3rd reinfection 8 yr old girl? pls advise

[WorriedMama]

A young, Caucasian female from middle class Americia living in a new home is diagnosed with 3 NEW nfections of h pylorie within 4 yrs yet the other 3 immediate family members in the home test negative. Please help!

My 8 year old daughter was sick doe years with symptoms that included acid reflux, burning sensation in tummy, lack of appetite, weigh loss, acidic smelling breath, and most importantly a pattern of vomiting yellow bile around 4 AM in the morning. Initially the vomiting would occur once every few weeks and after a few months the episodes would be only few days apart. It took several doctors over 2 years and multiple misdiagnosis before we found Pediatric Gastroenterology specialist who identified the problem Gastris due to h pylorie. Her 1st diagnosis was in 2009. The blood test and upper GI biopsy were actually negative but the specialist felt this was the issue so treated her with the standard triple therapy. Symptoms subsided almost immediately after starting meds. About a year later, the symptoms started again and in Jan 2011, the blood work confirmed another NEW infection of h pylori (based of IgM levels I believe) but the biopsy was still negative. This time, he treated with triple treatment (different meds) for 18 days. She felt better and follow up testing confirmed eradication. In 2012, the pattern started again and we though something else might be going on so wendid more testing which ruled out other issues such allergies, Crohn’s , Celiac. Once again, her blood work at her Pediatrician's office showed a new h pylori infection based on high IgM levels and she started another triple treatment of Clarithromycian, Amoxicillin and Precacid. Once again, we followed the instructions exactly and completed treatment. She stopped vomiting but I don't think it was eradicated completely this time. There was no follow up testing and she would get the burning sensation once a week. Now 5 months later, it's started again. Shes vomited 2 times in last week so we went back to Ped. Gast. Specialist who looked over all of the test results from Nov and confirmed she did have a NEW infection in Nov based off IgM levels. No testing this time because he feels the last series didnt get rid of it so now she is on Amox., Nexium, Metronidazole and Pepto Bismal.

Why does she keep getting gastris? With 3 reinfections (2009, 2011, and 2012) it makes sense to look at the immediate family as possible carriers. We are a very close family were known to share food, drinks, and loving kisses. (After the 1st diagnosis, we were much more cautious. ) My husband and I tested negative for h pylori in a breathtest in 2011 and blood test in 2012. Her only sister tested negative via blood test in 2012. My husband and I had probably taken Tums or some sort of antiacid within 30 days of the test due to bout of heartburn so perhaps we received false negatives? How about the possibility that her Grandma or Aunt might be giving it to her since she spends quite a but of time with them including 1 night week? Grandma (82 yrs old) has acid reflux issues and was told that her blood test indicated she had h pylori at some point in her life. Her doctor said that that she didnt have a current infection or something along the lines that it wasn't coming from her. Grandma will rarely take antibiotics and was never treated for h pylori so could she be the carrier? Another possibility is that my daughter was raised with cats and dogs in the house. One cats had digestive issues during her last few years in life and had some accidents (vomit and feces) on the carpet so perhaps this could be the culprit? I cleaned with enzymes and tried to sanitize as much as possible.

Please tell me how or from whom she might be getting this? A young, Caucasian female from middle class Americia living in a new home gets 3 new infections of h pylorie yet the other 3 immediate family members in the home test negative. What can we do to help prevent this little one from getting sick again? Perhaps this specialist is misreading the tests results and it was never eradicated period? Are there tests we should we request to find out more?

[Helico_expert]

I think this is a very interesting case study. First, how do we know if it is a new infection? blood test is never a good way of judging as our blood carry memories and one can stay positive for years. You are right about IgM, but it only works first time. the second time, it'll has to be IgG. unless it's a totally different species or a very very different H. pylori strain. Second, if it is truly new infection, there will be no need to change medication. Nevertheless, I'll speak to my colleague, an immunology specialist, later tonight and see what she thinks.

The ideal way is to have your child confirmed for eradication after treatment via breath or stool test. Many doctor does not do that. but it is the only way to tell us if the previous treatment truly work and the second infection is not due to resistance.

In regards to the transmission, although not established, but I believe that it is very possible that the grandma is the source of infection. It is known that H. pylori usually infect human during young age and there are reports suggesting that usually is the mother who pass the organism to the children. I think this is because mother is normally the person who spent most time with children. but we dont know how long two person (one infected and one not) have to stay together to infect the uninfected one. Another source of infection is the school where the toys are not cleaned and children likes to put everything in the mouth.

domestic animal can be a source of infection too. although H. pylori has been shown specific to only human, constant challenging H. pylori to domestic animal has been shown able to establish stable colonisation. If this is true, that MAY explain the IgM status.

Vomit is the most effective way to transmit H. pylori so far. So since your child in vomiting (i assume it is truly because of H. pylori), then you have to be very hygienic to prevent anyone else in the house to get infected.

Finally, hygiene is a good way to prevent transmission (not obsessive compulsive). constant hand wash and no sharing food.