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3rd therapy ongoing still positive

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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Navinavi
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Joined: Mon Sep 23, 2019 11:28 pm

3rd therapy ongoing still positive

Post by Navinavi » Mon Sep 23, 2019 11:49 pm

Had gastritis symptoms in 2011, and went to my GP who tested me for HP and it was positive. Completed a triple therapy and tested negative 2 months later, if I remember correctly.

Through 2018 I experienced frequent episodes of dyspepsia and heartburn, feeling of something stuck in my throat etc. After using PPIs for one month My symptoms were very mild and tolerable. But after stopping the PPIs the symptoms came back even stronger, so my GP referred me for a gastroscopy. The gastroenterologist told me I had mild gastritis and performed a biopsy.

The biopsy came back with chronic gastritis and positive for h pylori.

1 treatment failed - 7 days (Pantoprazole, Amoxicillin, metronidazole) stool test positive
2 treatment failed - 14 days (Pantoprazole, Amoxicillin and Metronidazole) stool test positive
3 treatment - 14 days introducing the antibiotics 2 days apart (Pantoprazol 40 mg 2xdaily, Amoxicillin 1g 2x daily, Metronidazole 500 mg 3 x daily, Clarithromycin 2 times daily and bismuth 125mgx2 2 times daily.

Now I have finished my 3 treatment 2 days ago and begin to feel heartburn - what to do if this treatment fails. I live in Denmark.

Helico_expert
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Re: 3rd therapy ongoing still positive

Post by Helico_expert » Tue Sep 24, 2019 12:46 pm

Your doctor shouldnt have given you the same treatment again and again. He should know that your strain is resistant to metronidazole, no matter how many days of metronidazole, it will fail. Your last treatment has included clarithromycin. Perhaps that will work.

Let's wait till you get the follow up result. be positive.

Navinavi
Posts: 8
Joined: Mon Sep 23, 2019 11:28 pm

Re: 3rd therapy ongoing still positive

Post by Navinavi » Tue Sep 24, 2019 1:35 pm

Hi Helico_expert,

You are right I was already treated with Metronidazole in 2011.

I have read in your previous posts that h pylori cant become resistant to Amoxicillin - then why not just give Amoxicillin + PPI + Bismuth?

This was results after 1st failed treatment
Helicobacter pylori ag Positiv Index 7.60

This was results after 2nd failed treatment
Helicobacter pylori ag Positiv Index 19.5

Both were stool tests.

Can you conclude anything from this

Helico_expert
Site Admin
Posts: 3470
Joined: Wed Mar 02, 2011 7:20 am

Re: 3rd therapy ongoing still positive

Post by Helico_expert » Tue Sep 24, 2019 2:07 pm

I have read in your previous posts that h pylori cant become resistant to Amoxicillin - then why not just give Amoxicillin + PPI + Bismuth?
Very good question, has been asked many times, and had been on trial many times.

Amoxicillin and PPI alone, only able to give about 50% cure rate. Plus bismuth, is only able to push it up a little higher.
The key is still on the PPI. Currently, no PPI (except the new vonoprazan), is able to give a complete acid suppression.

the new vonoprazan + Amoxicillin has been reported able to push cure rate to 94%. That may be a game changer. More trials are needed for this dual drug therapy.

https://www.karger.com/Article/FullText/502287

Navinavi
Posts: 8
Joined: Mon Sep 23, 2019 11:28 pm

Re: 3rd therapy ongoing still positive

Post by Navinavi » Tue Sep 24, 2019 2:12 pm

Thanks for you reply,

When you say cure rate of 50%, do you mean each time or?

In theory you can just continue the treatments until it is eradicated?

Helico_expert
Site Admin
Posts: 3470
Joined: Wed Mar 02, 2011 7:20 am

Re: 3rd therapy ongoing still positive

Post by Helico_expert » Tue Sep 24, 2019 4:44 pm

hahaha... it's just a number to show you that the cure rate is low.
there is no data that support 50% cure rate.
actually there is, but that's probably 20 years ago, when triple therapy just started.

but the situation is changed now. there are more antibiotic resistance cases. perhaps the cure rate is even lower than 50%. Then again, there is new PPI and bismuth. and everyone (and the bacteria strain as well) would respond differently to the antibiotics.

it would be unethical for me to ask you to try. as randomly exposing yourself to antibiotics is generally regarded as bad.

Navinavi
Posts: 8
Joined: Mon Sep 23, 2019 11:28 pm

Re: 3rd therapy ongoing still positive

Post by Navinavi » Tue Sep 24, 2019 5:03 pm

Thanks for your reply.

Let's wait for the test results.

Navinavi
Posts: 8
Joined: Mon Sep 23, 2019 11:28 pm

Re: 3rd therapy ongoing still positive

Post by Navinavi » Sat Sep 28, 2019 1:26 am

Hi Helico_expert,

I wondered if h pylori eradication is determined by low acid levels in the stomach? If it is, can eating acid foods, sodas, candy etc. have a negative impact?

Helico_expert
Site Admin
Posts: 3470
Joined: Wed Mar 02, 2011 7:20 am

Re: 3rd therapy ongoing still positive

Post by Helico_expert » Sat Sep 28, 2019 9:20 am

H. pylori can sometimes lead to high acid secretion - stomach ulcer
sometimes low acid secretion - atrophic gastritis - gastric cancer

So for those who is having low acid because of atrophic gastritis, should get annual endoscopy to prevent cancer

Can acidic food help? I dont think there is any food as acidic as gastric juice. Lemon and vinegar are both weak acid. while many websites claim that lemon and vinegar are good for health, I am worried that too much of them may be damaging to your teeth.

anyway, nothing should be taken excessively. keep a balance diet and life style.

Navinavi
Posts: 8
Joined: Mon Sep 23, 2019 11:28 pm

Re: 3rd therapy ongoing still positive

Post by Navinavi » Sat Sep 28, 2019 1:54 pm

Thanks for your reply.

My endoscopy shows chronic active inflammation - h pylori detected.

It says in the report that groups of h pylori are seen (microscope) No intestinal metaplasia, no intestinal dysplasia and no malignancy.

antrum ventriculi what does this mean is this where h pylori is found and does it have anything to do with atrophic gastritis? Would the endoscopy and biopsy have found athropic gastritis?

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