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Biopsies repeatedly positive, tests repeatedly negative - what's the explanation?

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

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Alfred001
Posts: 10
Joined: Mon May 25, 2015 7:08 pm

Biopsies repeatedly positive, tests repeatedly negative - what's the explanation?

Post by Alfred001 »

I'm going to post the full chronology of my tests in the second post here, but to keep it brief in this first post, my symptoms started in the summer of 2011 and since then I've had 3 stool tests and one breath test, all have come back negative. Yet two different sets of biopsies have found HP, the latest one was done as per the Sydney Protocol, so 5 samples, all were positive for HP.

My whole stomach is positive for HP (cardia, 2 corpus samples, incisura, 2 antrum - all positive). How is it possible for my whole stomach to be colonized by HP, but for every non-invasive test to come back negative?

I know atrophy can cause negative tests, but only my 2013 biopsy found intestinal metaplasia at the cardia, the 2022 biopsies, done as per Sydney, showed no atrophy in corpus, incisura or antrum.

Alfred001
Posts: 10
Joined: Mon May 25, 2015 7:08 pm

Re: Biopsies repeatedly positive, tests repeatedly negative - what's the explanation?

Post by Alfred001 »

Here is the chronology of my HP tests (DD:MM:YYYY format):

summer 2011 - symptoms start

28.12.2011. - stool negative

7.11.2013. - biopsies (only cardia area) show "rare bacteria resembling HP"

After the positive biopsy, I'm given no PPIs or antibiotics. I never took anything to eradicate the HP.

20.2.2014. stool negative

28.2.2014. - a single stomach biopsy is negative for HP, but the pathologist complains that the sample is very small

18.12.2014. - stool negative

16.7.2022. - breath test negative (so negative the value was SMALLER after ingestion of urea than before)

26.8.2022. - 5 biopsies, according to the Sidney Protocol - all positive (antrum - positive, incisura - positive, corpus - positive, but sparse)

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

Re: Biopsies repeatedly positive, tests repeatedly negative - what's the explanation?

Post by Helico_expert »

I think it's interesting that you've got so many negatives from in-vitro test and a positive from endoscopy/histology.

Nevertheless,
1. it is normal that the whole stomach is filled with H. pylori.
2. My first thought is that you probably have low stomach acid. low stomach acid can lead to false negative from breath and stool tests. However, your 2013 biopsy showed no atrophy. which is therefore suspicious.

photon
Posts: 31
Joined: Sat Jun 11, 2016 6:11 am

Re: Biopsies repeatedly positive, tests repeatedly negative - what's the explanation?

Post by photon »

Alfred001 wrote:
Thu Sep 22, 2022 4:23 am
I'm going to post the full chronology of my tests in the second post here, but to keep it brief in this first post, my symptoms started in the summer of 2011 and since then I've had 3 stool tests and one breath test, all have come back negative. Yet two different sets of biopsies have found HP, the latest one was done as per the Sydney Protocol, so 5 samples, all were positive for HP.

My whole stomach is positive for HP (cardia, 2 corpus samples, incisura, 2 antrum - all positive). How is it possible for my whole stomach to be colonized by HP, but for every non-invasive test to come back negative?

I know atrophy can cause negative tests, but only my 2013 biopsy found intestinal metaplasia at the cardia, the 2022 biopsies, done as per Sydney, showed no atrophy in corpus, incisura or antrum.
I agree with helico. Low stomach acid is probably the culprit. I do not have atrophic gastritis yet when h pylori invades my stomach, it does so very agressively. My first reinfection (its been 10 years im in my probably 5th reinfection) was the most severe..the doctor was surprised and told me that my stomach looked like a tiger went crazy on it in such a short period of time and the whole stomach was colonized by h pylori...the gastritis was described VERY SEVERE...also had intestinal metasplasia.

The first time was too severe because I had a high diet of iron which later did I find out h pylori feasts on it. The second reinfections were different...apparently having a second about just made my stomach more vulnerable against the neutralizing effects of h pylori and if you are mistakenly believed to have NO H Pylori due to neg stool test and breath test, doctors usually prescribe anti-acids which just makes the problem worse....even lower acid.

Alfred001
Posts: 10
Joined: Mon May 25, 2015 7:08 pm

Re: Biopsies repeatedly positive, tests repeatedly negative - what's the explanation?

Post by Alfred001 »

Helico_expert wrote:
Fri Sep 23, 2022 1:25 pm
I think it's interesting that you've got so many negatives from in-vitro test and a positive from endoscopy/histology.

Nevertheless,
1. it is normal that the whole stomach is filled with H. pylori.
2. My first thought is that you probably have low stomach acid. low stomach acid can lead to false negative from breath and stool tests. However, your 2013 biopsy showed no atrophy. which is therefore suspicious.
Sorry, about a year late with a response to this.

Hmmm... low stomach acid leading to false negatives? I've never come across that claim in my reading of literature. Oh, you probably mean by low stomach acid that there's been atrophy and that's why the bacterial load might be low, am I understanding you right?

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

Re: Biopsies repeatedly positive, tests repeatedly negative - what's the explanation?

Post by Helico_expert »

It is true that low stomach acid can lead to lower bacteria load.

also, HP can regulate the urease enzyme in producing ammonia to neutralize the acid.
if there is no acid, then HP will stop the urease enzyme from making ammonia.
The breath test is actually testing the urease enzyme. Therefore, the urease enzyme is inactive when there is no acid, so the breath test will give a false negative.

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