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Negative at urea breath test

There are several types of tests for H.pylori. The major ones have a their own forum.

Moderators: barjammar, Toni

Helico_expert
Site Admin
Posts: 4465
Joined: Wed Mar 02, 2011 7:20 am

Re: Negative at urea breadth test

Post by Helico_expert »

PPI is to stop acid secretion.
many gastric symptoms are caused by too much acid, or too little mucous protection. So the acid is burning the stomach lining.

UBT can only work in acidic condition. This is because H. pylori doesnt "produce" urease enzyme when the environment is neutral. The urease enzyme making too much ammonia will make the condition too alkaline to survive. The UBT is specifically designed to measure t he urease activity. So if you are taking PPI, there is no acid, then H. pylori is not making ammonia, and you'll get a false negative. That's why you need to stop PPI for 2 weeks before the UBT.

If PPI doesnt help your symptoms, then the doctor will try something else like domperidone or sucralfate.

Domperidone increase the mobility of the peristalsis movement of the stomach. Basically is to let your stomach empty faster. Stop the food being hold up in the stomach and give bloating symptoms.

Sucralfate creates a layer of protection on the stomach lining. The idea is to stop the acid burning the linings and buy time for the wound to heal.

Abubakar
Posts: 19
Joined: Sun Sep 26, 2021 3:11 pm

Re: Negative at urea breadth test

Post by Abubakar »

Hope you're doing well. Back once again for your kind opinion.
As I mentioned in my earlier post, I finished antibiotics at 9th September and got a negative UBT report at 14th October. Since then I took ppi, domperidon, multi vitamin, calcium ascorbate, vitamin D 40000 iu once a month, mastic gum, manuka honey, licorice, aloevera gel, prebiotic, cabbage juice, ginger, fennel, green tea etc. I have also eating a very bland diet. I think I was experiencing little improvement in some of my symptoms. Though I also got some flare-up for several days. It makes me confused about whether there is any real progress in my stomach issues.

I have attached my endoscopy report herewith.

At this point now I need your advice to take the necessary steps-
# as it is 3 months now post antibiotics, should I go for an endoscopy to check the gastritis condition ( please consider my endoscopy report)
# or I should repeat stool/ UBT to check H Pylori and if still negative then continue with the supplements for more days and let the gastritis be healed.

Thanks in advance.
Attachments
Endoscopy
Endoscopy

Helico_expert
Site Admin
Posts: 4465
Joined: Wed Mar 02, 2011 7:20 am

Re: Negative at urea breadth test

Post by Helico_expert »

Your biopsy looks pretty normal.
It's normal for experiencing "episodes" of symptoms once a while.
The idea is for the frequency of these episodes to come less and less frequent.
I think it's important to understand that H. pylori is there for many years. The damage is accumulative and sometimes irreversible (just like a scar of the wound).

Since H. pylori is gone, you can treat your condition symptomatically.
If you have reflux or burning sensation, continue PPI. otherwise, otherwise gradually reduce the dose.
If you have bloating or feel that the food is always in the stomach, continue domperidon.

celeron16
Posts: 19
Joined: Sun Jan 02, 2022 4:24 pm

Re: Negative at urea breadth test

Post by celeron16 »

Hi Abubaker

I wanted to know how you feel now. I am going through the same symptoms and not subsided

Regards

Abubakar
Posts: 19
Joined: Sun Sep 26, 2021 3:11 pm

Re: Negative at urea breadth test

Post by Abubakar »

Seeking your kind reply ASAP.

So.. 2 weeks ago I did my 2nd UBT. The value was 0.29 and cutoff was 4. Again seems a true negative. I stopped ppi more than 14 days ago.

But I was experiencing lots of flare-up in the last month. So I did an endoscopy yesterday and made an appointment with my gastro.

He seems has very little faith on stool/UBT test. He said he only trust how it looks like at endoscopy. I am attaching the endoscopy report herewith.

He prescribed me to take Roxithromycin 300 , Rifaximin 200 for 14 days and dexlansoprazole 30.
For my symptoms like low appetite, constipation, upper abdominal burning, discomfort, he also prescribed -
Domperidon 10 3x
Trimebutine malate 100 3x
Prucalopride 2 mg
Megaldrate+simethicone and lactulose for constipation
Clonazepam 0.5 and flupenthixol+militiamen for insomnia & anxiety.

I feel very hopeless and very much confused with antibiotics again even after 2 negative UBT.
I am on very bland dieting. If I tried any new but yet kind of simple food, I am experiencing a major flare-up for many days which seems worsening my stomach condition.

Please help with your kind and valuable opinion ASAP.
Thanks in advance.
Attachments
Endoscopy _ 06/01/2022
Endoscopy _ 06/01/2022

Helico_expert
Site Admin
Posts: 4465
Joined: Wed Mar 02, 2011 7:20 am

Re: Negative at urea breadth test

Post by Helico_expert »

yea.. your breath test looked very negative to me too.
it is common to have symptoms flare up even after H. pylori is eradicated.
The endoscopy report showed that you have some erosions. Probably that explains your symptoms.
I dont think you need the antibiotics. But you'll need the PPI for another month or until your erosion is healed.

