Is it possible that my eradication treatment was unsucessful?

[Christian96]

Hello,

I had stomach problems since March 2019. In June 2019 I diagnosed myself with Helicobacter Pylori infection and have completed an eradication treatment. It worked flawlessly! I used metronidazole + amoxicillin + PPI 40mg therapy, which seems to be a standard. After three months since the eradication the very exact symptoms came back. I did a stool test, twice, for H. Pylori infection - both came out negative.

Since then (September 2019) I have the very same stomach problems. I've been to a couple doctors, have tried all different diet regimes and products, betaine HCL, plenty of other supplements, also prokinetics (itopride + trimebutine), and psychiatric drugs (sulpiride). No effect at all.

I have completed two endoscopies, esophagus CT scan, and stomach emptying scintigraphy. No issue!

I have a stomach discomfort/heaviness feeling right away after eating and a lot of belching. Generally, throughout the day I can't stop belching - it's a constant feeling as if gas was stuck in my stomach. When I don't eat for a while, stomach discomfort completely disappears and instead I feel a belch 'stuck in my throat'.

I never had both stomach discomfort and feeling of something stuck in the throat. It's usually either this or that.

Lately I've been also trying fluconazole for Candida overgrowth. I didn't do a test for that - it was just an idea I had. After 10 days of treatment now I do feel slightly better. Coincidence? Maybe. But, that got me thinking...

I reminded myself that before testing again for H. Pylori 3 months after completing eradication treatment, I took antibiotic for a week while I was on a holiday in Thailand (I got some infection, I think a virus one, but trying out an antibiotic was worth a shot). This was 6 weeks before testing for H. Pylori again, which could be the reason why both tests came out negative... I think.

Now, I don't think I have Candida overgrowth in my stomach, but Fluconazole is also (According to an in vitro trial I saw on NCBI) fairly effective against H. Pylori. Not enough to eradicate it, of course, but possibly enough to reduce the symptoms.

First H. Pylori treatment completely relieved me of all symptoms. I was so happy that I booked a holiday to Thailand - finally, after 3 months of constant stomach issues I was free! An amazing feeling. Now it's 16 months that I feel sick and after being to many doctors I really am out of ideas. Trying out an neurologist is another step I want to take, but before that:

Is it really possible that, perhaps, my negative stool test results were because of an antibiotic I took 6 weeks ago? Also, even if not - is it possible that I caught H. Pylori again and it gave me the exactly same symptoms? From what I know, it's rather unlikely for once eradicated H. Pylori to come back (especially within 3 months!), and even if - it almost never is as severe. And this time - the symptoms are even worse than before...

If anyone could shed some light on this matter I would be very thankful. My idea is to wait a month (as I'm just finishing my 14-day Fluconazole treatment) and test for H. Pylori again - both from stool test as well as do two breath tests. Both stool tests have accuracy of > 90%, but still - 1/10 tests may be false-negative, so I rather take a couple tests every week or so this time.

Just - this seems very unlikely, but the timing is just too perfect. I went through an eradication treatment, all symptoms have disappeared, and then out of a sudden - 3 months later - they came back and persist for 16 months already. No other issues than stomach discomfort/dyspepsia and constant belching as well as feeling as if burp was stuck in my throat.

Thank you for your time!

[Helico_expert]

It is true that it's hard for adult to catch H. pylori back again. However, to be sure, it is better to have everyone living under the same roof to have H. pylori eradicated.

It is also true that the breath/stool tests are over 90% accurate. So after your multiple tests, I believe you have your H. pylori eradicated.

Sometimes, patients can experience episode of gastric symptoms after HP eradication. you can try some symptomatic treatment, eg PPI.

[Christian96]

Thank you for your answer.

To be honest, I would really want it to be a H. Pylori infection again. Second eradication would be the simplest solution here. But I'm aware that with two stool tests it's unlikely.

I plan to do another stool test and also a breath test. Is there a point in doing a blood test here? Also, do you think I should wait at least a month before finshing Fluconazole treatment to make sure I don't come off with a false-negative result?

Thanks!

[Helico_expert]

you can have another stool or breath test a month later. Your blood test is most likely to be positive as our immune system would have memory of the pathogen. It'll take a while for the antibody to gradually deplete.

I think in your next test, it is probably good to understand how negative is a negative result. Try to get the raw data from the laboratory.

In order to get accurate stool/breath test, you'll have to stop all antibiotics or PPI for a month.