High Bilirubin rate? Infection from family pet?

[helpinghubbie]

First, thank you for this wonderful resource. My husband has had undiagnosed GI problem for last ~3yrs and no clear diagnosis. His symptoms are similar to most on here with all the attendant lifestyle impacts. Colonoscopy prior was negative for issues. No food allergies. No IBS, no crohns etc. GI doctor recently suggested CT Scan but I am jumping in and "helping" hubbie now...insisting that he get answers on two abnormal tests called out in Qs below prior to CT scan. After reading your forums I feel like maybe we are on right track in thinking it could be HP.

1) GP doctor had stool test come back as positive for H. Pylori in Dec of 2012. Wierd thing is GI doctor had a separate blood test come back negative a couple of months prior to this (but during period he has had all of these issues). Is there chance of false negative with HP blood test or false positive with HP stool test?

2) He has had elevated bilirubin levels for years. Dr's have dismissed as not problematic b/c metabolic panels come back negative...I am wondering now in light of HP positive if maybe he doesn't have bleeding ulcer which is causing high bilirubin? Does that sound logical?

3) Are the effects of HP limited to stomach? e.g., can there be issues in gall bladder, liver or GI tract due to HP or other side effects like pH changes?

4) I see some concerns about use of PPIs and side effects. Would it be reasonable to use Bismuth, baking soda or other more natural approaches to lower pH and soothe stomach...or is that asking for trouble and possibly need to repeat treatment down the road?

5) If he is indeed positive, sounds like we need to test myself (though heaven help my if I have it and am asymptomatic...I am sure I'll hear for years about how I "poisoned" him. ), mand test our 4yr old daughter. What about 5 month old son? Is that too early to catch HP? (though would be a cinch to get the stool test! )

6) And finally...What about family dog. Is he a reinfection risk for us? We are not dog kissers, but they do the occasional stealth attack when we are playing fetch. I see on the forum they are not sure how it is transfered but on internet interspecies transfer is one theory (maybe not thru dog saliva but thru transference of dog fecal matter?)...your take?

Again, many thanks.

[Helico_expert]

ANS1: usually, stool test gives false negative and blood test give false positive. So in your case, it is very interesting. I think to truly find out, you'll probably need to find a specialist, who has access to research laboratory, get the biopsy, do DNA test (check for other helicobacter species), do CLOtest (check for helicobacter activity), and histology test (physically see the bacteria under microscope).

ANS2: bilirubin does relate to blood lyse. However, since your husband has completed all the test, it's probably alright. nevertheless, is the liver function checked?

ANS3: HP is limited to only stomach. However, other helicobacter species may infect other organs. Then again, it's very rare on human. Other helicobacter species infecting other organs is only reported in animals (eg. mouse). Some random study did isolate certain Helicobacter spp. from intestinal track of human. eg. H. cinaedi, H. winghamensis, and H. bizzozeronii.

ANS4: PPI, bismuth, baking soda, etc reducing acid only treat the symptom. If your husband's problem is because of H. pylori, then eradicating H. pylori is the only sensible way of curing him.

ANS5: 5 months is possibly too young. but you never know. In Japan, children as young as 2 years old were found positive for H. pylori. There is a theory that suggest that most H. pylori comes from mother (or other carer). and because children put everything in the mouth, most people actually was already infected when they are very young and carry the bacteria for decades asymptomatically. Nevertheless, it's hard decision to test your young child. what happened if you find out that she is positive? the antibiotics will probably do more harm than good to your child. in addition, some studies suggest that H. pylori infection at young age provide constant stimulant to immune system and so the child is less likely to be allergic to food and dust. That's why not many doctors want to check for children. Unless the children is suffering severely from the infection. furthermore, as long as an adult is hygienic, it is not easy to catch H. pylori from children.

ANS6: Very interesting question. Dog can be definitely be a source of infection. there are evidence that helicobacter jump host from domestic animal to human and vice versa. It would be very interesting to know if your husband is carrying a dog helicobacter strain. the only way to find out, is answered in ANS1.

[helpinghubbie]

Thank you for speedy reply. Sounds like DNA test would be good option, expecially since after reading forums we would prefer antibiotic sensitivity biopsy if possible. We live in Reno, NV, but maybe there are research facilities in nearby sacramento, california or San Francisco/bay area, california?

Regarding ANS4, I see in hindsight I didn't phrase question very well. My question was not if PPIs could sub in for antibiotics. Rather, when using triple therapy, can you try naturopathic substitues to lower acid and thus avoid concerns with PPI side effects without sacrificing antibitoic or overall therapy efficacy? In other words: Amox + Metro + baking soda/bismuth/other non-PPI

Thank you for info on child. For last 2 months our 4 yr old compains her tummy hurts almost every day before/after dinner and sometimes in a.m., but hard to know if that just means she is hungry, she wants to eat something other than her dinner, she doesn't want to go to bed, etc or that there may be an actual issue. We'll discuss testing or other options with pediatrician.

Same hubbie ER visit had blood panel with low alkaline phosphatase (result = 33). Also Ultrasound indicated they couldn't rule out blocked common bile duct. Awaiting results now of Hep A/B/C screen. May opt to do CT Scan. Still thinking best immediate option is to deal with HP with ulcer as potential source of high Bilirubin as no other results have come back with poor liver function. (other possibility is "Gilbert's" syndrome but GI dr. has never indicated how to rule this in/out.)

Again, thanks for all the advice you are giving in this forum. Have read a couple hundred posts in here over last few days and they definitely have educated us on the what's and whys and made me less worried about triple therapy as option.

[Helico_expert]

in regards to your PPI question, I think there is no replacement for PPI. the antibiotics only work in neutral pH and no other drug works better than PPI. By the way, I dont think bismuth affects the acids. However, it has some antibacterial effect and has been used together with triple therapy to boost the effectiveness.

about DNA testing, i think it has more research value than medical value. doesnt matter which helicobacter spp. they'll be killed by antibiotics.

about your child, you are right, please discuss with a pediatrician.

finally, h. pylori may not be the only problem. but i hope it is. at least it is easier to treat.

all the best to you and your family.

[helpinghubbie]

Hi There,

Just thought I would share that we got results back. My husband's blood test came back negative for H. Pylori. His indirect bilirubin came back consistent with Gilbert's. So the stool test "positive" and rest of GI complaints are still a mystery. My test, on the other hand came back positive. According to Dr. " labs are positive for a recent infection. The IgM antibodies are high and these are the first to respond to an infection." So, things seldom turn out the way you think they might in life!

Thanks again for all your help,
Laura

[Helico_expert]

it is a big mystery. do keep us posted what happened to your husband's diagnosis and treatment.

as for you, wish you get well soon. will you be getting your dog for a checkup?