Biopsy found HP like bacteria, dr thinks nothing of it

[Dimitri001]

I've had a gastroscopy which found minor ulceration in the esophagus, everything else was otherwise clean. A sample was taken and the paper which I have says it shows type 1 metaplasia and rare bacteria that look like HP. Now, I should say, the gastroscopy was done for the purpose of taking a sample to test for celiac disease so samples were taken of the intestine as well, the paper which I got from the pathologist, however, makes no mention of celiac disease, so I don't know whether these results refer to the samples taken from the esophagus or the stomach. I didn't ask my doctor which is the case, because I was in such shock, but he basically waved these bacteria off and told me we're gonna do another gastroscopy to take another sample for celiac disease and then if it comes back negative we're going to test to see if I have any food alergies.

I read a bit online about HP and I was expecting him to give me antibiotics, so now I'm kind of worreied about this. I did a stool test, however, I think a year and a half ago (I don't have my documentation with me now, I'll check later) that was negative for HP. Should my doctor be giving me antibiotics? Does the fact that the ulcer is in the esophagus mean that it is not due to celiac disease? Does the metaplasia mean that the ulcer (and maybe all the symptoms) are due to HP=

I'm 25.

My symptoms are these:

- started with diahrea around summer of 2011, diahrea lasted until summer 2012

- lost about 15.5 pounds

- have various indigestion type problems - bouts of flatulence that can last for 20-30 minutes, with having to break wind every 1-2 minutes, sounds from the stomach sometimes, little "explosions" and bumps in the stomach, like a bubble bursting

- sensitive to acidic fruit - sometimes I can eat it, sometimes it bothers me

- I've had hemerroids which have now passed, don't know if that matters

- had to throw out nuts, which I used to eat a lot of, because the diahrea would get worse

- I should say my symptoms fluctuate a bit, sometimes they are a bit heavier sometimes better

- sometimes, particularly in periods when my symptoms are bad, I get a bad feeling in the morning if I ate a lot late last night. A sort of "rotten" feeling


- there was a period from around March of 2013 to summer of 2013 where I would occasionally get these episodes where my stomach on a few occasions (4-5) would get very sensitive and I would have to eat white rice and bananas and toast exclusively for a day or two until my stomach recovered. These episodes would be triggered by eating acidic fruit or a lot of meat, or eat a lot late, but on the other hand sometimes these things wouldn't bother me at all

- then, from about summer to fall I had episodes where after eating I would feel as if I overate and I would get the same kind of sensitivity as these previous episodes, except they would last longer and, to recover, I would have to not eat at all for a while. This has since passed and now I don't get tehse bouts of sensitivity, its just the previously mentioned symptoms.

- there was one episode where after eating I got up and felt intense uncomfort in my stomach, as if its going to rip appart and I literally had to sit on the side of the street for like 15-20 minutes. This was the only such episode since the summer of 2011 when all this started. I've never had anything close to that intense before or since (this was maybe a year ago) and I've never, outside of this episode, had pain. All my symptoms are, at worst, a kind of, had to describe, uncomfortable feeling. Never pain.

My doctor sent me to do blood tests for celiac disease of which I'm still waiting for the results of (incidentally, is it necessary to fast before those? My dr told me nothing). I've done a stomach ultrasound which came back clean. I've been tested for some parasites (I can list them when I get to my papers) but all were negative. I've had some blood tests done ("general" tests, I think) and there were some thigns that were lowered and some elevated, but nothing my doctor remarked on (I can post those when I get to them).

I should also say that I do lead quite a stressful life, so I don't know whether any of this could be due to that.

[Helico_expert]

There is no straight forward answer to your question. Many of your symptoms dont fit the description of H. pylori. However, you could have multiple disease/infection happening in the same time. So, to check if you are H. pylori positive, you can go to any GP and ask for a breath test. That will tell if you are infected with H. pylori and decide whether you need treatment for H. pylori.

Another thing I would like to add is... mental stress can make your stomach symptom worse. Since the endoscopy and ultrasound showed a clean stomach, then it is a good news. The ulcer, if it is in the oesophagus, do you suffer from reflux? if you do, you can probably control it with PPI.

[Dimitri001]

Thanks very much for the help!

I went to see a GP today and she ordered a stool test for HP. So I should have the results of that next week. I should also get the celiac disease blood tests tomorrow or the day after so I'll post that

Regarding the reflux question, I'm not sure about this. I googled GERD and read up a bit on it and I'm not sure it fits my thing. The symptom that I have which might be described as reflux is that sometimes when I wake up I have a strange feeling in the stomach. I'm not sure how I would describe it, it is a kind of rotten, sour feeling. I should say that this doesn't happen always at all, like all my symptoms, it fluctuates, sometimes I don't get it for like a week or more, and sometimes I'll get it a few days in a row. In periods when my symptoms are mild it doesn't happen at all. It seems that it happens more frequently if I eat late.

The thing that makes me doubt that I have it, though, is that this sourness that I feel seems to me restricted just to my stomach, not in the chest area or under the chest. I have no heartburn.

