Questions regarding H. Pylori Treatment

[Al Here]

Hello, my name is Alex. I'm a 22 year old male from born in Romania (Eastern Europe) currently living in the United States since the age of 6. I have some questions that I would greatly appreciate some insight on. Last Saturday (April 11th), I found myself in a situation that greatly angered/stressed me out. The day after, Sunday (April 12th), I started experiencing diarrhea and a strange lightheadedness/dizziness/vertigo feeling I hadn't had much at all before, along with some nausea but no vomiting. The lightheadedness is a sort of detachment/brain fog. It doesn't affect my balance much but it is more definitely noticeable when I am sitting down or standing up versus laying down. I went to my primary care provider and she believed it was a stomach bug that should go away soon but gave me what I need to turn in stool samples if things don't get better. Things didn't get better so I turned the stool samples in and I tested positive for H. Pylori. I believe I was also positive for H. Pylori when I was about 16 and the only medicine I remember getting is a ppi and Flagyl. I don't remember if I got tested again to see if it had been properly eradicated back then.

My PCP recently started me on a 14 day treatment consisting of:
pantoprazole 40mg / once daily (I take it in the morning about 30 minutes before eating and taking the antibiotics)
amoxicillin 500mg capsules/ 2 capsules / twice a day.
clarithromycin 500mg tablet / 1 tablet / twice a day.

I have some questions in regards to this treatment and the circumstances around it. I'm grateful for all the insight/help I can get.

1. Could my stressful situation have caused the H. Pylori I may have already had make these symptoms come up? I thought it was strange this happened right after that stressful situation.

2. Is this a good treatment? Does the pantoprazole do its job if I am taking it the way I was prescribed? (40mg once a day) While browsing this forum, I saw multiple answers stating that rabeprazole 20mg 3 times a day may be the most effective PPI in terms of increasing eradication rate. I asked my PCP about this and was told to continue the current treatment as prescribed and to go back and have my stool tested again 2-3 weeks after I finish all the medications.

3. Should I supplement my treatment with Pepto-Bismol or just stick with the triple therapy without the bismuth? I read on this forum that it can reduce the chances of C. Diff arising from the antibiotics and can also improve chances of eradication but also that the first therapy is usually the triple therapy of 2 antibiotics and a PPI so I'm not sure if I should supplement my treatment with it. Also, is C. diff common from these antibiotics?

4. Do these antibiotics suppress my immune system/lung defenses and potentially make me more vulnerable to catching COVID-19 and having more complications from it? Would I be okay to hangout with my girlfriend inside? I was told I can still go on walks with her and hangout outside as long as we social distance. She's mainly only around her family but is still working at a job about twice a week with 1-2 other people wearing mask/gloves and are at least 8-10 feet apart at all times. I was told by my PCP that there is no data that indicates that these medications would put me at greater risk for COVID-19, but I was also advised against having anyone that I don't live with come over just to be safe while I'm on the medications. I found this to be somewhat contradictory.

5. Are there any foods that I shouldn't be taking these medications with that might reduce/alter its affects? I read that it's not advisable to take them with higher-fiber foods and/or dairy products.

6. Are there any potential drug interactions or risks to consuming marijuana by vaporization while I am on this treatment? I find that it helps reduce stress/anxiety about everything going on but it'd really help to know if it can affect treatment or cause interactions.

7. Will taking Align probiotic containing Bifidobacterium 35624 help at all? I read somewhere that taking probiotics while undergoing antibiotic treatment may delay the microbiome's ability to return to normal but I also read that taking that specific probiotic may reduce diarrhea side effects from the antibiotics. My diarrhea has subsided greatly since starting this treatment and reducing stress but the brain fog/lightheadedness is still present.

8. Can any of these medications cause more vivid dreams? I think I had the most vivid dream of my life the other night and I think I was aware I was actually dreaming for like the first time in my life. It was quite strange.

I apologize for the lengthy post. I understand if some of these questions can't be answered with certainty but any insight would be greatly appreciated. I am very thankful this very resourceful website/forum exist and I am glad to know I am not alone. Thank you so much.

[Helico_expert]

1. Could my stressful situation have caused the H. Pylori I may have already had make these symptoms come up? I thought it was strange this happened right after that stressful situation.

