GI MAP

[schism]

Despite the GI MAP indicating I have HP, my GI doctor wants to do an endoscopy next week before treating HP. He said because I've had burping and heartburn, he needs to see my stomach/esophagus and do biopsies before deciding on treatment.

I have no day to day pain in my stomach and I can eat anything I want except sugary carbonated drinks (those make my stomach ache bad). Other than that, I have some burping and with that, I get heartburn at times.

Is it overkill to do an EGD? I am having anxiety about the EGD and the knock-out drug they will use while doing it.

[Helico_expert]

it sounds scary, but you wont feel or remember a thing. So dont worry. It's good to have a record of your current stomach condition by EGD. So, in the future, for some reason that you need another EGD, at least you have something to compare with.

[schism]

Endoscopy completed and doctor told my wife everything looked good except erosion on esophagus and gave me a prescription for 40mg omeprazole once per day.

Still waiting on biopsies.

Can the erosion heal? My main concern right now is will the damage heal or not. I sure don’t want to be on a PPI my entire life...

Is HP a common cause of GERD and once fixed the GERD stops thus so do PPI?

[Helico_expert]

Erosion can heal when the acid reflux is stopped by PPI.

H. pylori can cause GERD, but not all GERD is because of H. pylori.

Some patients develop GERD after eradicating H. pylori.

I think we still dont know how GERD happened and so we dont have a good treatment plan for it other than PPI.

[schism]

Erosion can heal when the acid reflux is stopped by PPI.

H. pylori can cause GERD, but not all GERD is because of H. pylori.

Some patients develop GERD after eradicating H. pylori.

I think we still dont know how GERD happened and so we dont have a good treatment plan for it other than PPI.

That’s good news. When will the PPIs stop? If it takes a month to heal on PPIs that sounds good, but to what end?

I’m afraid to begin the PPI treatment worried that I will develop dependance and be on them for life. They reduce stomach acid yet stomach acid is very important to break down your food. PPI increases your risk of malnutritionment and upset microbiome and c diff.

I’ve read that gerd is usually from not enough acid — yet here we are taking away even more acid.

I’m just confused and upset. I need solid answers and direction and it seems no one has it.

[Helico_expert]

GERD is normally cause by too much acid. It's important to suppress the acid as the reflux can burn your throat and increase risk of throat cancer. Some very bad GERD can also cause tooth corrosion.

[schism]

I called the doctor's office and spoke w/ a nurse whom went over the results in a bit more detail. She said that the erosion was "grade A" which she said is the least damage grade (so that is good news). She also said they saw some "stomach discoloration". I asked if that is gastritis and she said maybe, waiting on biopsy.

I don't understand why I would be prescribed a 2 month course of PPI when I get biopsy results in a week which could indicate new information and avenues of treatment...

I think I'm just going to hold off on the PPI until I get biopsy results.

Helico_expert, in your practice and exposure to HP patients, do you see some that have their reflux cured when their HP is? For me, I feel like if HP eradication stops my burping, it will stop the reflux.

[Helico_expert]

Erosion and reflux (or GERD) is cause by the excessive acid. Hence you were prescribed PPI. It could be 2 weeks or 4 weeks. Since PPI is very safe drug, you can take for a long period of time.

So why is there "excessive" acid? in a simple way of explanation, it is because of H. pylori. H. pylori is the root of the erosion problem. getting rid of H. pylori can almost certainly cure your erosion and stomach inflammation. However, the reflux "switch" may already be turned on by H. pylori and to turn it back off is not that easy. at the moment we can only control the acid by PPI and hopefully it'll turn off by itself after a while.

[schism]

It seems as though you are saying 2 contradicting things. You’re saying it’s excessive acid that’s the problem and it’s caused by HP, but you also say you can eradicate it yet a “reflux switch” may still be on. So which is it.... excessive acid or just a reflux of acid? Are you saying that even after HP eradication, acid levels may stay high? Is that what you mean by reflux switch?

[Helico_expert]

sorry for being confusing. let me try again.

Story 1.

Your stomach is normally protected by a layer of thick mucus. So the acid cannot digest your stomach. When you are infected with HP, the HP hides underneath the mucus, in close contact with your stomach cells and extract nutrient.

Your stomach cells will send out signals to recruit immune cells to fight off pathogen. But HP is very smart. It is able to mask itself from the immune cells. So all these immune cells gathered and cannot see HP. These immune cells get stressed and do "mass destruction" (hence inflammation). The immune cells are hoping that in such mass killing of all cells will eventually kill of HP. But it doesnt.

So ultimately, all these mucus producing cells get killed and the mucus get thinner and thinner and finally, the acid reached the stomach wall and you get erosion. As erosion get worse due to the acid, you get ulcer.

This is why you take PPI to reduce the acid secretion. BUT, if you dont eradicate the HP, your mucus will remain thin and when you stop the PPI and the acid comes back, it is almost certainly that you will get erosion and ulcers. Only when HP is eradicated, your stomach can slowly heal and your mucus grow back and when you stop PPI, you'll be fine.

and yes. some people can develop GERD after eradication of HP.

***********************************

Story 2.

when you are infected with HP. there are three outcome.
1. higher acid secretion
2. no acid change
3. lower acid secretion

nobody knows why and how. different people infected with the same strain can gives different outcome. it's probably more related to the host immune response and how the stomach heals as the wound get repaired by either cells division or stem cells differentiation.

so if you happened to be those people who get more acid secretion after HP infection, you are more likely to get ulcers and GERD.