I mentioned this sourness to my gastroenterologist and he prescribed a PPI. I haven't taken it yet. I mentioned to the GP today that I've been proscribed a PPI but that I don't think I have reflux and she said that it isn't just for reflux its also for inflammation of the stomach lining or something like that and she said I DO have that so I should take it.

My concern is that, suppose it even is reflux, I still don't get this all the time, I might even say rarely, so if that means my acid levels are fine most of the time would I then do myself some harm by taking PPIs?

Also, you mentioned I should do a breath test for H pylori, but doesn't the biopsy result show that I have H pylori? (although, it said "rare bacteria similar to H pylori")

[Helico_expert]

Although people has been taking PPI for long term and proven safe, I suspect there will be underlying problem because without acid in the stomach, it means anything can start growing. Nevertheless, since you were diagnosed with ulcer, I think it's appropriate that you keep taking PPI until it's heal. You probably should ask your specialist how long you should take the PPI and when should you visit him again to review the ulcer.

breath test or stool test are more specific for H. pylori or any Helicobacter species. Maybe you caught a funny Helicobacter species from pets?

[Dimitri001]

I have a cat, so possibly I could have gotten something from her. On the other hand no one else in my family has any problems.

I should have the stool test results on Monday, so we'll see.

Here are the results of my blood test:

(S) tTg (IgA) 2 (the unit of measurement is RU/ml)

(S) IgG 12.23 (unit: g/L - same for all the below)
(S) IgA 0.04
(S) IgM 0.53

Also, don't know whether this means anything, but I have noticed this a number of times, and I swear I'm not kidding, some times when I have a bowel movement, though my stools are now fully formed and have been since summer of 2012, there are specks of stool floating on the surface of the water, really small specks, and they are constantly moving around on the surface of the water. Sometimes it looks like they are being repelled by the big, formed piece of stool, sometimes like they are repelling eachother, sometimes they just seem to move.

Again, I swear I'm not imagining this or making this up. Is this normal? Could this be indicative of anything?

[Helico_expert]

You probably have more than one problem.

IgA is antibody normally found in stomach.
IgM tells you if you just got infected
IgG tells you that you have been infected for a long time (>a week or two).

we should wait and see your stool test result. Nevertheless, if you are positive for H. pylori, the triple therapy may treat your other problems too.

[Dimitri001]

I got the stool test result and it's negative.

Now I don't understand how to reconcile this with the biopsy results, which, as I mentioned, said that "bacteria similar to HP were found in the sample." Could the bacteria in the biopsy sample still be significant even though they aren't HP?

I'm having a gastroscopy done tomorow and they are going to be taking samples again for celiac disease. I'll post the results of that when I'm done with it.

[Dimitri001]

I had my gastroscopy yesterday. The doctor who did it told me he saw no ulceration so the one which was found on the esophagus (the cardia, specifically) must have healed. Does this mean I should stop taking the PPIs?

He gave me a written report which I'll give my doctor when I see him a month from now when the lab is done with the samples from the biopsy.

The report says that the stomach lining is mildly hyperaemic and that it was biopsied "for histology and H. pylroi." I was surprised by this because the paper I got from my gastroenterologist and which I gave this doctor who was doing the gastroscopy said only to take a sample from the duodenum for celiac's disease. Is it just standard practice to take a sample if there's hyperaemia? This doctor who was doing the gastroscopy doesn't know that my stool was negative for H pylori or that the samples from the previous biopsy found something similar to H pylori.

Under the "diagnosis" section of the report he put in "gastropathy."

I should say, I didn't post here the whole report from the lab on the samples from the first biopsy, because the first post was already long. Anyway, I'll attempt a translation of it now (I'm not from an English speaking country):

"Surface epithelium as well as the epithelium of the glands shows signs of type 1 intestinal metapasia. Hyperaemia in the lamina propria, substantial infiltration of mononucleate and infiltration of granulocytes which can be found intraepithelialy in the glands. On parts of the surface of the samples there is regularly layered multilayered "plate like" epithelium. (the "plate like" is a literal translation, I think it should be "squamous," but I don't know)"

And then there's a bit at the end that says essentially that using giemsa staining "rare bacteria similar to H. p. were found."

Also, from the report it seems that they took only one sample from the duodenum. I read an article recently talking about how at least 4-6 should be taken and from different sections of the duodenum. I'm thinking about going gluten free, if it is, as the articles suggests, possible for the biopsy to miss celiac's.

Do you think that, in spite the negative H. pylori stool test, I should still take some sort of antibiotics on account of the bacteria from the biopsy sample and the blood test results?

[Helico_expert]

I think you should take triple therapy. or combine triple therapy with pepto bismol.

[Dimitri001]

Thank you for your help! I'll seek out a second opinion and hopefully the second doctor gives me the triple therapy, as that seems to be what every doctor I consulted suggests, other than my gastroenterologist.

One last thing, am I supposed to keep taking the PPIs even though the ulcer has healed? Is it supposed to help with the hyperaemia or something other than the ulcer?