formulate a new plan for your next treatment.
H. Pylori breath test (UBT) was positive, I think you meant the Tissue sample?

Right now I am working on restoring iron levels as the anemia has been wiping me out. I’m taking 325mg ferrous gluconate 2x/day plus 500mg Vitamin C once per day per my GP’s recommendation. They initially gave me bad GI reaction but I seem to have adjusted except for some typical unpleasant side effects.

I am hoping/wondering if restoring iron levels will help give me additional boost in strength to make a future treatment more successful (if there is any effect on the antibiotics treatment at all); I also wonder if oral iron supplementation with H. Pylori still in me will actually help me or only help the bacteria to thrive? I am guessing the sharp decline in my already-declining iron levels/iron stores may have been exacerbated by the high levels of antibiotics and PPIs that I have been on during the past 1-2 years, so I think trying another eradication treatment without proper iron levels in place may make my condition even worse due to absorption issues. What would your thoughts be on that? I am supposed to be on this supplementation regimen for 3 months and then get blood test redone to see what if any improvement has been made. If you don’t think iron supplementation will have much effect on the anemia given active H. Pylori infection, I would want to know rather to not have to continue this regimen as it is quite hard on my system too!

Here is one link that brings this concern: https://www.researchgate.net/publicatio ... nt_Therapy
“ All studies that explored the effect of H. pylori eradication on iron absorption concluded that H. pylori infection is associated with a poorer response to oral iron therapy, that its treatment can enhance the efficacy of oral iron replacement therapy and that the screening for this infection should be considered in patients with unexplained or refractory iron deficiency anemia [4, 8, 16].“

How soon would you suggest another treatment and/or endoscopy? I guess an additional breath test would be unnecessary given the latest Pathology result?

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Wed Dec 11, 2019 2:17 pm
by Helico_expert
H. pylori is associated with Iron and B12 deficiency. So eradicating H. pylori can improve your iron and B12 level.

You can start your next treatment anytime from now.

so can you summarise what antibiotics have you had previously?

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Wed Dec 11, 2019 6:55 pm
by ankiwo72
Helico_expert wrote:
Wed Dec 11, 2019 2:17 pm
H. pylori is associated with Iron and B12 deficiency. So eradicating H. pylori can improve your iron and B12 level.

You can start your next treatment anytime from now.

so can you summarise what antibiotics have you had previously?
From Dec 2015-present:
- Vancomycin (non-HP)
- Doxycycline+Clarithromycin+Lansoprazole (treatment #1) - 2015
- Levofloxacin (non-HP)
- Doxycycline+Clarithromycin+Omeprazole (treatment #2) - 2018
- Metronidazole+Tetracycline+Bismuth+Omeprazole (treatment #3) - 2018
- Amoxicillin+Doxycycline+Omeprazole+Bismuth (treatment #4) - 2018
- Rifabutin+Amoxicillin+Omeprazole/Pantaprazole (treatment #5) - 2019
- Nitrofurantoin (non-HP)
- Ciprofloxacin (non-HP)
- Ciprofloxacin (non-HP)
- Amoxicillin+Omeprazole (treatment #6- high dose x30 days) (treatment #6) - 2019

- Furazolidone is not approved/available in USA
- Vonozapran not approved/available here in USA
- Talicia not available in USA yet but has same combination as treatment #5 which failed (and got flu + 3 consecutive UTIs x3 different bacteria right after this treatment regimen)

- All treatments were 14 days except for first treatment which was 10 days, and last treatment which was 30 days
- Amoxicillin introduced later due to allergy testing to confirm allergy to amoxicillin, then undergoing desensitization protocol
- Antibiotic resistance pathology results were from late 2018 after treatment #3 failed; treatments #4-6 were based on the susceptibility results; current endoscopy sensitivity sample didn’t contain HP in Fundus but was found in separate sample (not sent for sensitivity testing) from Antrum

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Thu Dec 12, 2019 10:10 am
by Helico_expert
Gosh.. you really have tried everything. I think you need to find a laboratory that have access to HP culture to do antibiotic susceptibility testing.

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Fri Dec 13, 2019 9:32 am
by ankiwo72
Helico_expert wrote:
Thu Dec 12, 2019 10:10 am
Gosh.. you really have tried everything. I think you need to find a laboratory that have access to HP culture to do antibiotic susceptibility testing.
I did susceptibility testing last year and those results were what the last 3 treatments were based on. I dont think labs here include rifabutin in the susceptibility test panel. But more than likely the bacteria would be even more resistant to the antibiotics now after these last few treatments making it even harder to treat, no?

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Fri Dec 13, 2019 11:12 am
by Helico_expert
every few years, we will encounter 1 case like yours. Super resistant H. pylori and no antibiotics can kill it. In desperation, we would admit that patient to hospital for 10 days and get the nurse to give 5 antibiotics + PPI by intravenous.

But for your case, if your endoscopy is not too bad, then perhaps you want to wait a while. There is a theory that after a while, the resistant strains will gradually die out or replace by sensitive ones. That is based on natural selection. When there is no antibiotics in the system, the bacteria will hopefully lost its resistance against antibiotics.

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Fri Dec 13, 2019 6:39 pm
by ankiwo72
Helico_expert wrote:
Fri Dec 13, 2019 11:12 am
every few years, we will encounter 1 case like yours. Super resistant H. pylori and no antibiotics can kill it. In desperation, we would admit that patient to hospital for 10 days and get the nurse to give 5 antibiotics + PPI by intravenous.
Did this method cure all those cases?
Helico_expert wrote:
Fri Dec 13, 2019 11:12 am
But for your case, if your endoscopy is not too bad, then perhaps you want to wait a while. There is a theory that after a while, the resistant strains will gradually die out or replace by sensitive ones. That is based on natural selection. When there is no antibiotics in the system, the bacteria will hopefully lost its resistance against antibiotics.
How long would you recommend waiting, at minimum and at maximum?

Thank you again!

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Fri Dec 13, 2019 8:42 pm
by Helico_expert
i would say 50% of those extreme case works. we are not entirely sure why.

How long to wait? perhaps 6 months? I dont know. This is uncharted territory.

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Sun Dec 15, 2019 12:01 pm
by ankiwo72
Helico_expert wrote:
Fri Dec 13, 2019 8:42 pm
i would say 50% of those extreme case works. we are not entirely sure why.

How long to wait? perhaps 6 months? I dont know. This is uncharted territory.
Whoa, that’s a lot of antibiotics!

When is such drastic method warranted? When it turns into intestinal metaplasia?

What happens to the 50% that don’t have success with the 5 antibiotics? Is it time then to just give up trying treatments altogether and just monitor through endoscopy?

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Sun Dec 15, 2019 10:30 pm
by Helico_expert
eventually new treatment will be available to try.

For example, in Japan, there is this new PPI, vonoprazane. It seems promising. Perhaps you should wait till it's available in your country.