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

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

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ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

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

Post by ankiwo72 »

Helico_expert wrote:
Tue Nov 26, 2019 9:45 am
Every treatment over the past year has had PPI 20mg/3x day except for last treatment which was 40mg/3x day PPI with high dose amoxicillin 3000mg/day, still didn't work
and which PPI was that? 20mg omeprazole is probably equal to 10mg of rabeprazole.
Omeprazole. So it would have been equivalent to 20mg rabeprazole 3x/day
Helico_expert wrote:
Tue Nov 26, 2019 9:45 am
Ciprofloxacin: >2
Clarithroymycin: >0.5 Resistant
Metronidazole: 32
Tetracycline: 1
You've got the most resistant strain I have ever encountered.
But your Metronidazole resistance is not too bad. Have you tried Rabeprazole + Bismuth + Tetracycline + Metronidazole combination?
Yes, that is the typical formulation for the Pylera “quadruple therapy” but uses omeprazole instead. That was the 3rd eradication combination treatment I had (Aug 2018) which failed.
Helico_expert wrote:
Tue Nov 26, 2019 9:45 am
high RDW with H. Pylori has some correlation to intestinal metaplasia
i have not come across articles that state correlation between RDW and intestinal metaplasia. But I think if it is significant, it would be mentioned in the treatment consensus as a marker.
Here is the link to the article I encountered: https://pdfs.semanticscholar.org/7849/b ... d262cb.pdf

Also, is there a predisposition for H. Pylori turning into more antibiotic-resistant and/or pathogenic versions with certain people depending on blood type? I’m AB+ so wondering if this has had any cause in being unable to eradicate this bug: https://bmccancer.biomedcentral.com/art ... 019-5355-4

I had my endoscopy and am awaiting results. It appears after all these treatments much of the gastritis has resolved but looks like inflammation now only at the fundus. Why does the H. Pylori seem to keep migrating upward after failed eradication treatments?

ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

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

Post by ankiwo72 »

Dear Helico expert,

My endoscopy test results came back and although most of the gastritis appears to have cleared up in my stomach, I still have gastritis caused by H. Pylori, now located in Fundus. Last year endoscopy showed the gastritis was all over the mid-Corpus.

The question that was posed recently was since the last treatment (high dose regimen of Amoxicillin + PPI for 30 days) seemed to have cleared up quite a bit of the H. Pylori, does it make sense to go on the same regimen for longer, or indefinitely? This is simply to aim for gastritis not increasing further and keeping symptoms at bay since it is the only remaining effective antibiotic that I can use. Or would that give rise to H. Pylori possibly becoming resistant over the long run?

Also, I have been confirmed as fully anemic now and was advised to go on Iron supplements and Vitamin C for 3 months and to retest levels at the end of it. Would antibiotic therapy even be effective on those supplements, as not only would H. Pylori gobble it up but also wouldn't the antibiotics and/or PPI make the Iron supplements less absorbable or vice versa, make the antibiotics less effective? Is there any effect on the other?

I am still waiting on the antibioitic susceptibility test result, to see if any resistance has changed since last year.

Thanks!

Helico_expert
Site Admin
Posts: 3711
Joined: Wed Mar 02, 2011 7:20 am

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

Post by Helico_expert »

Ok, let's wait and see the antibiotic susceptibility test result.

meanwhile, how was the HP detected? rapid urease test? histology? urea breath test?

ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

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

Post by ankiwo72 »

Helico_expert wrote:
Thu Dec 05, 2019 9:17 am
Ok, let's wait and see the antibiotic susceptibility test result.

meanwhile, how was the HP detected? rapid urease test? histology? urea breath test?
Breath test positive then endoscopy biopsy confirmed H. Pylori-associated gastritis in the Fundus. I got message from nurse about the pathology result but asked to see actual report to see if there is any atrophy mentioned. I think I would have been told but just want to be sure.

ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

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

Post by ankiwo72 »

Helico_expert wrote:
Thu Dec 05, 2019 9:17 am
Ok, let's wait and see the antibiotic susceptibility test result.

meanwhile, how was the HP detected? rapid urease test? histology? urea breath test?
Dear Helico Expert,

Unfortunately no H. Pylori was obtained from the biopsy so a susceptibility test could not be run.

The endoscopy report stated “H. Pylori-associated gastritis.”
It did not state if it was active or inactive gastritis. And they could not get a sample of H. Pylori from the biopsy so I’m confused.

