Helicobacter Forums

Hi,
My mother is suffering from stomach issues from last few years. She is on pantoprazole from last 1.5 years because a GI doctor said she has gastritis. However from last two months her symptoms got worse. She has lost her appetite to the point that if she eats anything she feels like a heavy burden on her stomach and she can eat in very small portions otherwise she feel so full that it irritates her. In addition, she is having severe anxiety like symptoms mostly irritation and restlessness. Previous doctor also put her on anti-anxiety drug because he thought it was all in her head. Recently we switched the doctor, she went through endoscopy and its report said chronic gastritis, antrum area. and from the images that area was red and inflammed. her white blood cell count is also slightly raised. They took biopsy from two different areas but biopsy report said no H Pylori found. Now doctor has put her on omeprazole with another benzo drug cause they think its IBS. Due to all these issues she is getting very weak because of improper nutrition. My question is, is it possible to have false negative from biopsy? because of long term use of PPI?
Also around 2 months ago when this recent episode started she was complaining of pain with diarrhea so she took Metronidazole for like 2 days which improved her pain. Then after endoscopy doctor prsescribed her Metronidazole and Ciprofloxacin for 5 days, she took these for only 2 days and discontinued due to severe side effects. Should we go for another test for HP? mostly stool and blood tests are available here and maybe some lab can perform heliprobe but I am not sure.

If she is on PPI (eg. pantoprazole), histology may give false negative result, depending on the experience of the pathologist.

if the stomach is inflamed, it is usually due to HP.

can you get your mother to do a blood test to check for HP antibody? if negative, then we can conclude that your mother's problem is not due to HP.

if positive, then it means your mother's immune system has seen HP before within the past 3 years. To see if she is infected now, she can do Urea Breath Test. It's non invasive and simple. But she will have to stop pantoprazole and replace by ranitidine for 2-3 weeks.

Ranitidine is weak acid blocker that will not interfere with breath test.

Thanks for your input. We got her blood tested for antibodies and got following results.

H pylori IgG - 0.785 where range is given as (Negative (<0.9) Borderline (0.9 - 1.1) Positive (>1.1)

H pylori IgA - 42.8 where range is given as (Negative (<20.0) Borderline (20 - 25) Positive (>25.0)

So as per above ranges IgG says Negative but IgA says Positive.

Can you please guide how to interpret these, do they show an active infection?

IgG is more general in the blood.
IgA is usually found in the mucous area, stomach, saliva, breast milk, etc

regardless which one, having one of them positive means you had H. pylori before. Do you still have it now? that you will need further test. having the actual reading of IgA is useful. So you can repeat the blood test in 3 months time, then see if the value has raised or dropped. A continuous dropping of antibodies is an indication of not having H. pylori.

because she is taking PPI and she also had metronidazole/ciprofloxacin recently, those make it hard for the diagnosis.

a negative histology from two regions showed no H. pylori is promising though. Although no test is 100% and we have seen false negative Histology before, it is very rare for a trained pathologist to miss it.

anyway, see if your mother respond well with ranitidine instead of PPI. take ranitidine for a month, repeat stool test and blood test. If she is lucky, the 5 days metronidazole ciprofloxain treatment works. if she is not that lucky, she'll get a positive result and she'll need a different quadruple therapy.

We got her tested for UBT. And her value is high positive. 115 (where cutoff value was < 3)
Given that she has taken cipro/metronidazole previously (didn't complete the course), would it be better to use following therapy ?

Clarithromycin 500mg x 2 , Amoxicillin 500mg x 2 , omeprazole 20mg x 2 (for 14 days)

Perhaps can ask the doctor to give her something stronger.

Omeprazole 20mg, twice a day, is probably not enough.

try the following

Rabeprazole 20mg, three times a day. (this is probably equal to 120mg of Omeprazole per day)
Bismuth 220mg, four times a day (bismuth may be difficult to get in Europe, but try your best)
Amoxicillin 1g, three times a day
Rifabutin 150mg, two times a day

This is a fairly safe combination with little side effect. The only risky one is rifabutin.

Rifabutin may cause the urine turn pink. Ask your mother not to worry. Also, Rifabutin may cause low white blood cell. Ask the doctor to monitor your mother's side effect.

otherwise, this should give high cure rate. try to finish the treatment if the side effect is not too bad.

Hi thanks for your input. Due to unavailability of Rifabutin, we replaced it with Clarithromycin and gave Bismuth in liquid form. Its been one week since she has finished the course of antibiotics. She felt better during last week of treatment and had some appetite, but afterwards she is still complaining of appetite loss and stomach distension. My question is should we repeat UBT? and is it possible that her present symptoms are not due to h pylori but rather because of stomach damage.

It is important for her to get a follow up breath test 2-3 weeks later. She will have to stop all PPI and antibiotics for at least 2 weeks before the breath test.

Wish her all the best!

If the breath test result is negative, then the symptoms will gradually recover.