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false negative stool test and positive biopsy

Posted: Fri Dec 22, 2017 9:22 pm
by helicosufferer

My story in brief: since March 2017 I started many unpleasant symptoms (dizziness, nausea, heart palpitation, shortness of breath, bloating) i made lots of visits to doctors and made a lot of tests but found nothing. I searched the net a lot and suspected H Pylori and requested for stool test but unfortunately it came back negative although I wasn't on any type of medication. Then I was enrolled for an endoscopy and the doctor found a hiatal hernia (small one), mild gastritis with esophagitis and the biopsy showed positive for H Pylori.

At first, I liked the idea of giving a try for natural treatment and things went great for a while but I had some symptoms coming back. The pain under my left rib cage disappeared, the nausea as well and shortness of breath and palpitation but I still have a recurrent acid reflux and a strong bloating with whatever I eat which effects clarity of mind and leaves me with fatigue although I am on nexium 20 once daily.

I retested for H Pylori three times: two times through blood test (in August and November) and both came back negative. And once for a stool test which came back negative as well (but I was on nexium at that time)

So, My question is how can I be assured that I do or do not have H pylori to take the antibiotics?
Is the stool test sensitive? It gave me false negative in the first place.
I can't perform the UBT as I do not swallow capsules and they don't have the UBT with a solution option in my country.
It is also invasive to repeat the endoscopy.

Could you please help me.
For example, is it useful to repeat a stool test for 2 or 3 times to be assured of the result?

I appreciate your help.

Thank you.

Gastroscopy Report:

indications: dyspepsia, GERD
instruments used: OLYMPUS EXERA III
level of insertion: third portion of the doudenum
Biopsies: Histology
Esophagus: z-line at 38cm. distal esophageal erythema ++ lax GEJ +++
stomach: Antral erythema, mild biopsy for histology taken
Duodenal Bulb: normal up to D3
conclusion: NERD mild antral gastritis

Re: false negative stool test and positive biopsy

Posted: Sat Dec 23, 2017 2:30 am
by Helico_expert
your biopsy test that came back positive was suspicious. How was the biopsy tested that concluded positive? is it by histology or specific immuno stain? or culture?

blood test is usually very accurate for negative result.

Since you did multiple tests, and other than the biopsy test, they are all negative. I think you do not have H. pylori now.

more importantly, if the endoscopy did not see anything severe like ulcers or cancer, there is no need to worry much.

if you have reflux, you need to protect your throat by control your reflux symptom with Nexium or Zantac.

Re: false negative stool test and positive biopsy

Posted: Sat Dec 23, 2017 8:27 am
by helicosufferer
Thanks for the reply and info.

The biopsy was tested through HISTOLOGY.

I forgot to mention as well that the first stool test I took I had iron injection two or three days before so I don't know if this affects the result of the stool test.

So how could I consider my symptoms coming back? Especially the severe bloating and constant burping even after a gulb of water although I am eating very healthy.
Any way to double check that I am actually free now of h pylori?

I don't even have that much pain in my stomach so why do I have so much symptoms?

I never had any digestion troubles before that.

Any input regarding the sensitivity of tests?


Re: false negative stool test and positive biopsy

Posted: Sat Dec 23, 2017 12:04 pm
by Helico_expert
blood test is usually pretty accurate for negative result. If you had H. pylori before, your blood test will give positive result for months or even years.

So if you are blood test negative, then it means you had never had H. pylori before, at least within the past few weeks or months.

Your symptoms are probably not due to H. pylori. In the histology report, did it mention how severe is your gastritis?

Nevertheless, you can always get a breath test a few months later to confirm your H. pylori status. Unfortunately urea breath test is best non invasive test to find out if you currently carrying H. pylori. IT's not a big pill. It shouldn't be a problem swallowing.

Re: false negative stool test and positive biopsy

Posted: Sat Dec 23, 2017 12:12 pm
by helicosufferer
Great info. Thanks.

So you mean to say that the biopsy results through histology may not be accurate?

Just in case I couldn't perform the UBT would a multiple stool test do the job?

Is there any way to order a UBT with a drink kit through the internet?

The endoscopy showed "mild gastritis."

Re: false negative stool test and positive biopsy

Posted: Sun Dec 24, 2017 2:46 am
by Helico_expert
actually many of these tests rely on the technician's skill. I personally think that UBT and blood test require the least skill, so less likely to have a false result.

Histology is usually the best as it require a specialist that manually go through all the slides thoroughly. Then again, people make mistakes. But there may be hint from the histology that may suggest presence of HP. for example, the pathologist could order a specific immuno stain that stain only the HP cells, or by tracking the polymorph, can give hint the presence of HP.

UBT with solution is not as accurate as the mouth organism will start react with the urea pill. The pill is designed to dissolve in the stomach where there is no other organism but HP.

Re: false negative stool test and positive biopsy

Posted: Sun Dec 24, 2017 8:35 am
by helicosufferer
Aha very interesting.

I read around this forum and it seems that all the tests no matter how sensitive have a possibility of failure which is something very frustrating as it keeps us within the circle of chasing H Pylori to find it and if we fail we still suspect it because of the constant symptoms we have.

One more thing to add, I actually had my blood test done after 2 months of my hp positive biopsy. Also the biopsies were taken from 3 places of my stomach lining and from the place where I had the mild gastritis. So doesn't this give a strong indication of hp presence? Besides, I had all the same symptoms that hp patients had.
But my new challenge I believe now is to find whether it is still there or not.

Does a comprehensive stool test to check for other pathogens requires stopping ppi?

I you have a clue: does a hiatal hernia causes bloating or indigestion?

Thank you for sharing your time and knowledge with us.

Re: false negative stool test and positive biopsy

Posted: Sun Dec 24, 2017 9:19 am
by helicosufferer
One more question please:

If H Pylori was detected through a biopsy does that necessarily mean it's an overgrowth or it just says that h pylori is present?

Re: false negative stool test and positive biopsy

Posted: Sun Dec 24, 2017 12:38 pm
by Helico_expert
stool test is actually as sensitive as breath test, if it is done correctly.

the volume of HP, so far, has no clinical significance. The UBT can sort of tell you the amount of HP. The higher the UBT reading, the higher the HP mass. However, we have seen very high UBT reading patients without symptoms and we have also seen very low UBT reading patients with ulcers.

So, all you need to know is if you carry HP.

2 months after biopsy is unlikely to affect the blood test result. Nevertheless, you have two negative results from blood and stool tests. which suggest that your histology may be false positive. Therefore, I think it is worth to ask the pathologist to re-examine your biopsy with immuno stain. He should have your left over biopsy for such test.

Re: false negative stool test and positive biopsy

Posted: Sun Dec 24, 2017 1:48 pm
by helicosufferer
Great info. I never thought of it that way. I had the notion of overgrowth HP to make all this mess in our digestive system.

I have an interesting input.
I have a relative who was diagnosed with HP and got treated with antibiotics. She was retested then via blood test and to my surprise she got a negative result. How could that happen in a very short time!