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):
CLARITHROMICIN
METRONIDAZOLE
AMOXICILLIN
OMEPRAZOLE
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:
LEVOFLOXIN, PPI AND AMOXICILLIN.
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.