Help: 2nd Treatment also failed, scared of taking antibiotics

[XXQQ]

Hi,

I am originally from China and living in UK now. I have gastritis symptoms for years and recently got much worse. I have tried the triple therapy of Clarithromycin，Metronidazole, Omeprazole twice 2 years ago and this year, but both failed. I know it is not good to repeat Clarithromycin and Metronidazole now but my GP just didn't really care...

Now the doctor gave me Metronidazole, Ciprofloxacin and ranitidine for the 3rd treatment. But I just do not trust them anymore so I haven't started yet. I did an endoscopy last week and still wait for the biopsy result along with the sensitivity test result. I haven't done any breath test yet but I suppose I have very high h.Pylori level in my stomach.

Even worse, I may have Penicillin allergy (I had red rash when taking tablets when I was little, but I am fine to be ingested). So I may not be able to be treated by Amoxicillin.

I have heard about Metronidazole resistance may be overcome by bismuth? And people who have penicillin allergy can take some treatment to overcome it?

I really hope h.p expert can give me some advice. I am eager to hear from you. Thank you so much!

Regards,

[Helico_expert]

It is not good to repeat the same antibiotics.

So your strain is most likely resistant to Clarithromycin and Metronidazole.

It is true that metronidazole resistance can be overcome, but so far only have data from Tetracycline and not yet from bismuth.

Nevertheless, it is probably not a good idea to try metronidazole again.

we should wait for the antibiotic susceptibility test result. Many Chinese are also carry HP strain resistant to ciprofloxacin.

[XXQQ]

Hi h.p expert,

Thank you for your reply.

Today I checked with my GP and he got the result from hospital of my biopsy: They cannot isolate h.p from my stomach and duodenal biopsies. And they did not diagnose any gastritis or inflammation.

However, about three months ago (September), my stool sample did show positive, which was 3 months later after my second eradication treatment this year(beginning of June).

I am really confused now, although my GP said the stool sample result may be false positive. However, I do have symptoms all the time every day for months, except the period when I had the antibiotics.

I would like to know your opinion.

Kind regards,

It is not good to repeat the same antibiotics.

So your strain is most likely resistant to Clarithromycin and Metronidazole.

It is true that metronidazole resistance can be overcome, but so far only have data from Tetracycline and not yet from bismuth.

Nevertheless, it is probably not a good idea to try metronidazole again.

we should wait for the antibiotic susceptibility test result. Many Chinese are also carry HP strain resistant to ciprofloxacin.

[XXQQ]

By the way, I am taking Lansoprazole 60mg every day for more than 3 months now. Maybe it is a reason that causes they cannot isolate h.pylori from my biopsy?

[Helico_expert]

yup. PPI can lower the stomach acid and other bacteria can grow. These contaminants will compete with H. pylori for nutrient and so H. pylori's number will reduce. So that increases the challenge for the laboratory to pick up H. pylori from a mixture of contaminants.

Nevertheless, what did the histology report say? no inflammation? That could mean no more H. pylori?

[XXQQ]

Hi expert,

Hope you had a good day.

Now I think it is definitely false negative. I did not stop the ppi for two weeks in advance because my endoscopy was scheduled as an emergency. I am also taking probiotics every day so it may make it even more difficult for the lab.

However, if the H.pylori's number reduces, does it mean it is a good thing? Or it doesn't really matter about the amount if they are still there XD
My GP said the lab did not find inflammation or gastritis, just normal upper tract (Although i am in pain sometimes and bloating all the time, feeling full very easily while still hungry, belching a lot...). I doubt British NHS endoscopy is not very detailed :{

Therefore I will go to a H.pylori lab in a hospital in China early next year and do the endoscopy along with culture test again. By then I will let you know the result and hopefully can get more advice from you.

By the way, I really appreciate that you can talk to me. GP is too general to discuss specific issues. They cannot really understand my frustration.

Many thanks,

yup. PPI can lower the stomach acid and other bacteria can grow. These contaminants will compete with H. pylori for nutrient and so H. pylori's number will reduce. So that increases the challenge for the laboratory to pick up H. pylori from a mixture of contaminants.

Nevertheless, what did the histology report say? no inflammation? That could mean no more H. pylori?

[Helico_expert]

It is actually the inflammation that is doing you the harm.

So, even if H. pylori is in low number, the inflammation will not go away and continue causing damage to your stomach lining.

If your doctor said that there is no inflammation and you indeed have H. pylori, perhaps you need to check your immune system. If you had vaccinated yourself before, try check if the antibody is still active.