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Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

After first line treatment, various "second line" treatments can be used. The policy for H.pylori is: Make sure the infection is real (breath test for follow-up). Always give a high dose of PPI (acid blocker) when using amoxicillin. In the second treatment, give a different drug in place of clarithromycin.

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VDE028
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Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by VDE028 » Mon Mar 27, 2017 1:28 am

Hi All,

I am 33 year old health male living in Singapore since 2014 , having lived the rest of my life in India.
I have been fighting this H Pylori menace since August 2016.

Generally i have had never any digestive issues for the first 32 years of my life , in August 2016 I started having a lot of bloating and generally slow digestion. I thought it is what i am eating and tried to eat light for 2 weeks , however whatever i ate ( even a banana) gave me massive bloating tho the point where i looked 6 month pregnant.

1st week of September 2016 I visited the GP in Singapore who advised i need to eat less at night and gave me anti-acidity medicines. I went back to him after a week complaining the same , and he said he suspects a stomach infection and gave me Cipromixacilin 500 X 2 tabs a day for 10 days + antacids + pro-biotoc tablet. The medicines made me really sick , and i started having loose motions and nausea ! I went back to him , and he said its normal and should be fine in next 15 days. The bloating was gone but my digestion was a mess !

Fast Forward to 3rd week of October , I went back to India for a 2 week vacation and i went to a family friend ( who's a doctor) house for dinner. when i told him about my story he refereed me to a Gastroenterology doc. I had a Ultra sound to rule out Gall -Bladder stone , and a general blood work to see any abnormalities. All came out Ok. Then he suggested a Endoscopy , and after initial reluctance i said yes. The endoscopy + Biopsy was done , and he found "Discreet multiple duodenal ulcers" . The Biopsy was positive for H Pylori and read - Active gastritis induced by H Pylori.

I was prescribed the standard HP Kit ( Pantocid HP Kit as they are called in india)- pantoprazole 20 mg twice daily ,amoxicillin (750mg twice daily), and clarithromycin (500 mg twice daily) for 14 days . I had no side effects and i felt very good after 6-7 days of medication. Unfortunately as felt good i neglected the regime in last 3-4 days and i missed 3 doses , which i had later . meaning the 14 day course was stretched to 15 and half days.

Till this point i had never googled about H Pylori in details, and wasn't much aware of the implication of antibiotic resistance etc. I finished my regime on 17 November 2016. And started a 30 days course of 40 Mg pantoprazole once a day ( morning empty stomach) for 30 days. I was back in Singapore by now.

Fast forward to 28th November , i started feeling all those things again , Nausea , bloating , zero Appetite etc. My Gastroenterology doc from India had give me Domperidome 10 Gm x 3 times a day as an SOS if i felt nausea. I called him and explained him my symptoms and he asked me to have the dom 10 mg x3 for 7 days. This didn't help much and i was getting very impatient now.

I asked my GP in Singapore to refer me to a Gastroenterology doc , he refereed me to a very nice doctor in a good hospital.

I visited the doctor on 23rd December, He explained me how H Pylori works and asked me to stop taking the pantoprazole , wait for 3 weeks and do a Urea Breath test . The test was done on 17 January 2017 , which was again positive for H Pylori.

He explained this is not uncommon and prescribed me the Bismuth based Quadraopulate

Bismuth-based quadruple therapy with bismuth subcitrate, metronidazole, tetracycline and rabeprazole .

(rabeprazole 20 Mg x 2 times a day + bismuth subcitrate 120 mg four times per day, tetracycline 500 mg four times per day, and metronidazole 500 mg three times per day. )

This time i downloaded an app on my phone , and made sure i took all the doses as directed. I finished the regime on 30 January 2017.I felt really good after 6 months of struggle and was positive that this time the bug is gone.

This lasted till 2nd week of March, last 2 weeks i have been again feeling bloated , nausea and all those digestive issues. So i called by the doctor and he set me up for another breath test on 30 March 2017 .

Notes:
- My diet through this episodes since 2016 October is very bland , and non-spicy. I have reduced my portion size by 50%.
- I weighed 92 Kgs in July 2016 , today i weight 79 KG's.
- After the 1st round for HP Medications in October , I started experiencing acid re-flux for the first time in my life , but it happens only if i eat a heavy meal at night .
- Nausea , bloating , poor appetite and irregular bowel movement has been my complains.
- I never had any burning feeling ( which i read is an ulcer symptoms)
- Gastroenterology doc in Singapore said there is no need for another endoscopy as you had one on 30 October 2016 , with the Biopsy .

Now my Questions :

If the breath test is again positive , i know i have 2 options - take another combination of antibiotics or do a resistance test. I would like to try another round of antibiotics before i do the resistance test ( as its not covered by the insurance and would be very expensive in Singapore 2.5k-3.5k USD range)

Can someone suggest a good antibiotic combination ? ( i am not too keen to Take rifabutin)

Thank you all for reading this and helping me fight this Bug !

Helico_expert
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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by Helico_expert » Mon Mar 27, 2017 3:49 am

you had a very good treatment. I am pretty sure it will work. Nevertheless, if you did come back with some unfortunate positive results. you can take the following.

Rabeprazole + Bismuth + Amox + (Rifampicin or furazolidone)

unfortunately these are the only two antibiotics that you have not been exposed. otherwise, you'll have to do the antibiotic sensitivity test to find out exactly what antibiotics to take.

VDE028
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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by VDE028 » Mon Mar 27, 2017 5:40 am

Thank you very much for reading through my post and responding. very much appreciated.

I had a call with my gastro Doc. ( in India ) he suggested Levofloxacilin as an alternate.

Rabeprazole + Bismuth + Amox + Levofloxacilin.

