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Two failed attempts - what next?

The cure of Hp usually requires antibiotics. Other things have been tried and have a weaker effect.

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kail
Posts: 2
Joined: Tue Dec 06, 2022 8:15 pm

Two failed attempts - what next?

Post by kail »

Hi,

I am 41/M from Bangalore, India. I had 2-3 episode of vomiting during 2nd week of January-2021 and since then I am having continuous nausea, I lost appetite, can’t eat or even smell food as it makes me nauseous.

Following which I got the endoscopy done in Feb – 21, which came as RUT +Ve for H Pylori. There after I have taken two treatment plans for H pylori and both failed. Details as follows.


Main Symptoms

Mild Nausea, Can’t eat, see, smell food, Need to keep something in mouth 24 hours so that saliva is produced, it help me 15-20% with Nausea and other symptoms, but soon after removing it from mouth symptom starts and Nausea increases drastically, and feel shortness of breath.
Lost weight about 6-7 Kg in 1.5 year
No Appetite. Gurgling almost all the time in abdominal.
Weird sensation in the veins across hands, legs and in the back, this adds to Nausea
Abdominal tenderness and tightness, Epigastric sharp pain, This pain comes in when I lie down straight.
OGD
Feb - 21 D1 – Small Superficial Ulcers, D2 – Normal
Body – Mild Erythematous Gastritis, Antrum - Mild Erythematous Gastritis
RUT – Positive
Medication: – PPI, Clarithromycin and Amox (For 10 days)
April - 21 D1 – Normal, D2 – Normal
Body – Normal, Antrum - Mild Erythematous Gastritis
RUT – Positive
medication – PPI, Clarithromycin and Amox (5 days)
June – 21 D1 – Normal, D2 – Normal
Stomach Body –with an Ulcer with No bleed stigmata
RUT – Negative (Was on PPI, Possible Sampling error)
August – 21 Largely all normal, RUT was not done. Ulcer healed.
Jan – 22 D1 – Normal, D2 – Normal, Body – Normal
Antrum – Antrum predominant Gastritis
RUT – Positive
medication – PPI, levofloxacin and doxycycline + Bismuth (14 – Days)
UBT
March – 22 Positive (after taking medication – PPI, levofloxacin and doxycycline + Bismuth)
CT Scan
Feb – 21 1) Multiple Tiny sub centimeter sized non necrotic soft tissue mesenteric nodes noted
Feb – 21 Same as above
Aug – 21 Almost same as above
Dec – 21 Two small simple cysts measuring up to 4mm noted in segment 6 & 7. Normal otherwise.
USG
Feb – 22 Normal

Questions:
1) Is there any place in India where Resistance tests it done?
2) I have been having chronic urticaria since 1st November 2022, is it related to H Pylori?
3) What is the best possible combination can I try now in order to eradicate the infection?
4) All these days I have taken multiple PPIs and I never felt good, even when I was taking them with Antibiotics. But when I took H2 blocker for urticaria, I felt a little better in my stomach. Is H2 blocker are a better acid suppressing option then PPIs? Should that be tried with next regime? Or H2 blocker and PPI both can be taken together?
Last edited by kail on Sun Dec 11, 2022 1:48 pm, edited 1 time in total.

kail
Posts: 2
Joined: Tue Dec 06, 2022 8:15 pm

Re: Two failed attempts - what next?

Post by kail »

Hi Helico_expert,

Also I would like to mention that I did an GI Map test and they found H pylori there (Helicobacter pylori 1.4e3 High <1.0e3) but the resistance was not found, could this be a false -ve (attached)? as I have taken two therapy for it already.

Would sincerely appreciate your kind response in the troubled time that I am going through.
Attachments
H pylory - resistance.JPG

Helico_expert
Site Admin
Posts: 4489
Joined: Wed Mar 02, 2011 7:20 am

Re: Two failed attempts - what next?

Post by Helico_expert »

Hi,
Sorry for the late response.
I am sorry to hear about your resistance story.
First of all, I am not too sure about GI Map in diagnosing H. pylori and its resistance.

about your treatment failure, I wonder what PPI were you taking? in your next treatment, you may ask for rabeprazole or vonoprazan.
Vonoprazan is a new type of PPI, may not be available in your country.

I am afraid I dont know anyone in India that is doing antibiotic susceptibility testing.

nevertheless, amoxicillin and bismuth are both very good anti-H. pylori agent. H. pylori almost never become resistant to these two drugs. Therefore, your next treatment will be
Rabeprazole + bismuth + amoxicillin + one antibiotic that you have never tried. for example metronidazole, rifabutin, or furazolidone.

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