Coccoid form helicobacter test and treatment

[Zizem]

First of all, thank you very much for helping us all with our problems.

I would like to know how to diagnose and treat the coccoid form of Helicobacter Pylori (Because I think I have this type)

My story starting with antral gastritis + hp
Ongoing chronic inactive gastritis without treatment after many years and that they no longer find bacteria ı have a story

f/33

- In 2008, I became an endoscope; HP positive (+++)
IM and AG negative were given Amoxicillin + Levofloxacin + PPI. but the treatment was very heavy, I could only use it on the first day and could not be treated. Dr did not recommend another treatment.

- My problems continued; In 2016, another hospital was again endoscopied by another doctor, this time the endoscopic and stool antigen test negative.
The doctor said that the bacterium was spontaneous eradicate and did not give treatment, I didn't believe because it was still a problem.

- In November 2018, I went to a different doctor and checked with an endoscopy. as a result, HP was negative again, but this time there was intestinal metaplasia (incomplete). My doctor agreed with me and said that the helicobacter was there but did not appear.
amoxicillin 2x1000 mg + tetra 4x500 mg + PPI 40 mg + bismuth 2x1 (14 day) I trust treatment.
I've finished treatment without any side effects.

(I have received short-term antibiotic therapies too many for different diseases over the past 10 years)
when I take this and the previous results into consideration, I know that all or most of the bacteria in me turn into the full coccoid form. I have read many articles and case reports about this coccoid form.

I know that this coccoid form is not dead and stomach still influenced by virulence factor.

-and this bacteria no longer exhibits urea activity and is naturally hidden in the urea breath test.
-and these bacteria are often not detected in pathology in my country (Giemsa, H&E)
-and not detecting due to low bacterial load in stool antigen test

and the most frightening ; is amoxicillin ineffective for coccoid form HP

In this condition for patients and for me I would like you to provide information for treatment and testing methods

Thank you, i’m grateful

[Helico_expert]

You have interesting story. However, blood test and stool test are usually very sensitive. especially blood test. cocoid or not, it will show up in blood test.

Did your doctor measure your stomach pH during the endoscopy? because if you are not producing acid, for whatever reason, stool and breath test can give false negative result.

Did your doctor ask for immuno stain? usually H. pylori, cocoid or not, will be stained under histology examination.

I think it is important to have an accurate diagnosis. otherwise, we are not sure what we are dealing with.

[Zizem]

Thank you for your quick return.

Yes, unfortunately so Then I'm going to want a blood test. (IgG and IgA right?)

No, ph measurement was done not during endoscopy, I will remind my doctor during the next endoscopy. (I will perform endoscopy every year due to metaplasia)

My doctor received tissue samples from the stomach for pathology and HP examination, but my country used giemsa staining. ( It is difficult to recognize coccoids of this stain shape, I've read it in in some articles) Best practice IHC right?

[Helico_expert]

if possible, ask the doctor for a titre of the antibodies (IgA or IgG or both). Over time, you monitor the trend of the titre to estimate the presence or absence of HP. Should HP be eradicated, the titre should gradually decrease over time.

giemsa staining on histology is good enough to hint if there is an infection. of course an immuno stain would be more specific and clear.

[Zizem]

Absolutely I agree

If the titre is now high and will decrease over time, this will show us the accuracy of eradication.

My treatment finished 1 mount ago but i don't think titre decrease, it must still be high now. (Use of PPI does not affect blood results, it's true?)

Thank you very much, I will test it in a few days and I will share the results with you.

[Helico_expert]

everyone has different level of IgG or IgA for H. pylori. some people's IgG/IgA deplete within months. Some takes years. Nevertheless, you can get a titre of your IgG/IgA now and see how it goes in a few months time.

PPI will not affect blood test result.

[Zizem]

Thank you very much, I had a blood test yesterday, I will get my results after a week.

By the way, i want to ask there is one more thing is very important for me.

I have been suffering from excessive bloating and belching for a long time. (for this reason I have heart arrhythmia)

My doctor first thought this was due to helicobacter but bloating and belching continue after the treatment.

After, doctor told me I could be SIBO for my problem.

Prescribe; Rifaximin but I am afraid to take this medicine because until today

I have used all the antibiotics that will work on helicobacter. (due to different diseases)

Except Rifabutin. If the last treatment did not work, i'm thinking last chance Rifabutin.

Rifaximin and Rifabutin same active substance, if i take Rifaximin, I think HP will develop resistance in Rifabutin.

- This in the circumstances, what do you suggest? If there is such a possibility, I don't want certainly take Rifaximin.

- As you said, if my stomach acid is minimal, explains why the this SIBO. In the circumstances, less stomach acid or especially SIBO, prevent the passage of medicine into the bloodstream? (Ask about for medicine of helicobacter pylori; tetra + amox. + bismuth and others)

Sorry for the long article and insufficient english.
Thank you so much

[Helico_expert]

You are right about taking rifaximin for SIBO and would induce resistance for H. pylori. I think you should wait till you confirm the eradication of HP before the next treatment. is it not possible to get breath or stool test done? you'll get the result sooner.

instead of using rifaximin, what about bismuth or amoxicillin? these are two antibiotics that H. pylori will not become resistant to.

[Zizem]

I don't trust stool antigen test because I received false negative result before like pathology results (but still it can be tried)

I have to wait a bit for the breath test, I hope it gives the right result for me.

The interesting, I used antibiotics for HP I didn't feel any good or bad effect. Less stomach acid or especially SIBO, prevent the passing of HP medicines into the blood stream? I thinking, is that why i didn't feel the effectiveness.

[Helico_expert]

not everyone experience side effects from antibiotics. you are lucky to have little side effects.