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欧洲幽门螺杆菌治疗共识 5

Hpylori symptoms and treatment advice

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Moderator: barjammar

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Posts: 4470
Joined: Wed Mar 02, 2011 7:20 am

Re: Hpylori symptoms and treatment advice

Post by Helico_expert »

It's the wound that gives you the symptoms. Some wound can take a long time to heal. If PPI can help reduce your symptoms, you should continue to take PPI. Anxiety and stress can definitely trigger gastric symptoms. We have done human trials and showed that extreme stress and anxiety can trigger gastric symptoms.

it's very rare for stomach cancer to develop within 3 years. especially when your endoscopy had not shown anything abnormal and you dont have family history of gastric cancer. It usually take decades for stomach cancer to develop.

Posts: 74
Joined: Mon Dec 07, 2020 5:23 am

Re: Hpylori symptoms and treatment advice

Post by AMERC »

Hi Helico_expert

My situation is also very similar

First has acidity issues in June 2020

Had endoscopy in Oct 2020. No inflammation or gastritis or Hernia. Only H pylori positive

Did two separate 7 days triple therapy treatment

since than I have tested negative for h pylori on 3 stool tests done over 12months. None when I was on PPI

Between July 21 and Jan 22 . No PPI taken because hardly any acidity symptoms

Since late Jan 22. Acidity symptoms. Pain in the epigastric region and occasional heartburn has return. Sometimes the pain is very sharp stabbing like

Now taking Dexilant 30mg one a day to keep symptoms in control

However saw a Gastroenterologist today. He said that I should do a breath test to find out if the bacteria has truly gone because he said stool tests are not very accurate. I told him that I have done 3 stool test in 12 months all of them can't be wrong

[Anyways he said that either the bacteria has not cleared or it has cleared but it has made the stomach very sensitive to acid. Much more than before

Is breath test better than stool test for h pylori post eradication therapy?

Can I be really unlucky to have 3 stool test give false negative despite not being on ppi or antibiotics in 15 days before ?

If the bacteria is present how come I don't have the symptoms all the time. it only comes and go especially during stressful times

Can the stomach become very sensitive to acid post eradication? I note the symptoms comes during stressful days or when I have slight stomach upset

Posts: 2
Joined: Sat Aug 06, 2022 3:56 am

Re: Hpylori symptoms and treatment advice

Post by Colorado5280 »

August 5, 2022

Hello Helico_expert:

US member here. I'm happy to have found this forum!

I have just joined this forum after fighting a very stubborn H. pylori infection for 19 years now (post lap-chole aka gall bladder removal surgery in 2003). I have gone through an upper endoscopy and 2 horrible antibiotic regimens so far. The H. Pylori and bile gastritis (from the GB surgery) were diagnosed by endoscopy.

The first HP treatment was around 2004 and was the standard triple therapy at that time in the US. Breath test afterwards was negative but then symptoms have happened again off and on over the years.

The last treatment after stool test confirmed HP in Feb. 2021 was the 14-day quadruple therapy (family practice doctor):


I have started to have the same symptoms again last week (bad nausea, poor appetite, lethargy, fullness after eating, etc.) so believe I will have to go back to the doctor to do a stool/breath test unfortunately. Because of COVID I haven't done the follow-up test yet but need to.

I just read about Vonoprazan and am very interested if/when it will be available in the US. My interest is because I have had 2 horrible reactions to high dose PPI's in the last 19 years (omeprazole and PPI's mixed with H-2 blockers) due to hypo-magnesium (before the FDA put a black box warning on PPI's and my doctors not warning me about this possible reaction) and had to go the ER twice for side effects. Does anyone know if there are hypo-magnesium issues with Vonoprazan since it is a different type of acid blocker? May not be a consideration if this is not available in the US yet or I don't know if it would be available at an academic medical center at all.

Also, I don't know if there is a recommendation for how much magnesium (or type) to supplement if I do have to use more PPI's for my current symptoms and/or "round 3" of H. Pylori eradication treatment (to avoid having hypo-magnesium issues again)? The doctors and pharmacists I've spoken to don't seem to be very knowledgeable about this issue.

Is it possible to substitute an H-2 blocker (in combination with Pepto Bismol possibly (bismuth)) instead of a PPI (e.g. omeprazole) with an eradication treatment? I've read there is a lower chance for hypo-magnesium issues with H-2 blockers.

In addition, I have heard there is a lot of CLARITHROMICIN resistance within the US. Because of this, one GI doctor I heard on a podcast recently recommended a third possible regimen:


Does this sound like "best practice" in the US for a third round of H. Pylori treatment given my 2 past failures (if HP is indeed confirmed) or is there a better third round treatment recommended given current research globally? I know there are often different opinions among clinicians so I wanted to post my question here to see what the global H. Pylori experts suggest.

After the 2 prior, horrible antibiotic treatments, I would like to make sure I use the most effective third H. Pylori eradication treatment possible if I have to suffer again for 1-2 weeks with the antibiotics. Because of the intense symptoms, I certainly want to do everything I can to improve how I feel so I can return to a more normal life.

Thanks in advance! :)

PS - I also posted under another thread ("HP is a Beast") but thought this thread is the most appropriate since my questions are regarding H. Pylori treatments. Thanks.

Site Admin
Posts: 4470
Joined: Wed Mar 02, 2011 7:20 am

Re: Hpylori symptoms and treatment advice

Post by Helico_expert »

I am not familiar with the magnesium problem.
But PPI + Amox + Levo is probably not strong enough. If possible, try to add bismuth in the treatment.
If PPI is not working for you, what about H2 blockers?
the cure rate of using H2 blocker is lower, but there are some successful cases when using H2 blockers.

Abdelaali Wirzgane
Posts: 2
Joined: Thu Oct 27, 2022 12:01 am

Re: Hpylori symptoms and treatment advice

Post by Abdelaali Wirzgane »

Hello, please help me, I am from North Africa, I have been doing tests to see what was wrong with me for 5 years with no hope. Last month my h pylori blood test came back positive.
My main symptoms are constant stomach and chest tightness and shortness of breath, indigestion, fatigue, dark circles under my eyes, I don't feel any pain and my stomach not producing acid, I am a week out from the treatment now.
my treatment was
Clarithromycin 500 mg twice a day
Amoxicillin 1000 mg 2 times a day
Metronidazole 500 mg twice a day
Proton pump inhibitor twice a day
For 14
sorry for my bad English,
please help.

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