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

Posted: Sat Sep 07, 2019 3:48 am
by ankiwo72
Hi,

I am going on Treatment #7 in a couple of weeks. I will be getting desensitized to amoxicillin (again) and will be on 1000mg amox 3x/day plus PPI 3x/day for one month. If treatment fails I will need to redo it all over again.

Questions I have are:

- My last blood test showed normal iron levels but my serum ferritin was low (10) and RDW elevated (slightly High at 15.9). Is this caused by H.Pylori? If so, what does this mean as far as the seriousness of the infection? I have been trying to eat more meat but hasn't really helped with my deteriorating cognitive/memory issues and it is starting to worry me and affect my work.

- I had an endoscopy last year that showed "gastric antral mucosa with mild chronic inactive gastritis" in the antrum; and "gastric oxyntic mucosa with chronic active H. Pylori-associated gastritis" in the corpus. Does the inactive gastritis mean that the bacteria is still there but not active or has it completely jumped ship from that area, and why would it do that?

- At the last endoscopy the biopsy had antibiotic sensitivity performed. Should this be repeated? I have had several other non-HP infections since then requiring antibiotics, plus H.Pylori treatments, so wonder if another sensitivity test would be warranted.

Thanks!

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

Posted: Sat Sep 07, 2019 9:48 am
by Helico_expert
How do you know you are still infected with H. pylori? your last endoscopy showed inactive gastritis. usually that means no more HP. I assume this is from a histology examination. otherwise, visual endoscopy examination is not good enough.

if you are indeed positive of H. pylori, what is your next treatment? only PPI + amox? it's better to combine with Bismuth and another antibiotic. eg. Furazolidone.
which PPI will you be taking? hopefully it is Rabeprazole.

If you do not have H. pylori, I am not sure what is the amoxicillin for.

What is your last antibiotic sensitivity test results showing? what antibiotics did you take after the endoscopy?

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

Posted: Sat Sep 07, 2019 7:46 pm
by ankiwo72
Helico_expert wrote:
Sat Sep 07, 2019 9:48 am
How do you know you are still infected with H. pylori? your last endoscopy showed inactive gastritis. usually that means no more HP. I assume this is from a histology examination. otherwise, visual endoscopy examination is not good enough.
I had a breath test done 6 weeks after my last treatment, and the result was positive. I have inactive gastritis in the antrum, but active gastritis in the corpus. I am wondering why gastritis in the antrum was inactive but gastritis in the corpus was active.
Helico_expert wrote:
Sat Sep 07, 2019 9:48 am
if you are indeed positive of H. pylori, what is your next treatment? only PPI + amox? it's better to combine with Bismuth and another antibiotic. eg. Furazolidone.
which PPI will you be taking? hopefully it is Rabeprazole.
The doctor is putting me on omeprazole (40mg 3x/day) and amoxicillin (1000mg 3x/day) only, for 30 days.
Helico_expert wrote:
Sat Sep 07, 2019 9:48 am
What is your last antibiotic sensitivity test results showing? what antibiotics did you take after the endoscopy?
The last sensitivity test results (one year ago) were:
* Amoxicillin: <=0.008
* Cipro: >2
* Clarithromycin: >0.5 R
* Metronidazole: 32
* Tetracycline: 1

The last treatments I had since then were:
- Amoxicillin, Doxycycline, Omeprazole, Bismuth x14 days (for H.Pylori)
- Amoxicillin, Rifabutin, Pantaprazole x14 days (for H.Pylori)
- Nitrofurantoin x7 days (UTI)
- Cipro x5 days (UTI)
- Cipro x7 days (UTI)

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

Posted: Sat Sep 07, 2019 10:41 pm
by Helico_expert
i am not sure if this duo therapy will work for you.

I think you'll have higher chance with
Rabeprazole 20 mg TID
Bismuth 220mg QID
Amoxicillin 1g TID
Furazolidone 100 mg TID

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

Posted: Sun Sep 08, 2019 8:07 am
by ankiwo72
Helico_expert wrote:
Sat Sep 07, 2019 10:41 pm
i am not sure if this duo therapy will work for you.

I think you'll have higher chance with
Rabeprazole 20 mg TID
Bismuth 220mg QID
Amoxicillin 1g TID
Furazolidone 100 mg TID
I think I encountered this issue before in discussion, that furazolidone is not available in the US. The FDA banned this drug in 2005 so we can’t get it here.

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

Posted: Sun Sep 08, 2019 8:38 pm
by ankiwo72
I will discuss your treatment recommendation with my doctor but since there is no furazolidone, that particular treatment combination will be unavailable to me. However, my questions are:
ankiwo72 wrote:
Sat Sep 07, 2019 3:48 am
Hi,

- My last blood test showed normal iron levels but my serum ferritin was low (10) and RDW elevated (slightly High at 15.9). Is this caused by H.Pylori? If so, what does this mean as far as the seriousness of the infection? I have been trying to eat more meat but hasn't really helped with my deteriorating cognitive/memory issues and it is starting to worry me and affect my work.

