HP +ve following biopsy - were not able to culture?
Posted: Fri May 03, 2013 2:26 pm
Long story, but might help someone ....
Mid to late 90s, presented to doctor with nausea (lost 10kg), pain in the stomach upon rising, no appetite despite feeling hungry, etc. No test was done - the doctor put me on a 'triple therapy' regime. Beginning it made me feel terribly ill within the first day, doctor advised to start at half tabs and increase to full dose and complete regime. I felt better almost immediately and post treatment, no more issues … until …
About 10 years later (2008), I had been trying to cope with increasing heartburn. Seemed at first to be food sensitivity. Vegemite, bread, oats, etc., seemed to send my heartburn through the roof. Strangely enough, though, I can eat pasta by the bucket load and it caused no issues. Same with Semolina (both durum wheat). Other usual suspects - alcohol, tomato, chilli, citrus/pineapple, etc., were also culprits. Although at other times, it seemed to come on via my regular diet. So along with a trigger food avoidance, I was also taking Zantac (reg strength) once a day and supplementing with Tums when required to keep the burn under control. Visited doctor who advised breath test for helicobacter. It came back positive. I was put on the Hp7 regime (Clarithromycin, Amoxicillin, Nexium). Follow up breath test proved it did not work. Doctor put me on a second course of the Hp7. Another breath test proved positive still for the HP. She referred me to Gastroenterologist for endoscopy.
Via endoscopy I had biopsy for celiacs & helicobacter done. Celiacs - negative. HP - positive. Some mild oesophageal scarring, but otherwise all good - no ulcer, no barrett's, no erosion, etc. Gastroenterologist discussed my results, advised that remaining on the 'rani' (rantitidine - Zantac) for now would be fine while it managed my symptoms. He also discussed further treatment as being 'quad therapy'. He talked about the risks, the possible effectiveness, chances that the HP might be a red herring in resolving my reflux. He also advised that to undergo the quad therapy would involve me importing the drugs from overseas myself, through customs, into Australia … but it would cost … & it was something that I was unable to afford. I took the customs paperwork anyway, in case my finances changed in the future. I continued with the Zantac, Tums and trigger food avoidance. I got back to my life and time moved on for a while.
By about 2011, the burn became what I would call chronic. I discovered Zantac extra strength and I was never without those or Tums wherever I went as I suffered everyday and it was so hard to avoid wheat products (they really are EVERYwhere!). Life was busy, finances still tight, so I continued, until I noticed late last year that many more foods seemed to set off the burn and the extra strength Zantac was not lasting the usual 24 hours. I was chewing more Tums (falling asleep with one on my tongue so I could sleep, etc.). Then at the beginning of this year (after a highly stressful 12mths) I developed terrible pain roughly where the 'food tube' met the stomach and approx. about the location of my adams apple. Then one day I woke up and I had what felt like a golf ball in my throat ... and it didn't go away. I thought the absolute worst. After four days I made an appointment with my doctor and told her my symptoms, she put me on Nexium 40 (previously she'd put me on 20 which did nothing more than the Zantac and it was cheaper). She referred me for endoscopy with new Gastroenterologist.
I had the endoscopy (after worrying myself sick the entire 5 weeks about cancer, mostly of the oesophagus, but stomach, throat, Barrett's, etc.) and the GI said 'all clear, no ulcer, no cancer, no inflammation, no Barrett's, all looks normal. We've taken biopsies and they're already with pathology downstairs for culturing. Given your history of failed eradication, we'll be conducting sensitivity testing and see your doctor for follow up and treatment'.
So today I go to my doctor after she called me in. The results were HP - positive, however they weren't able to get it to grow/culture
- like bread that won't rise because there is something not working with the yeast. My GP said she doesn't know what to do now. She decided to refer me back to the GI for a consultation. She provided me with a print out of the results, which were hideously confusing 
- e.g. ‘lamina propria contains a dense mixed and acute chronic inflammatory cell infiltrate, comprising predominantly of plasma cells, lymphocytes, and occasional eosinophils. Neutrophils are present and transmigrate into glandular epithelium.' There was more, but in this vein. The GP could not decipher for me, other than to say 'well the HP is everywhere in your system, it seems'. The good news is - no Whipple cells, granulomas, Giardia, atrophy, metaplasia, epithelial dysplasia, malignancy or ulceration in either the duodenum or gastric antral. I phoned the GI and they said that I had to be patient, they would write to my doctor (so today has been a total runaround 
).
The summary diagnosis
Gram stain - polymorophs - Nil, no bacteria seen.
Culture - no growth after 5 day's incubation. No HP isolated.
Gastric antrum - moderate helicobacter pylori associated chronic active gastritis / duodenal biopsy - no pathological diagnosis / gastric mucosa - moderate helicobacter pylori associated chronic active gastritis / Conclusion - endoscopially normal upper gastrointestinal tract.
Any advice/feedback on the above clinical observations and/or is it usual that pathology is not able to culture HP? I know it seems like a stupid question
, but do I actually have gastritis? How should I manage this for the moment? What are the risks of leaving HP as it is? Any thoughts on how a regime would be devised in such a case, given they can't culture in order to develop a 'bacto-killer cocktail'?