It is not typical adverse effect of H. pylori to give stress symptoms like diarrhea, dizziness, vertigo. Usually people catch H. pylori when they are very young. So, you have this bacteria for decades. your body is kind of used to the bacteria. But stress from work or family or environment can induce ulcer at the age of 20-30. and if H. pylori is not dealt with, the damage by H. pylori can accumulate and your digestive system can further deteriorate, and at the age of 40, you can get some intestinal metaplasia (pre cancerous), and by the age of 50 and above, your cancer risk can increase depending on the severity of the damage done by H. pylori.

2. Is this a good treatment? Does the pantoprazole do its job if I am taking it the way I was prescribed? (40mg once a day) While browsing this forum, I saw multiple answers stating that rabeprazole 20mg 3 times a day may be the most effective PPI in terms of increasing eradication rate. I asked my PCP about this and was told to continue the current treatment as prescribed and to go back and have my stool tested again 2-3 weeks after I finish all the medications.

Pantoprazole is not bad, at least it is better than omeprazole. We like to use rabeprazole as it is more effective in most people. we like to give high dose of PPI as that can boost the cure rate. What you are given is a standard triple therapy. In Australia, the cure rate is about 80%. However in Europe, it's less than 60%. Your doctor would know the cure rate in your region.

3. Should I supplement my treatment with Pepto-Bismol or just stick with the triple therapy without the bismuth? I read on this forum that it can reduce the chances of C. Diff arising from the antibiotics and can also improve chances of eradication but also that the first therapy is usually the triple therapy of 2 antibiotics and a PPI so I'm not sure if I should supplement my treatment with it. Also, is C. diff common from these antibiotics?

Pepto-bismol can give your treatment a boost. It is good because not only H. pylori cannot become resistant to it, it can prevent C. diff complication. although C. diff can be found from the environment, it is more associated with uncook food. Some people can carry C. diff, but the C. diff is in dormant due to the abundant microbiota. However, when the microbiota is wiped out by antibiotics, the C. diff can surge and cause trouble. Anyway, your doctor would know the prevalence of C. diff incidence in your region.

4. Do these antibiotics suppress my immune system/lung defenses and potentially make me more vulnerable to catching COVID-19 and having more complications from it? Would I be okay to hangout with my girlfriend inside? I was told I can still go on walks with her and hangout outside as long as we social distance. She's mainly only around her family but is still working at a job about twice a week with 1-2 other people wearing mask/gloves and are at least 8-10 feet apart at all times. I was told by my PCP that there is no data that indicates that these medications would put me at greater risk for COVID-19, but I was also advised against having anyone that I don't live with come over just to be safe while I'm on the medications. I found this to be somewhat contradictory.

it's ok to have the antibiotics. Clarithromycin is actually a common antibiotics for bronchitis infection. However, if you are living with someone else in the house, everyone should get tested for H. pylori to prevent cross contamination.

Nevertheless, I agree with your doctor about keeping social distancing at all time when possible. This COVID is too contagious and deadly to people with underlying diseases.

5. Are there any foods that I shouldn't be taking these medications with that might reduce/alter its affects? I read that it's not advisable to take them with higher-fiber foods and/or dairy products.

You can take anything you want except for alcohol. Although there is no supportive evidence that alcohol interfere with the treatment, we just make it a general rule, no alcohol during antibiotic treatment.

6. Are there any potential drug interactions or risks to consuming marijuana by vaporization while I am on this treatment? I find that it helps reduce stress/anxiety about everything going on but it'd really help to know if it can affect treatment or cause interactions.

hmmm... good question. to be honest, we dont have much experience with marijuana and antibiotics. My guess is no interaction. But it is better you ask your doctor about it.

7. Will taking Align probiotic containing Bifidobacterium 35624 help at all? I read somewhere that taking probiotics while undergoing antibiotic treatment may delay the microbiome's ability to return to normal but I also read that taking that specific probiotic may reduce diarrhea side effects from the antibiotics. My diarrhea has subsided greatly since starting this treatment and reducing stress but the brain fog/lightheadedness is still present.