- I had an endoscopy last year that showed "gastric antral mucosa with mild chronic inactive gastritis" in the antrum; and "gastric oxyntic mucosa with chronic active H. Pylori-associated gastritis" in the corpus. Does the inactive gastritis mean that the bacteria is still there but not active or has it completely jumped ship from that area, and why would it do that?

- At the last endoscopy the biopsy had antibiotic sensitivity performed. Should this be repeated? I have had several other non-HP infections since then requiring antibiotics, plus H.Pylori treatments, so wonder if another sensitivity test would be warranted.

Thanks!

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

Posted: Sun Sep 08, 2019 10:33 pm
by Helico_expert
I dont think H. pylori is related to RDW. But H. pylori is known to have association with low iron and B12.

active or chronic gastritis is based on the particular immune cells gathering. sometimes, they can be missed depending on the biopsy taken.

I think one antibiotic resistance testing is good enough for now.

you have not tried rifabutin before. perhaps you can try

Rabeprazole 20mg TID
bismuth 220mg QID
Amoxicillin 1g TID
Rifabutin 150mg BID

please discuss the above combination with your doctor.

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

Posted: Mon Sep 09, 2019 2:58 am
by ankiwo72
Helico_expert wrote:
Sun Sep 08, 2019 10:33 pm
I dont think H. pylori is related to RDW. But H. pylori is known to have association with low iron and B12.

active or chronic gastritis is based on the particular immune cells gathering. sometimes, they can be missed depending on the biopsy taken.

I think one antibiotic resistance testing is good enough for now.

you have not tried rifabutin before. perhaps you can try

Rabeprazole 20mg TID
bismuth 220mg QID
Amoxicillin 1g TID
Rifabutin 150mg BID

please discuss the above combination with your doctor.
Hi,

I already tried rifabutin treatment. It failed too :(

If H. Pylori causes iron deficiency, what is the reason for this and will iron supplementation help? Or will I be unable to raise my ferritin levels until the bacteria is eradicated? What is the mechanism involved--Is the bacteria consuming the iron stores or is it just making my body unable to absorb it?

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

Posted: Mon Sep 09, 2019 11:55 am
by Helico_expert
hmm... rifabutin is also used. you really run out of option here if you are not allowed to have furazolidone.

Perhaps you want to give Prof. David Graham a try? see if he has some tricks for you
https://www.bcm.edu/research/office-of- ... aham-david

In regards to iron, H. pylori loves iron. Perhaps it absorbed all the iron? not too sure about the exact in vivo mechanism.

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

Posted: Mon Sep 09, 2019 9:20 pm
by chetanvenki
ankiwo72 wrote:
Sat Sep 07, 2019 7:46 pm
Helico_expert wrote:
Sat Sep 07, 2019 9:48 am
How do you know you are still infected with H. pylori? your last endoscopy showed inactive gastritis. usually that means no more HP. I assume this is from a histology examination. otherwise, visual endoscopy examination is not good enough.
I had a breath test done 6 weeks after my last treatment, and the result was positive. I have inactive gastritis in the antrum, but active gastritis in the corpus. I am wondering why gastritis in the antrum was inactive but gastritis in the corpus was active.
Helico_expert wrote:
Sat Sep 07, 2019 9:48 am
if you are indeed positive of H. pylori, what is your next treatment? only PPI + amox? it's better to combine with Bismuth and another antibiotic. eg. Furazolidone.
which PPI will you be taking? hopefully it is Rabeprazole.
The doctor is putting me on omeprazole (40mg 3x/day) and amoxicillin (1000mg 3x/day) only, for 30 days.
Helico_expert wrote:
Sat Sep 07, 2019 9:48 am
What is your last antibiotic sensitivity test results showing? what antibiotics did you take after the endoscopy?
The last sensitivity test results (one year ago) were:
* Amoxicillin: <=0.008
* Cipro: >2
* Clarithromycin: >0.5 R
* Metronidazole: 32
* Tetracycline: 1

The last treatments I had since then were:
- Amoxicillin, Doxycycline, Omeprazole, Bismuth x14 days (for H.Pylori)
- Amoxicillin, Rifabutin, Pantaprazole x14 days (for H.Pylori)
- Nitrofurantoin x7 days (UTI)
- Cipro x5 days (UTI)
- Cipro x7 days (UTI)
What does this sensitivity numbers mean, please eloberate on how much dosage of antibiotics would be susceptible with these numbers. I am due to get my susceptibility test result this week.