Reinfection or old infection

[new_guy]

I'm being treated now again with Aciphex, amox, clarith for 2 weeks for possible H pylori because my endoscopy showed mild gastritis and mild duodenitis and I'm symptomatic. I say possible because the biopsy showed negative because I'm taking aciphex 20mg 2x daily and zantac 300mg at night for my laryngopharyngeal reflux and I wasn't off the meds when the biopsy was taken since I can't just get off them easily. 11 years ago I was treated for H Pylori with the Prevpac I was sick terrible for 2 years till I received the proper treatment. Then I did an endoscopy several weeks later because I was still sick but the endoscopy showed fading gastritis and negative H pylori. The GI gave me Prevacid and another month or 2 I recovered completely. Even a few years later I did a breath test but not through the balloon but test tubes and was negative.

I know reinfections are much less common then not being able to get rid of an infection and my questions are
1) Is it possible to not eradicate H Pylori but recover completely or will you stay sick till you get rid of the bacteria?
2) My blood test showed positive but my biopsy negative...can a blood test still show positive even after 11 years if I have eradicated H pylori?

[Helico_scientist]

1) it is difficult to say, usually people stay sick if the bacteria hasn't been eradicated
2) the blood test will stay positive for a while even after eradication. I don't know about 11 years though

After your treatment, I would definitely recommend to try to stop the meds for a couple of weeks and do stool test or breath test to make sure you are Hp negative. It is the only way to know.

[new_guy]

I'm planning only to do a breath test if I'm still symptomatic 2-3 months post treatment. It's because if I abruptly stop my meds my throat will get quite bad and it will take a few months or more to recover. I do know you gotta stay 2 weeks off PPIs and H2 Blockers for the breath test. So if I will do the breath test and let's say have it done after being off my meds for about 15-16 days will it be accurate? I been on Aciphex and Zantac for like 5 years now. I know 1 week is not enough to be off to do the breath test I'm sure 1 week I could handle it but 2 weeks will be very hard

[Helico_expert]

You may use this guide to check how long should you stop your PPI.

http://www.imvs.sa.gov.au/wps/wcm/conne ... OD=AJPERES

Hint: you may substitute your PPI with H2 Receptor Antagonists until the day before the test.

[new_guy]

In the guide it says 1 week no ppis but h2 blockers are fine but other places I read it says 2 weeks no ppis and even no h2 blockers. Getting off ppis for me is very hard so I need to be 100% sure what's the right thing to do. I'm confused.

[Helico_expert]

The best is to avoid everything. But if you really cannot stay away from any acid blocker, H2 blocker is the alternative.

if you are going for an endoscopy, make sure you ask for bacterial culture and histology.

[new_guy]

I had an endoscopy which showed mild gastritis in body and antrum and mild duodenitis. My GI didn't do histology and/or culture just regular biopsy I guess. But since I'm on PPIs wouldn't a culture and/or histology still produce a false negative? If not I wouldn't have bothered with the antibiotics which I'm taking now and would've made my doctor do it and wait for a result.

[Helico_expert]

With PPI, Culture may be tricky. But if it is an experience laboratory, they will be able to culture H. pylori.

Histology should not be affected by PPI, the pathologist will be able to physically see the bacteria under microscope. By seeing the white blood cells under microscope will be able to determine the level of gastritis and predict the presence of H. pylori.

[new_guy]

In my endoscopy report it says biopsies were taken from antrum and body and the h pylori stain was negative. Is the "stain" thing the histology? But I read that when you are on PPIs any biopsy test can be affected whether its CLB culture histology etc.

[Helico_expert]

Yes, the staining is from the histology.

and yes, you are right about the PPI. PPI can reduce the acidity in the stomach and so other bacteria can start growing and compete with H. pylori. So, the concentration of H. pylori may be reduced due to that and the histology may not be able to find H. pylori as efficient.

Culture of H. pylori will become very tricky as there will be lots of contaminant. So, all these will rely on skillful laboratory technician. It's not 100%, but if the technician is skilled enough, the chances of picking H. pylori is higher.