I don’t think I could get another endoscopy done for a while, but I do have some questions regarding what actually was found (“Erythematous mucosa in the gastric fundus. Biopsied”) in pathology result:

Tissue Culture
Final report: Viridans Group Streptococci (two morphotypes). Isolated from broth only.
Organism 3: Viridans Group Streptococci
Gram Stain Report: Few WBCs seen
Sparse gram positive cocci in pairs

Can you please translate that for me in plain English as far as what the implication(s) is/are?
Is it possible that the last treatment of long-term high-dosage Amoxicillin + PPI actually eradicated the H. Pylori, and the positive breath test was caused by another gram-positive urease-producing bacteria (Strep)?
1. I’m wondering how I could possibly have Strep in my gut given the Amoxicillin should have actually killed that bacteria too! Unless that Strep colonized me after eradicating H. Pylori? Or could this be a very bad Amoxicillin-resistant strain of Strep?
2. Could Strep cause the gastritis that I have on my Fundus? How could pathology report be able to tell that gastritis was caused by H. Pylori and not Strep if an “Active H. Pylori” culture could not be obtained?
3. Can Strep also deplete my iron stores?
4. I thought H. Pylori would push out Strep from the gut, so if I do have H. Pylori will it eventually push out the Strep from my gut?
5. Is Strep in my gut more dangerous/contagious/pathogenic than H. Pylori?

Here are some of the articles I found which is why I’m questioning the breath test result. They seem to conflict with each other so I would like your opinion if possible. Thanks!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309916/
“Staphylococci and streptococci are the other major urease-producers present in the gastric mucosa and may interfere with the detection of H. pylori based on the urease activity.”

https://cmr.asm.org/content/20/2/280
“The other urease-positive bacteria present in the gastric mucosa, i.e., streptococci and staphylococci, produce a lower amount of urease, which does not interfere in a short-time detection (<2 h), rendering the method specific to H. pylori.”

Helico_expert
Site Admin
Posts: 3711
Joined: Wed Mar 02, 2011 7:20 am

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

Post by Helico_expert »

H. pylori is the only microbes that can live in the stomach. Others, which you had mentioned, are common mouth bacteria, and are just temporarily there because of you swallowing saliva.

Sometimes, when the stomach acid is low, due to gastritis or PPI or old age, other bacteria can start growing and give a false positive result. But false positive likely this is usually weak positive. So it would be good if you can access the raw data of the breath test. How positive is your positive test.

The stomach is normally protected from a layer of mucous. Not many bacteria can penetrate through. Again, due to gastritis or old age, the mucous producing ability may reduce, other bacteria may start growing and cause further gastritis.

anyway.. for your case, I think you are probably free of H. pylori, and is already in recovery state. Wait a few months and recheck your breath test or stool test or blood test. We can discuss again what treatment to use when you get another positive breath test later.

since your endoscopy did not show any abnomality, i think there is nothing to worry about. Gastric cancer doesnt appear in a year time. It's very chronic. it'll take years to happen.

ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

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

Post by ankiwo72 »

Dear Helico Expert,

Thank you so much for taking the time to consider my situation and your thoughtful and comprehensive response, as this has been such a long and tedious journey and your words were the first in a very long time that has given me real hope and a sense that I may finally have come out the other end of this!

Unfortunately the test result for H. Pylori doesn't give a level or range for result, just a "positive" or "negative." I am not sure I could be approved for another endoscopy so soon after this last one, but I will see if I can do another breath test before the end of the year and see result. So, by your prediction the result could turn negative?

Helico_expert
Site Admin
Posts: 3711
Joined: Wed Mar 02, 2011 7:20 am

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

Post by Helico_expert »

I assume the biopsies were examined by good pathologist and if no HP is found, then it should be true.

So I look forward to hearing more good news from you after Christmas.

ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

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

Post by ankiwo72 »

Helico_expert wrote:
Sun Dec 08, 2019 3:23 pm
I assume the biopsies were examined by good pathologist and if no HP is found, then it should be true.

So I look forward to hearing more good news from you after Christmas.
Dear Helico Expert,

Although the tissue sample report above hasn’t changed, I just received more results (seems to be getting released to me slowly in bits) from the actual pathologist’s report that stated:

“DIAGNOSIS:
A. Stomach, antrum, biopsy: Chronic active H. Pylori-associated gastritis.”

The information I conveyed in earlier post didn’t indicate the “active” portion of the gastritis (incomplete information was originally conveyed to me by the nurse in a message), and I think the tissue sample report showing Strep was from the Fundus, not the Antrum. I also thought that I didn’t have any gastritis in any place except the Fundus, because it was red and that’s where the tissue sample was taken from for sending to test the H. Pylori susceptibility. Does this new information substantially change my scenario from “likely cured” to “unlikely cured” now? Or is the tissue sample from the Fundus more important?

Seems this would indicate I still have a problem: http://www.pathologyoutlines.com/topic/ ... acter.html
“ Active inflammation if neutrophils in glandular or surface epithelial layer, presence of active inflammation after eradication therapy is sign of treatment failure
Antibiotics may cause H. pylori to assume coccoid appearance”

What is your estimation of my problem? I’m a little bummed out now but still hoping for some good news? Thanks Again!

Helico_expert
Site Admin
Posts: 3711
Joined: Wed Mar 02, 2011 7:20 am

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

Post by Helico_expert »

“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.

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