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Complicated helicobacter and gastritis case with negaitive culture

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Helico_expert
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by Helico_expert » Thu May 10, 2018 3:06 pm

There are people who suffer from gastritis without H. pylori. The reason is still unknown.

If the problem still persist without H. pylori, then it is better to get a annual endoscopy check.

The following information is just for you and other readers to know. Not necessary that you have it.

H. pylori only colonise the stomach cells. As inflammation becomes severe, sometimes the stomach cells start to change to other cell type. We call it the metaplasia. This is the pre-cancer stage. When it is no longer stomach cells, H. pylori will no longer able to colonise. Then doctors will start getting negative result from rapid urease test, breath test, stool test, and histology test. That is why for doctors who dont understand how H. pylori works, they think that Gastric Cancer can frequently happened without H. pylori. But in fact, it is H. pylori that had done the damage and gone without a trace.

The good news is, in many case, When H. pylori is eradicated, the metaplasia cells will be killed by stomach acid. Metaplasia stage is reversible after H. pylori eradication.

nikolay
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by nikolay » Thu May 10, 2018 4:44 pm

Thanks for the info. And do you think gastritis can be caused by my antihypertensive drug or it's less likely?

For the metaplasia - I have 2 endoscopes in the last 3 months from two different doctors and both see only gastritis with some erosions, some initial esophagitis, histology sample taken only from antrum last time and I still wait the result. Not sure if this metaplasia condition can be seen visually but both doctors didn't say there is something more worrisome. Of curse I keep forward and we will see - if the there is no hpylori and no resolution I will go deeper with another endoscopy and better histology sampling. At least with 2 endoscopes now I am not worried at all to make another 5 if that will solve my issues. :) Also I feel physically well except the stomach - my blood results were never been out of normal, I continue to bike and even perform better than before, so it should not be something too serious I believe.

And I somehow believe it's more likely hpylory, first time when I was under treatment I was feeling very well. (with ammox and clarithomicin 10 days) - my tongue even completely cleaned from white coating. However after stopping the PPI I again feel bad, maybe 14 days would resolve it but I was on 10 days therapy. With my 2nd therapy (ammox and lovefloxacin 10 days), my tongue didn't cleaned well, although it was better. So my stupid theory is that Ii I feel difference from antibiotics then it should be the bacteria. Otherwise no change will happen if it's not a bacteria. The antibiotics should not have any benefits to the stomach without bacteria. Now when I take 2/day only PPI my tongue did not clean, although I feel better because of the lower acid. And I think white coating on the tongue is very good indicator for stomach inflammation (at least for me) - when I was feeling good, it's less, when not - it increases.

Helico_expert
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by Helico_expert » Thu May 10, 2018 8:33 pm

it's less likely you will feel anything if antibiotics work in killing H. pylori. Usually is the PPI that reduces the acid that make you feel better. In addition, usually antibiotics can come with side effects and make you worse.

I dont think hypertension drug can cause gastric symptoms. usually hypertension drugs are related to kidney problem. Nevertheless, if your endoscopy did not show any abnormal, I think your risk of gastric cancer is low. But a good histology slide can tell lots of information. So we shall wait and see.

nikolay
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by nikolay » Mon May 14, 2018 10:48 pm

The things are starting to look very funny for me. :) I've done last week home blood test with capillary blood which is testing against IgG antibodies and it came back negative, then I go to a lab to do proper blood test and see what it will show and here are the result:
screenshot.png
So to my understanding this shows I had hpylori in the past (because of the high IgA), but I do not have it now (because of the lower IgG which reacts faster as what I read). With negative predictive value of more than 90% of IgG it is highly unlikely I have active infection. On the other end I am close to the cut-off of 15 and I read in some paper about 7% of negative IgG and positive IgA are still hpylori positive for unknown reason. What do you think, can I conclude I am hpylori free or still have to do stool/UBT?

I stopped PPI and switched to H2 blockers to prepare for stool/breath test anyway. Also I wait histology to came out (eventually)...

Helico_expert
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by Helico_expert » Tue May 15, 2018 8:26 am

Yea, you'll need a breath/stool test to be sure.
Unfortunately blood test cannot tell your current infection status unless you have another reading 3 months ago that you can compare with. It is not wise to compare IgG and IgA like this.

nikolay
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by nikolay » Tue May 15, 2018 3:47 pm

Thanks for the clarification, indeed it's good to have some previous results but I did not done such quantitative test before. I have only one negative blood test 1y ago but it was from these simple yes/no ones. And it was negative while I have positive UBT.

Waiting for histology and will do stool/UBT after 2 weeks, to be sure will even stop the H2 meds 1 week prior to the tests. Although if histology says positive maybe I can skip them and proceed to another treatment.

Helico_expert
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by Helico_expert » Wed May 16, 2018 2:18 pm

As long as one of them shows positive, then you can proceed with treatment

nikolay
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by nikolay » Thu May 17, 2018 4:13 pm

I got the histology report, unfortunately it does not says anything about hpylori either positive or negative and they probably didn't tested it as the examination of the biopsy was done 24 days after the endoscopy. Not sure if they can detect the bacteria in histology after so many days.

The doctor which gave the result says it's not worrisome. The histological results are (I try to translate but I do not know the exact terminologies in English medical language): "Corpus biopsy: chronic surface gastritis, in activated phase with inflamed erosions (exact written: flamy erosions). Diagnosis: Chronic active (or activated/acute) erosive gastritis"

I guess I should still do hpylori test as there is a chance this gastritis is not caused by hpylori ... ?

Helico_expert
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by Helico_expert » Thu May 17, 2018 11:28 pm

Usually when we see the word "active" gastritis on histology, it's a sign that there is presence of H. pylori. Perhaps your doctor can ask for a HP specific stain to check if there is HP.

nikolay
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Re: Complicated helicobacter and gastritis case with negaitive culture

Post by nikolay » Fri May 18, 2018 5:58 pm

Helico_expert wrote:
Thu May 17, 2018 11:28 pm
Usually when we see the word "active" gastritis on histology, it's a sign that there is presence of H. pylori. Perhaps your doctor can ask for a HP specific stain to check if there is HP.
I didn't know it's possible to detect it 24 days after the biopsy was taken. But anyway that will not be possible with this doctor/lab, how to explain you - over here we do not have experts in HP, GI doctors focus on serious issues - ulcers, cancer, etc. For most of the doctors my diagnosis is not very serious.

I will stop H2 pills and will do UBT in 2 weeks. I want to be sure before going into another treatment. Will keep you informed here. Also then will decide about the eradication scheme if it's possible. Thanks for your help!

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