Mid to late 90s, presented to doctor with nausea (lost 10kg), pain in the stomach upon rising, no appetite despite feeling hungry, etc. No test was done - the doctor put me on a 'triple therapy' regime. Beginning it made me feel terribly ill within the first day, doctor advised to start at half tabs and increase to full dose and complete regime. I felt better almost immediately and post treatment, no more issues … until …
About 10 years later (2008), I had been trying to cope with increasing heartburn. Seemed at first to be food sensitivity. Vegemite, bread, oats, etc., seemed to send my heartburn through the roof. Strangely enough, though, I can eat pasta by the bucket load and it caused no issues. Same with Semolina (both durum wheat). Other usual suspects - alcohol, tomato, chilli, citrus/pineapple, etc., were also culprits. Although at other times, it seemed to come on via my regular diet. So along with a trigger food avoidance, I was also taking Zantac (reg strength) once a day and supplementing with Tums when required to keep the burn under control. Visited doctor who advised breath test for helicobacter. It came back positive. I was put on the Hp7 regime (Clarithromycin, Amoxicillin, Nexium). Follow up breath test proved it did not work. Doctor put me on a second course of the Hp7. Another breath test proved positive still for the HP. She referred me to Gastroenterologist for endoscopy.
Via endoscopy I had biopsy for celiacs & helicobacter done. Celiacs - negative. HP - positive. Some mild oesophageal scarring, but otherwise all good - no ulcer, no barrett's, no erosion, etc. Gastroenterologist discussed my results, advised that remaining on the 'rani' (rantitidine - Zantac) for now would be fine while it managed my symptoms. He also discussed further treatment as being 'quad therapy'. He talked about the risks, the possible effectiveness, chances that the HP might be a red herring in resolving my reflux. He also advised that to undergo the quad therapy would involve me importing the drugs from overseas myself, through customs, into Australia … but it would cost … & it was something that I was unable to afford. I took the customs paperwork anyway, in case my finances changed in the future. I continued with the Zantac, Tums and trigger food avoidance. I got back to my life and time moved on for a while.
By about 2011, the burn became what I would call chronic. I discovered Zantac extra strength and I was never without those or Tums wherever I went as I suffered everyday and it was so hard to avoid wheat products (they really are EVERYwhere!). Life was busy, finances still tight, so I continued, until I noticed late last year that many more foods seemed to set off the burn and the extra strength Zantac was not lasting the usual 24 hours. I was chewing more Tums (falling asleep with one on my tongue so I could sleep, etc.). Then at the beginning of this year (after a highly stressful 12mths) I developed terrible pain roughly where the 'food tube' met the stomach and approx. about the location of my adams apple. Then one day I woke up and I had what felt like a golf ball in my throat ... and it didn't go away. I thought the absolute worst. After four days I made an appointment with my doctor and told her my symptoms, she put me on Nexium 40 (previously she'd put me on 20 which did nothing more than the Zantac and it was cheaper). She referred me for endoscopy with new Gastroenterologist.
I had the endoscopy (after worrying myself sick the entire 5 weeks about cancer, mostly of the oesophagus, but stomach, throat, Barrett's, etc.) and the GI said 'all clear, no ulcer, no cancer, no inflammation, no Barrett's, all looks normal. We've taken biopsies and they're already with pathology downstairs for culturing. Given your history of failed eradication, we'll be conducting sensitivity testing and see your doctor for follow up and treatment'.
So today I go to my doctor after she called me in. The results were HP - positive, however they weren't able to get it to grow/culture
- like bread that won't rise because there is something not working with the yeast. My GP said she doesn't know what to do now. She decided to refer me back to the GI for a consultation. She provided me with a print out of the results, which were hideously confusing - e.g. ‘lamina propria contains a dense mixed and acute chronic inflammatory cell infiltrate, comprising predominantly of plasma cells, lymphocytes, and occasional eosinophils. Neutrophils are present and transmigrate into glandular epithelium.' There was more, but in this vein. The GP could not decipher for me, other than to say 'well the HP is everywhere in your system, it seems'. The good news is - no Whipple cells, granulomas, Giardia, atrophy, metaplasia, epithelial dysplasia, malignancy or ulceration in either the duodenum or gastric antral. I phoned the GI and they said that I had to be patient, they would write to my doctor (so today has been a total runaround ).The summary diagnosis
Gram stain - polymorophs - Nil, no bacteria seen.
Culture - no growth after 5 day's incubation. No HP isolated.
Gastric antrum - moderate helicobacter pylori associated chronic active gastritis / duodenal biopsy - no pathological diagnosis / gastric mucosa - moderate helicobacter pylori associated chronic active gastritis / Conclusion - endoscopially normal upper gastrointestinal tract.
Any advice/feedback on the above clinical observations and/or is it usual that pathology is not able to culture HP? I know it seems like a stupid question
, but do I actually have gastritis? How should I manage this for the moment? What are the risks of leaving HP as it is? Any thoughts on how a regime would be devised in such a case, given they can't culture in order to develop a 'bacto-killer cocktail'?