Helicobacter Forums

Dear Prof Marshall,

In February this year, my GP had me a UBT done and it came positive for h.pylori (reading 1380). Then he treated me with Nexium HP7. I finished the 7 day therapy and did a second UBT after 4/5 weeks. Still positive for h.pylori (reading higher 2250).

Then I went to see a gastroenterologist and he treated me with Rifabutin 300mg+ Clarythromycin 1gm+ Doxycilin 200mg + Pantoprazole 80mg daily for 7 days. After finishing this course he did an endoscopy and the histology report shows "severe Helicobacter gastritis with intestinal metaplasia". He did not send any sample for a strain culture!

Now he has put me on Salvage therapy - my third antibiotic course with Levofloxacin 1gm+ Amoxicillin 2gms + Pantoprazole 80 mg daily for 10 days. I'm on my 9th day. He has also scheduled me for another endoscopy in December!

1. Am I on the right path of treatment?
2. What if my third therapy fails to eradicate the bacteria? Is there any other treatment option left?
3. Couldn't my gastroenterologist have done a strain culture from my first endoscopy?

It just doesn't seem right to me that each time I will be given an antibiotic course on the basis of pure assumption and then undergo an endoscopy to confirm eradication. There is risk involved in endoscopy.

The second therapy looks like a good one and should work so take heart! Not everyone has a lab which can culture Helicobacter. Fingers crossed.

Barry Marshall

Thank you very much, Professor, for your response.

My endoscopy was done at the Royal Prince Alfred Hospital in Sydney. I assumed that they should have a lab where they could do the culture. Anyway, I've just finished the salvage therapy. Still continuing with Pantoprazole as per my gastroenterologist's advice. Continuing 2 daily for one month and then 1 daily for another month.

By the way, apart from reducing stomach acid does Pantoprazole kill Helicobacter, too?

And is it a good idea to take probiotic capsules to replenish the gut bacteria after finishing the therapy?

Sorry, I ask too many questions

Hi msreza16

I am one of the people taking about 4 rounds of regime, and my last recently completed 3 days ago.
Easing off the PPI.

Like you, I had 2 fragments of biopsy taken, and returned with features of chronic gastritis and intestinal metaplasia, no active gastritis and no helicobacter traces on the biopsy.
Obviously, i scurried away to google to understand what those means...and brought more worries, stress and anxiety.

So, for you and me...just focus on getting well. Eat a good well balance diet..take some high dosage of Vit C, and some good probiotics before bedtime.
Stop googling for more answers...

All the best to you and speedy recovery sir.

I havent heard back from Prof. Marshall. So let me response on his behalf.

Yes, Pentoprazole does reduce bacteria load. how it works is unclear. Perhaps PPI tricked H. pylori by making too much alkaline and kill itself? or the stomach is no longer acidic and other bacteria start colonising and killing off H. pylori.

in terms of probiotic, there is no guideline which is a better probiotic. But, some members in this forum claim good experience from probiotics. So, i guess there is no harm trying.