Helicobacter Forums

Hi,

Im 36 yrs old, male, and was diagnosed last Sept 2012 with Non-Hodgins lymphoma, Malt lymphoma to be specific. Had enlarged lymph nodes in the omentum and stomach ulcers which were biopsied that revealed the findings. During that time I was given the Esomeprazole-Amoxiccilin-Clarythromicyn for 14 days as first line of treatment to first eradicate H. pylori as there are strong ties between h. pylori and malt lymphoma. After 3 months (Dec 2012) I was tested again, ct scan-endoscopy-biopsy, and nothing has changed I still have Malt lymphoma but negative for h. pylori. The oncologist is now thinking of using rituximab (monoclonal antibody) as the next line of treatment as h. pylori eradication didnt work - or at least h pylori is not the culprit.

As the h. pylori came out negative from the biopsy last Dec 2012, should I request a 2nd line of eradication (read about metrodinazole...) before really going thru the rituximab route OR are the results via biopsy conclusive enough? Can biopsy results be false-negative (no sure of the correct term) and not totally accurate?

Thanks in advance.

the accurately identification of H. pylori infection in patients with gastric MALT lymphoma is very relevant, as lymphoma regression has been demonstrated after H. pylori eradication. It is probable that the reduced H. pylori prevalence found in some studies, as in ours, could be explained by false-negative results obtained when only one diagnostic method was used. Therefore, one negative result obtained by histology (or rapid urease testing) should be followed by the use of a non-invasive diagnostic method before the exclusion of H. pylori infection.

http://www.grupoaran.com/mrmUpdate/lect ... =RVN&Eng=0

I have requested Prof. Marshall to review your story.

thanks a lot! So this means that I need to get another h. pylori test, right?

just an update.

Decided to go to the doctor and ask for another h. pylori test before finalizing my lymphoma treatment (rituximab cost is no joke so better be sure that h. pylori is not the culprit). She gave me a urea breath test order. When I went to the department that performs the breath test they told me the preps needed - 6 hours fasting, no antibiotics for at least a month, no ppi for at least a week, no antacids 24 hrs prior to test. Wont have a problem with fasting, antacids and antibiotic. Concerned though on the non-use of ppi (although I understand the importance). Im taking esomeprazole now for my ulcer and gerd. My ulcer is thought to be caused by maltoma. Will not taking ppi/esomeprazole worsen it? Esomeprazole actually helps my symptoms (stomache ache, gas, etc) so outside the ulcer worsening it makes me feel better. Can I take antacids for now and will this help? at least for a week until the urea tests are done?

An area of management worthy of discussion. Firstly, every (DIRECT) test becomes less accurate as we interfere with the stomach environment. In order these effects are:
antibiotics > bismuth > PPI > H2-Blockers > antacid. So tests which measure actual bacteria in the stomach (biopsy, culture, breath tests, stool tests) will be less accurate. This means you might still have Hp but it was not detected. That is bad if you have gastric lymphoma. Lymphoma in the stomach could cause false positive and negative breath tests I expect - depending on how big it was and how much acid is being produced in the stomach.
Tests which detect antibody should still work, because these should not be affected in the short term by medicine which suppresses Hp.
So my recommendation is that you take the serology test. It should be negative. Then have a few biopsies taken at endoscopy - not only of the tumour but also of other parts of the stomach.
If anything comes up positive then be alerted to possibility of a continuing Hp presence.
For the direct tests, cease all interfering medication except essential ones. Take Zantac and antacid for the 7 days before a breath test or biopsy. Take only antacid in the 24 hours before the tests. Double check with a stool test. When two or three tests are negative, then forget about Hp. (But just in case, double-check in 6 months and each year, in case serology goes from negative to positive.)
p.s. The best confidence comes from multiple biopsies studied by a thoughtful pathologist.