Helicobacter Forums

BACKGROUND - I am a 51 yo female, born and raised in the Balkans, where I probably picked up H.Pylori in childhood (living in the US for the last 30 years). H.Pylori was an incidental finding in 2019, on endoscopy done for unrelated symptoms that passed. I was immediately prescribed quad therapy including Levaquin, which I had a severe reaction to within 2 days and had to stop it (tendon pain, severe brain fog, confusion etc). So fluoroquinolones are a no-go. That really spooked me and it took me a while to recover, mentally and physically from that episode. In the meantime, I was thrown into raging hormonal issues from the peri and menopausal transition, which have completely thrown my nervous system off track and I have developed sensitivities to many things, lights, sounds, smells, medications. I had a minor Paronychia toenail infection last year, requiring a short 5 day course of low dose antibiotics - I could not tolerate Doxycycline, Amoxicilin caused racing heart and anxiety etc. So here I am, six years since H.Pylori was initially diagnosed, not having treated it yet, as I am terrified to try the multi-drug treatment again, while my body is dealing with all this hormonal turmoil. I had a hysterectomy last year, and am currently working with my GYN on trying to balance my hormones enough to help regulate my nervous system.

DSL STOOL TEST - In the meantime, I recently paid for the DSL stool test with virulence factors (results attached here), which came back "positive" just over the stated limit, but also positive for cagA, iceA, and virB/D which really scared me, as it seems that many studies have shown that cagA is highly correlated with worst outcomes. I have an extremely clean diet (Mediterranean/organic), never smoked, no alcohol, and have been taking many botanicals for years that have been proven somewhat beneficial in H.Pylori (sulforaphane, L.reuteri DSM17648, Lauricidin, NAC, oregano oil, etc), which has possibly helped lower the bacterial load.

SYMPTOMS - I have never had any upper digestive symptoms, except suspected LPR since perimenopause started (throat clearing and sore throat), which I was told is not really associated with H.Pylori - my ENT suspects low estrogen and small hiatal hernia causing LPR. Endoscopies in 2019 and 2023 showed mild gastritis and H.Pylori. I have had decades of intermittent flares of lower intestinal cramping/bloating, which has been diagnosed as IBS. This has also flared up in menopause, which is common, and is another factor that makes me leery of H.Pylori treatment, as I am concerned that the amount of antibiotics required will make my IBS so much worse.

OUTLOOK - I guess I am posting to get some feedback on how much risk I am putting myself at, by postponing the treatment, especially in light of the virulence factors presence. I am so torn - on one hand, the thought of attempting the multi-drug treatment causes severe dread, on the other hand the fear of cancer causes even more dread. Ugh. Any useful feedback will be greatly appreciated.

Forgot to mention, if relevant - my dad did have an ulcer at some point in his 60s and did the treatment, though he does not remember much about it (he was also a long-time smoker with a very unhealthy diet). Other than that, there is no other family history of serious gastric issues.

EDIT - I just read about a newer treatment called Voquezna Dual Pak, which only contains high dose Amoxicillin and PCAB, and is supposed to have a very high eradication rate. I'm thinking that this would potentially be a gentler treatment, compared to other multi-drug options? Has anyone here used Voquezna Dual, and tolerated it well?

Hi,

Thanks for sharing your story here.
I think Vonoprazan + high dose amoxicillin is worth a trial.
amoxicillin itself is quite safe. You should be able to tolerate well.
do keep us posted with your treatment.

Helico_expert - thank you so much for your reply. Without getting into the weeds of my current nervous system dysregulation (even a massage triggers it), I don't see myself being able to attempt the HP treatment this year at least, while working out all these issues. However, since my brain works best when I have an abundance of data, I would like to understand better the risks of prolonging my treatment - specifically in light of the presence of virulence factors. There is so many sources of information online, and many are suggesting dramatically increased risk of gastric cancer in people positive for cagA, some claiming even upward of 20-fold increase (!). On the other hand, I've read that an estimated 50-85% of H.Pylori cases worldwide are positive for cagA, so the numbers don't quite seem to add up. Anyway - since you are doing the actual research, I was wondering if you have more reliable data on the risks of GC in cagA positive HP? As I mentioned, I am 51 and my last endoscopy in 2023 showed mild gastritis, unchanged from 2019. No upper digestive symptoms. Thank you again for taking the time to contribute on this board, the entire website has been a wealth of information.

I don't think there is accurate clinical data on how many CagA positive H. pylori actually cause gastric cancer. Most of the statistics you saw from the CagA are based on laboratory data. Not real patient data.

This is because H. pylori causes inflammation, and inflammation causes different diseases, including gastric cancer.

So, because everyone has a different immune response, the outcome of the disease is different.
Nevertheless, the longer you have H. pylori, the more damage is accumulated, which can also mean a gradual elevation of the risk of gastric cancer.

Hence, it is the chronic inflammation that leads to gastric cancer. And since ALL H. pylori, with or without CagA, can lead to chronic inflammation, I don't think there is clinical significance between the two variants.

Helico_expert - thank you so much for your insight, and for all the information you provide on this board and the website as well!