Since probiotics are harmless, you can take it if you want to. Some people find it helpful.

8. Can any of these medications cause more vivid dreams? I think I had the most vivid dream of my life the other night and I think I was aware I was actually dreaming for like the first time in my life. It was quite strange.

there is actually a whole list of side effects by the antibiotics and everyone responded differently. My guess is that your dream is most probably not related to antibiotics but the mental stress you are experiencing now.

[Al Here]

Thank you so much for the quick and in-depth response. It is greatly appreciated. I don’t believe I have an underlying disease, but I was diagnosed with IBS when I was younger. What I was wondering is does this regimen of medicines suppress my immune system and it’s ability to prevent/fight viruses due to messing up the microbiota and throwing things off? I read that antibiotics can mess with the immune system. Also, will taking the PPI I was prescribed every 24 hours be enough to keep my acid levels low enough to boost the eradication chances? I’m going to try supplementing this treatment with Pepto-bismol and hopefully that helps.

[Helico_expert]

Amoxicillin and clarithromycin are very common and broad spectrum antibiotics. They are very safe and have little side effect. I dont think they will have impact on your immune system.

but immune system cannot be measured. How good it is in recognising a pathogen is probably depending on how much practice it has. So people living in the developing country with poor hygiene, they are most probably going to have very good immune system. In contrast, people living in the modern society where everything is so clean, there is little chance for the immune system to learn what is good and bad.

so, what i am trying to say is, the strength of your immune system cannot be judged by quantity. It's not the more white blood cells, or whatever T cells or B cells or neutrophils or basophils you have. It will be how much data is available in the immune cell's memory.

[Al Here]

How much Pepto-bismol should I take each time(in mL) and how many times a day should I take it to improve chances of eradication and also decrease chances of C. diff? I assume 15mL contains about 250mg or so of bismuth and I should do that 4 times a day? How come it decreases chances of C. Diff? I also talked to my PCP and I was prescribed pantoprazole 20mg twice daily instead of 40mg once daily per my request. Does that make a difference since I will be taking it in the morning and at night now instead of just in the morning? Are there any specific probiotics you would recommend that is known to potentially decrease chances of C. Diff from the medications I am taking? I read online that taking a probiotic with Lactobacillus rhamnosus GG can reduce the chances of getting C. diff from the antibiotics but I don’t know how accurate that is. What are the chances of getting C. Diff in general if I also supplement my treatment with bismuth?

[Helico_expert]

please follow the instruction on the pepto bismol.

but we prescribe 240mg of bismuth 4 times a day. so i guess 15 ml is fine.

bismuth will stay on top of the skin of your digestive system. So it is like your digestive system being coated with a layer of heavy metal. The microbes like C. diff will die when touching them.

20mg pantoprazole twice a day works better than having 40mg once a day because the acid suppressant in your blood stream is more constant.

There is no guideline to what probiotics work best. So you can do some experiment to find out the best one that suits you most.

if you are taking bismuth, your chance of catching C. diff will be very low. In our clinic, we havent seen a single C. diff case for the past decade. Nevertheless, it could be due to low prevalence of C. diff in Australia. Your doctor would know the risk of C. diff better.

[Al Here]

Thank you so much for the reply. My doctor said I could take the pantaprazole 20mg twice daily or the 40mg once daily but that I shouldn’t take the 40mg twice daily for some reason. Do you know why that might be? What if I take the 40mg in the morning and the 20mg at night? I’ve read multiple studies suggesting that taking the 40mg twice daily is far more effective so I was somewhat confused by that. I’m trying to do whatever I can to improve my chances of eradication this first time around.

[Helico_expert]

you can have 40mg BID. But your doctor is responsible for your overall well being. you can discuss with your doctor about having 40 mg twice a day.

[Al Here]

When supplementing with bismuth, does it make a difference if it’s bismuth subcitrate or bismuth subsalicylate? Also, is it better to take the liquid or pill form or does it not make a difference?

[Helico_expert]

very good question. So far no actual comparison of efficacy on the different bismuth compound has been done. But theoretically they should all get broken down to the same by product, bismuth.

base on my visits in various China hospitals, they just grab whatever bismuth compound is available on the shelf and is able to yield the similar outcome.