Abubakar
Posts: 19
Joined: Sun Sep 26, 2021 3:11 pm

Re: Negative at urea breadth test

Post by Abubakar »

Thanks a lot for your quick reply.
Can u please clarify a few more points..
# In the 2nd photo of my endoscopy report, I can clearly see the erosion. Can u please tell me how severe is this?
# what about the 3rd photo? Are those little red dots something abnormal or normal?
# In my previous 2 endoscopy reports, findings were inflammation in fundus & body. Whereas this new report says erosion in body & antral region. Does it mean that fundus healed and antral got eroded?
# I am taking turmeric, raw & manuka honey, little black seed oil, extra Virgin coconut & olive oil, chew ginger after every meal, green tea with ginger, basil & fennel, DGL, probiotic, zinc L carnosine, spirulina cap, mastic gum, milk thistle and have L glutamine in my stock. Can I continue these in my current situation?
Thanks in advance.

celeron16
Posts: 19
Joined: Sun Jan 02, 2022 4:24 pm

Re: Negative at urea breadth test

Post by celeron16 »

Hello AbuBaker,

I am sorry to know that your still unwell. I am going through the same problems and I'd like to know what diet are you following and whether it is helping you. Doctor here is reluctant to do my H Pylori test as they believe the gastritis is caused by Stress and Lifestyle. I cannot do H Pylori as I am on PPI. I want to get rid of this horrible disease.

Was your gastritis stress induced or H Pylori?

Regards,

Abubakar
Posts: 19
Joined: Sun Sep 26, 2021 3:11 pm

Re: Negative at urea breadth test

Post by Abubakar »

Eagerly waiting for your kind reply helico expert.

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barjammar
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Location: Perth Australia
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Re: Negative at urea breath test

Post by barjammar »

This reply is primarily to Abu Bakar Siddiquy but has general interest for anyone unclear about endoscopy findings.
I created a brief summary below. Note that nothing is 100% true in medicine. Exceptions sometimes occur and can’t be explained. See the links in wikipedia (https://en.wikipedia.org/wiki/Gastritis and https://en.wikipedia.org/wiki/Atrophic_gastritis and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033768/
For 90% of cases the following applies.

1: Symptoms of Gastritis for a lay person may be feelings of stomach discomfort of some kind - it may be gastric pain symptoms, even vomiting, even with a little blood. It has a poor correlation with histology which is often normal. Acute gastritis in this category is just temporary surface damage due to something hurting the mucosa - such as strong alcohol or aspirin.
2: Endoscopic Gastritis means that a doctor has actually looked at the stomach and changes can be seen. It could be erosions (small shallow ulcers less than 1 mm deep) or visible erythaema, or red spots or petechiae. Once again, it has a poor correlation to histology. Therefore a biopsy is necessary to REALLY figure out what is going on.
3. Histologic gastritis means that a biopsy specimen has been examined by a pathologist. This is REAL gastritis and is everything abnormal such as an infiltration of cells such as polymorphs ( “active gastritis”) and mononuclear cells (plasma cells, lymphocytes, macrophages). H.pylori ALWAYS causes histologic gastritis with a mixed pattern of activity and chronicity (“active chronic gastritis”). Half the world has H.pylori.
There is not much else to see! Just cure H.pylori with antibiotics. End of story!

But to answer you more specifically:
# In the 2nd photo of my endoscopy report, I can clearly see the erosion. Can u please tell me how severe is this?
A: Erosions don't usually get any worse. These don't look very bad. Try a mucosal agent such as sucralfate, or just a proton pump inhibitor such as Nexium.
# what about the 3rd photo? Are those little red dots something abnormal or normal?
A: Without a biopsy we can't say much. Any abnormality which does not have H.pylori is probably caused by past H.pylori but other causes of red spots etc. are hard to define and are generally not serious. There is a condition called varioliform gastritis so yours looks a bit like this.... but it's just a descriptive diagnosis and probably correctly means it is caused by a virus. There is nothing specific to do about that. Presumably it goes away eventually and is not cancerous. Biopsy might show some lymphocytes collecting there.
# In my previous 2 endoscopy reports, findings were inflammation in fundus & body. Whereas this new report says erosion in body & antral region. Does it mean that fundus healed and antral got eroded?
A: Not sure what it means. Its not an important distinction. After H.pylori infection some minor changes (spots and redness) often persist for years.
# I am taking turmeric, raw & manuka honey, little black seed oil, extra Virgin coconut & olive oil, chew ginger after every meal, green tea with ginger, basil & fennel, DGL, probiotic, zinc L carnosine, spirulina cap, mastic gum, milk thistle and have L glutamine in my stock. Can I continue these in my current situation?
A: If you like to take this kind of treatment it is up to you. There is no scientific reason to do so, these are placebo as far as I know. But if you feel better on this then that is good in your case.

Finally, there is a condition called autoimmune gastritis where chronic inflammation is present and the stomach wall is thinner (atrophic gastritis) and acid secretion can disappear. Biopsy helps diagnose this but often there are antibodies detected in the blood - directed against parietal cells (acid secreting cells). Symptoms are mild vague stomach discomforts (dyspepsia) or anemia (low vitamin B12 and iron loss). If you have another endoscopy make sure you are not taking any acid blockers in the 7 days before the test and ask the G.I. doctor to biopsy the corpus of the stomach to make sure parietal cells are all OK and also to take an aspirate of stomach juice to confirm the presence of stomach acid.
8-) 8-) 8-) 8-)
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

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