Helicobacter Forums

It is common to have some episodes of relapses even after HP eradication. But if you are indeed HP negative, your symptoms will gradually reduced.

Hi Helicoexpert,
I just had the endoscopy done. Everything was normal, and the HP was negative. But my symptoms still persist after being on a month of famotidine (20mg twice a day). The vomiting and nausea slightly improved (now I still vomit about 1-2 times a week), but the upper abdominal pain, bloating, gas and diarrhea persists. I still feel so full and bloated within 2-3 hours after eating.
Would you recommend switching from famotidine to omeprazole? If so, would 20mg/day work? I have one question-would the PPI make the food digestion even slower and keep me bloated for longer, since it works better at reducing acid secretion?

Hi,

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zcheng32 wrote: Sat Jun 13, 2020 6:34 am Hi Helicoexpert,
I just had the endoscopy done. Everything was normal, and the HP was negative. But my symptoms still persist after being on a month of famotidine (20mg twice a day). The vomiting and nausea slightly improved (now I still vomit about 1-2 times a week), but the upper abdominal pain, bloating, gas and diarrhea persists. I still feel so full and bloated within 2-3 hours after eating.
Would you recommend switching from famotidine to omeprazole? If so, would 20mg/day work? I have one question-would the PPI make the food digestion even slower and keep me bloated for longer, since it works better at reducing acid secretion?

It is common that the symptoms can persist even after H. pylori eradication. Give it a few weeks or months to recover. I would expect your symptoms is milder compare to before treatment and should gradually improve over time.

It is also very important to be sure that you are free of H. pylori. I assume your endoscopy examination is accurate.

If you think that famotidine is not helpful, you can ask your doctor to switch it to rabeprazole. Omeprazole is cheaper, but it's not as effective as rabeprazole.

Although PPI is meant to reduce acid secretion, but your stomach acid is never going to be neutral. The pH in your stomach will still be around 5. So you should still be able to have proper digestion. Nevertheless, you can try avoid food that is difficult to digest, eg. apple skin, brown rice, uncook vegetables.. etc

Hi helico expert,
Typically after how many days on PPIs are you supposed to feel better for someone with a normal endoscopy result and HP negative? I'm on Day 5 and haven't felt much improvement...Thanks

unfortunately there is no guideline to what is "normal" under endoscopy examination.
Normally during endoscopy, the gastroenterologist is simply looking for obvious abnormalities, eg. polyps, inflammation, ulcers, bleeding, etc.
Then they will take a small biopsy for examination.
The small biopsy on that location may not represent the whole stomach.
So even if the biopsy shows that it's healthy, there is still a small risk of abnormality.

But in general, if no obvious abnormality is observed, then it should be healthy.
The "recovery" is subjective. It could be days, weeks or months.

So what symptoms are you experiencing now? do you find PPI helpful?

At first (shortly after finishing the HP eradication): I had nausea, vomiting, upper stomach pain, diarrhea, lack of appetite, bloating and gas
Then after a month of famotidine (20mg twice/day), the nausea and vomiting greatly improved, became occasional, but the other symptoms did not get better and the stomach pain actually became worse. Then I switched to PPI.
Today is the 4th day I'm on PPI (20mg omeprazole twice/day, once 1h before breakfast, and once 1h before dinner). The bloating, gas and pain improved but the vomiting and nausea became worse. The vomiting and nausea was the most terrible in the morning, and some times lasts though the entire afternoon. The diarrhea and lack of appetite did not improve or worsen. The pain does not seem to be associated with bowel movements so I don't think it's IBS. I don't have food sensitivity and have been paying good attention to what I eat.
I thought the PPI should start working 3-4 days after starting it, right? May be I should just give it more time?
For some reason, my doctor said he doubted PPI would work for me since a month of famotidine was not very effective, and given my endoscopy was normal...I have no idea why he's drawing that conclusion.

I assumed you have checked that you are actually free of H. pylori now.

Your symptoms may not be because of H. pylori as H. pylori doesnt give diarrhea. and only in acute phase, give you vomit.

Some H. pylori patients get nausea because of low iron level and that could be due to H. pylori. Usually iron level goes back up after eradication of H. pylori.

If omeprazole doesnt work, try rabeprazole or esomeprazole or pantoprazole. But I think rabeprazole works better than others.

You can probably ask your doctor for domperidone. We use it to increase the stomach motility to push food down. But it can help with the vomit and nausea.

I'm wondering how to control my morning nausea/vomiting symptoms. I think these are due to the acid in the stomach after a night without food. Since I recently replaced famotidine with PPI, the PPI won't take effect as quickly as famotidine... (but famotidine could not help with the stomach pain and bloating)
After how many days of taking it would you know one PPI "doesn't work" and you should switch to another? A week? 2 weeks? Thanks

PPI will give a more complete inhibition of acid secretion and long lasting. But the effect will kick in slower.
Famotidine is fast acting and doesnt stay effective in your body for long.

Omeprazole is an old PPI and probably half of the people are less sensitive to it. Meaning you need a higher dose to have the effect.
esomeprazole and pantoprazole are the better version as they get rid of some impurities in omeprazole. But again, some people are resistant to it due to the faster metabolic rate.
Rabeprazole is perhaps a better choice as it does not get impacted by the metabolic rate.

anyway, there are a few PPI choices that you can try. Maybe one of them will suit you better.