Is levofloxacilin and furazolidone from the same family ? I googled a bit but couldn't come up with any conclusive answers.

I will get my breath test results on 31st March , i will come back and update . I hope its gone this time, and the stomach problems i have now are all part of healing !


Edit : I googled anf found out they are different . but I also read a few articles suggesting furazolidone is Banned in USA since 2003 as it is related to elevate risks of Cancer ! I not know if these online articles are true or not.

i would appreciate your guidance.

Also would appreciate your opinion and experience for Rabeprazole + Bismuth + Amox + Levofloxacilin.

Helico_expert
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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by Helico_expert » Tue Mar 28, 2017 5:59 am

Hi, Levofloxacin is similar to ciprofloxacin.

I didnt suggest that because you had taken Cipro previously. I am not sure if Levoflox is a good suggestion.

Furazolidone is widely prescribed. It's banned in a few countries. But, metronidazole is also a carcinogen. but it's still being used widely.

https://www.accessdata.fda.gov/drugsatf ... 061lbl.pdf

VDE028
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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by VDE028 » Wed Mar 29, 2017 1:07 am

Thank you very much doc.

Appreciate your response. And again thanks for clarifying my confusion. I hope these carcinogenic effects are when the medication is taken long term and is as much a carcinogen as the pollutant air we inhale .

I hope my breath test tomorrow will be negative and my current symptoms are only "healing" gastritis.

I will update all day after tomorrow on my results and future course of action.

VDE028
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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by VDE028 » Wed Mar 29, 2017 7:22 am

I was reading a few articles online about Emerging antimicrobial resistance pattern of Helicobacter pylori in Western part of India ( though i am from eastern) http://www.ijmm.org/text.asp?2014/32/4/408/142256

I am very surprised to see the results that 72 % are resistant to Amoxillin :o ?


it is publised by: IJMM is the official publication of Indian Association of Medical Microbiologists (IAMM). The journal is peer-reviewed open access publication and published quarterly in January, April, July and October. The journal is abstracted and indexed in PubMed/MEDLINE (National Library of Medicine, USA), Science Citation Index Expanded (Thomson Reuters, USA), EMBASE (Elsevier Science, Netherlands) and IndMed (ICMR, India).

Any thoughts on the findings ?

Helico_expert
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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by Helico_expert » Thu Mar 30, 2017 1:47 am

i do not believe it. every now and then, we see papers about amox resistant strains. but when we request further evidence, they usually cannot produce and the result cannot be replicated.

in our laboratory, where we only culture antibiotic resistant H. pylori, we have never seen a amox resistant strain, regardless how many times the patient had been exposed to amoxicillin.

Some articles used a very low cut off value to determine the resistance of Amox. However, Amox is a very safe antibiotic and can be given in high dose (1g tablet, 3 times a day). So there is no reason to use a low cut off value.

VDE028
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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by VDE028 » Fri Mar 31, 2017 1:35 am

Thanks doc .

I am so appreciative of communication channels like this where people like me can reach out to real experts and can get their view with a click of few buttons. Its amazing how regularly and religiously experts like you attend to 100,000's of questions and answer with such diligence.

Salute !

My breath test was done yesterday , however the doc will be back in town on Monday and 10.AM Monday he will share the results . fingers crossed.

I have also noted something new - My stomach was very nervous , and feeling nausea / bloated since last 4 days. I guess i was very anxious about the test and results. 30 mins after the breath test , my stomach felt very normal , and i have been feeling great since yesterday ! I haven't had any medicines also , amazing how much power your mind has , and what effect a calm mind has on our body.

I will update on Monday once i know more.

Cheers.

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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by Helico_expert » Fri Mar 31, 2017 2:19 am

our mind is indeed very powerful. We had a human trial, where we infect one group of healthy participants with live H. pylori to study the immune response; and another healthy group with placebo as a control. One night, one of the participants was admitted to hospital because of severe gastritis. He was vomiting and very bad stomach cramp. Our whole HP research team was very worried that night. and guess what? he was given the placebo. We felt so relief. Turns out that he was too anxious and the constant thinking of not able to get of the bacteria gave him all that symptoms. That's why since then, we always ask patients to think positively. Try not to think about the gastric problem. Distract yourself with something you like to do.

VDE028
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Re: Twice positive for H pylori , no relief after Bismuth-based quadruple therapy

Post by VDE028 » Mon Apr 03, 2017 2:47 am

Just came back from the doctor - NEGATIVE ! :D

I listed down my complains :

- Slow digestion
- Gas
- Acid reflux in the morning.

He has given me NIXIUM 40 MG one tab a day for 60 days . he explained many people develop other gastric issues even after successful eradication of HP. He gave a wonderful example : If you cut your thumb and its infected by a bacteria , then even after you successfully kill the bacteria , the skin / flesh takes time to heal. And if you add pressure to that are the wound open up. Similarly HP had induced gastritis and duodenal ulces in my case , so even if the bacteria is gone now the stomach will take time to heal.

He has asked me to visit him after 2 month if i have issues. He also said the breath test is as accurate as it gets, so no need to another stool test to re-confirm.

In short his advice :

1) PPI for 60 days
2) reduce 5 Kg weight (i am 81.5 KG's for 179 CM height)
3) last meal of the day before 7 PM
4) Avoid protein and fats at night.
5) Caffeine free life
6) reduce stress - regular exercise ( which i do)

Report reads :

Pylori Status - Negative
Excess d 13 C UBT - Result 0.3 | Reference ( 0.0 - 2.4 ) Mil

He said dont worry about 0.3 MM , its nothing. :?:

Do you all thing i am through and have fought off this H Pylori mess ?? I cant believe it !

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