Helicobacter Forums

Hi. Just had endoscopy. They found 2 small ulcers. Biopsy comes back on Tuesday but - from what I read online - pylori must be the cause.

My question is whats the best possible first line treatment? (I may be allergic to amoxicillen - gonna have to get tested) My doctor wasnt very informative - which is a bit disconcerting.

Thanks for your help.

One further question.

I may not go on treatment for like a week (til I check out allergic status). Is there a problem going on a PPI until then to try to get some relief?

You can try the classic triple therapy PPI + Clarithromycin + Metronidazole. If possible, add bismuth into the combination to make it a quadruple therapy. That will boost the success rate.

It's ok to start taking PPI now and start treatment later.

by the way, HP is not the only cause of stomach ulcer. NSAIDs (ibuprofen, aspirin, etc) can also cause stomach ulcer.

So a biopsy could still come back negative for Pylori even with ulcers.

Im confused. With a stomach ulcer caused by Pylor - one would do a 2 week treatment. Then stop PPI? And get tested a month later?
So you would be off the PPI - not treating the ulcer until test time?

So how does the diagnostic test work?
1. it's measuring the activity of the urease enzyme produced by the H. pylori.
2. the more H. pylori, the more urease enzyme available.

The urease enzyme only works when the environment is acidic.
because H. pylori is very smart. it'll turn off the enzyme if there is no acid around. It doesnt want to create more ammonia which will make the environment too alkaline to survive.

So if you take PPI, the acid will be low, the enzyme will be turned off, and you'll get a false negative.

in addition, when you take PPI, the acid will be low, other bacteria start to grow in the stomach, competing with H. pylori.
H. pylori is a very slow growing organism. It will quickly be out compete by other microbes.
However, out compete doesnt mean complete eradication. The other microbes may keep the H. pylori number low.

So, PPI will not only reduce the acid level, will also indirectly reduce the bacteria load.
That's why you will get false negative from diagnostic tests.

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How H. pylori cause ulcer and why PPI can help?

H. pylori causes some damages in the stomach lining.
the stomach cells are unhappy and send out signals to attract immune cells.
H. pylori has the ability to hide away from immune cells.
So the immune cells got stress out because they cannot find the pathogen.
Then the immune cells causes huge amount of inflammation to kill off everything, including the mucous producing cells in the stomach.
The immune cells hope that the mass destruction can kill off the pathogen.
As the mucous deplete, the acid start digesting your own stomach. That's how you get ulcer.

if you take PPI, your acid is reduced. the ulcer will heal. But the mucous is still not there because of inflammation.
that is why in old time, if the patient stop taking PPI, without killing the H. pylori, the ulcer always come back.
Prof Marshall proved that after killing off H. pylori, the ulcer almost never comes back.

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So in your case, it doesnt matter when you take PPI. The idea is to stop the acid and so your ulcer will heal.
you will need to take antibiotics to kill off H. pylori and that will subsequently reduce the inflammation.
Then depending on your healing ability (younger = better healing ability), the symptoms will gradually improve.

if the antibiotic only kill off 99% of the bacteria. you will need at least 2 weeks for the 1% resistant H. pylori to grow up in numbers. So you will be able to detect it.

Thanks for the info. Appreciate it. Re - younger heal faster, Im 60 so. We shall see.....