H PYLORI test result - Antigen DETECTED

[SJ66]

Hi helico expert and team

Looking for help and guidance, please.

Background:

June 2018 - HPylori POS, blood and stool

Aug 2018 - eradication 2 abx - Metronidazole & Amoxicillin, Pepto Bismol, Ranitidine. Taken for 14 DAYS straight.

Oct 2018 - HPylori NEG - antigen NOT detected, stool test

Feb 2019 - HPylori NEG - antigen NOT detected, stool test

Sep 2019 - HPylori POS, stool test - result below:

17 Sep 2019
H pylori antigen test
Comments:
Helicobacter pylori Antigen DETECTED

No idea why I’ve tested positive this week when last 2 stool tests have been negative. All stool tests have been done at same Hospital Lab (Royal Free, London).

Would very much appreciate your thoughts on what I can/should do.

Many thanks.
Sarah-Jane

[Helico_expert]

It's very rare for adult to have reinfection of H. pylori. However, it's not impossible. You may have caught it from your partner. Anyone living with you at home is also a carrier of H. pylori?

or it could be a false positive from stool test. Perhaps you can find out how positive is the positive test? a borderline positive is likely to be false positive. Perhaps you can do a breath test instead?

[SJ66]

Hi
Many thanks for your reply. So should I suggest that my partner and son (he’s 19) get a stool test even though they don’t have any HPYLORI symptoms?

False positive - does that really happen with stool tests? If I can’t get further information on how positive the stool test was I did on Monday (I’m seeing my GP this evening) is there anything else I can do? The breath test over here in UK doesn’t seem to be offered by my GP. Should I ask to redo the stool test?

Wondering now if it’s possible that I never fully eradicated HPYLORI last Aug 2018 even though I did 2 weeks of continuous treatment, which was hell.

Always appreciate your help and expertise.

Thanks so much.
SJ

[Helico_expert]

Yes, both of them should get tested. False positive is less likely. But nothing is 100%.

[SJ66]

Thanks so much for your reply.

Can you advise and give further help, please?

My GP says it’s not necessary to get family members tested because HPylori isn’t contagious! It’s an almost impossible task for me to get the GP to agree to stool tests for my family. So, I guess I’ll have to somehow arrange to have them done privately. In the UK, GPs seem somewhat uninformed regarding HPylori, treatment regimes, etc.

Regarding treatment for myself, (if necessary):

In July 2017
I took Amoxicillin and Metronidazole for a week for infection in my gums.

In August 2018
I took for 14 days:
Amoxicillin 2 x 500g BID,
Metronidazole 1 x 400g BID,
Ranitidine 1 x 150g BID,
Pepto Bismol 30mg TID

I am concerned that I’ve overused Metronidazole therefore can you make any treatment suggestions, bearing in mind I couldn’t tolerate Omeprazole or Lansoprazole. And would I be best to do a 7, 10, 14 day treatment regime. Would I need to take the Antibiotics maybe 3 times a day to keep them in my system and have a better chance of eradicating? I know HPylori never become resistant to Amoxicillin and Bismuth - thank goodness!

Regarding my family, if they test positive, they’ve had very little exposure to antibiotics (my son only once in his life) therefore would a 7 day regime, for example:
PPI + Amoxicillin + Metronidazole + Pepto Bismol be adequate?

Also, is Rabeprazole possibly easier to tolerate/metabolised differently than other PPIs?

I am so grateful for all your responses.
Kind regards, SJ

[Helico_expert]

It is very rare for adult to get reinfected. H. pylori is contagious, just very poorly. otherwise, you may ask your doctor to explain what would be the reason for the following?

Oct 2018 - HPylori NEG - antigen NOT detected, stool test
Feb 2019 - HPylori NEG - antigen NOT detected, stool test
Sep 2019 - HPylori POS, stool test - result below:

if he suggested that the diagnostic test is useless, creating false positive or false negative, perhaps he should use other diagnostic test, such as breath test.

I assume that the diagnostic test is accurate. Therefore, your recent infection is from someone else. and hence, your previous exposure to metronidazole doesnt matter. Unless that someone else also exposed to metronidazole before.

In general, 7 days has about 80% cure rate and 14 days have about 90% cure rate. Prof. Marshall thinks that 10 days is enough. Probably the additional few days for an insignificantly higher cure rate and most probably significantly increase the risk of side effect is not worth it.

All the PPI works the same. Their chemical structures are very similar. Everyone would metabolise them differently. So you can try rabeprazole if you want and see if you can tolerate it.

[SJ66]

Hi
Many thanks to you for your very informative response. It is a great help to be able to discuss and get answers about H Pylori. This forum has been a tremendous help and I thank all of the team.

May I just clarify:

It is very rare for adult to get reinfected. H. pylori is contagious, just very poorly. otherwise, you may ask your doctor to explain what would be the reason for the following?

So, are saying that H Pylori IS contagious when people live in and share a household, despite hygiene, cleanliness of home, proper food preparation?

Also, because I had a POS Antigen in JUNE 2018, took 14 day ABX therapy in AUG, then NEG Antigen OCT 2018 , then NEG Antigen FEB 2019, POS Antigen SEPT 2019, then I now must have become reinfected by one of the members of my family?

I do not think the Stool tests are inaccurate, although I did ask the GP last Friday if there were numbers associated with the result. GP said the Hospital only return a comment which is either ANTIGEN DETECTED or ANTIGEN NOT DETECTED with stool tests. So, I brought up the option of getting a Breath Test (in order to look at numbers) and she said she would contact the Gastroenterology Dept at the Hospital and get back to me by this Friday 27 Sept.

In your opinion, would you advise to treat ALL members of family (ie: partner, my son, and myself) with a 10 day course of TRIPLE THERAPY with Pepto Bismol added and all of us taking the same ABX, Amoxicillin, Metronizadole ?

Question regarding PPI, I believe PPI is a very important part of the eradication therapy. However, I used RANITIDINE in August last year to eradicate HP. If I cannot tolerate the PPIs again, could I use RANTIDINE 150mg again or would it be useless?

Huge thanks, again, for all your advice.
SJ

[Helico_expert]

Yes, everyone in the same household (except children below 16 yr old) should get tested for H. pylori and treatment if positive.

Since you had two negative stool test previously and then a positive stool test, how else could you get it from? You must have infected from one of your family members, usually your partner through kissing (and usually before brushing teeth).

the success of the antibiotic treatment rely heavily on how well you suppress your acid secretion. PPI has a better suppression of acid than ranitidine. Therefore, PPI would have a better cure rate. For those that cannot take PPI, ranitidine is the only choice. in your case, your previously treatment with ranitidine work. So that's very good.

[SJ66]

Many thanks for your reply.

Are you able to make a suggestion on a suitable regime/therapy for eradication, ie: which antibiotics, how many times a day and the length of time, plus if adding in Pepto Bismol is still a good idea. An earlier reply above says Prof Marshall suggests 10 days is enough for the treatment. (My first eradication was 14 days and was very tough, with side effects and awful yeast infections for weeks after.)

Thank you.
SJ

[Helico_expert]

Your family doctor would be more suitable to recommend a treatment that is suitable for the local infection.

however, the guideline suggests that
Clarithromycin based triple therapy should be tried first. if failed then
Metronidazole based triple therapy. if failed then
quadruple therapy.

since pepto bismol is so safe and effective, you can always add them to your treatment as well.

final tip... rabeprazole seems perform better than other PPI. so you can ask your doctor to prescribe rabeprazole, double dose.