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Gastroenterology (Expert Forum)
Need advice re: h pylori treatment
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Need advice re: h pylori treatment
by Katenyc, Dec 06, 2003 12:00AM
Dear Doctor,
I'd like another professional's opinion as to a somewhat complicated matter involving h pylori. A few months ago, I started having rather severe burning in my esophagus and throat/tongue. Was treated with several PPI's and prescription Zantac -- all to no avail -- nothing helped alleviate the symptoms. I had an upper endososcopy done which showed nothing at all visually but on biopsy, minor gastritis and minor esophagitis. My diagnosis was basically gerd. I tested negative for h pylori and stomach ulcers. I continued trying to take PPI's [double dosages] for a couple of months with absolutely no relief. A few weeks ago, I went to another GI doc for a different perspective [with copies of all of my records] and he immediately felt that I did not have gerd, but rather "sensitive esophagus" or "nerd" as it is sometimes called -- and he prescribed Librax, twice a day. I did get better -- not sure if it was the Librax or that I was just coming out of a very bad episode of gerd.
At around the same time I went to the 2nd GI doc, I asked my 1st GI doc if I could have a blood test for h pylori. I had it, and it came positive. She prescribed the PrevPac for me and under normal circumstances, I would have started the treatment right away. However, I had a very severe case of c difficile last year after taking Clindamycin for a root canal infection, and I have been warned over & over again about being very cautious when taking antibiotics. The c diff went away after 2 weeks on Flagyl, but I've been left with what is believed to be IBS. My GI doc [both 1st & 2nd ones I went to see] said to treat the h pylori -- however, I saw an infectious disease specialist last week who said "not" to treat it, since it showed up negative on endoscopy. He felt that the infection might not even be active at this point and I could potentially be trading one problem for another [h pylori for c diff]. He said that my chance of ever getting stomach cancer from h pylori is about "zero".
Lastly, I am scheduled for UREA breath test on Dec. 19th to see if this is an active infection or not. I'm confused about what to do if it is active because 2 docs tell me to treat it; 1 says not to [even if it shows active on a breath test]. My reflux symptoms are mild now and much more under control [even though I have stopped taking all meds until the UREA breath test]. I'm not sure what to do about h pylori if it an active infection.
Any advice on this from the doctor would be very appreciated.
Thank you.
Kate
I'd like another professional's opinion as to a somewhat complicated matter involving h pylori. A few months ago, I started having rather severe burning in my esophagus and throat/tongue. Was treated with several PPI's and prescription Zantac -- all to no avail -- nothing helped alleviate the symptoms. I had an upper endososcopy done which showed nothing at all visually but on biopsy, minor gastritis and minor esophagitis. My diagnosis was basically gerd. I tested negative for h pylori and stomach ulcers. I continued trying to take PPI's [double dosages] for a couple of months with absolutely no relief. A few weeks ago, I went to another GI doc for a different perspective [with copies of all of my records] and he immediately felt that I did not have gerd, but rather "sensitive esophagus" or "nerd" as it is sometimes called -- and he prescribed Librax, twice a day. I did get better -- not sure if it was the Librax or that I was just coming out of a very bad episode of gerd.
At around the same time I went to the 2nd GI doc, I asked my 1st GI doc if I could have a blood test for h pylori. I had it, and it came positive. She prescribed the PrevPac for me and under normal circumstances, I would have started the treatment right away. However, I had a very severe case of c difficile last year after taking Clindamycin for a root canal infection, and I have been warned over & over again about being very cautious when taking antibiotics. The c diff went away after 2 weeks on Flagyl, but I've been left with what is believed to be IBS. My GI doc [both 1st & 2nd ones I went to see] said to treat the h pylori -- however, I saw an infectious disease specialist last week who said "not" to treat it, since it showed up negative on endoscopy. He felt that the infection might not even be active at this point and I could potentially be trading one problem for another [h pylori for c diff]. He said that my chance of ever getting stomach cancer from h pylori is about "zero".
Lastly, I am scheduled for UREA breath test on Dec. 19th to see if this is an active infection or not. I'm confused about what to do if it is active because 2 docs tell me to treat it; 1 says not to [even if it shows active on a breath test]. My reflux symptoms are mild now and much more under control [even though I have stopped taking all meds until the UREA breath test]. I'm not sure what to do about h pylori if it an active infection.
Any advice on this from the doctor would be very appreciated.
Thank you.
Kate
Doctor's Answer
by Kevin Pho, MD, Dec 08, 2003 12:00AM
, Dec 08, 2003 12:00AM
The endoscopy test for H Pylori has a sensitivity of 88-95% versus a sensitivity of 88-94% for the blood test. The urea breath test has a sensitivity of 90-95%.
What this means that if you have the disease, the sensitivity is the chance that it can be detected (i.e. the breath test as a 90-95% chance of detecting the disease if you have it.)
The blood test has a specificity of 74-88% - meaning that if the test is positive, there is only a 74-88% chance that you have H Pylori.
I know this sounds confusing, but it all goes to show that there is no perfect test. I would suggest undergoing the H Pylori breath test. If positive, I would think that there would be more benefit in treating the disease - since untreated H Pylori disease is associated with a variety of gastric cancers.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
What this means that if you have the disease, the sensitivity is the chance that it can be detected (i.e. the breath test as a 90-95% chance of detecting the disease if you have it.)
The blood test has a specificity of 74-88% - meaning that if the test is positive, there is only a 74-88% chance that you have H Pylori.
I know this sounds confusing, but it all goes to show that there is no perfect test. I would suggest undergoing the H Pylori breath test. If positive, I would think that there would be more benefit in treating the disease - since untreated H Pylori disease is associated with a variety of gastric cancers.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
I forgot to mention that I did have a 24 hour ph test [showed no acid, although on the day of the test I had no symptoms] and a normal manometry study.
Thank you.
Kate
Thanks,
Kate
I already bought the 14 day treatment -- my health insurance covered it so it wasn't expensive for me. I'm just worried about a return of c difficile -- that's why I'm hesitating to start it.
Kate
This is extremely high dosage of antibiotics for long period, typically 14 days. The side effects can be quite severe.
in my case, I was not feeling much discomfort with my stomach but blood test still showed positive for the infection.
Unfortunately, i was on this treatment twice and ever since then, my digestive system never has been the same. I ended up with chronic gastritis and IBS. Somehow I also noticed my muscle especially in the addominal region and lower back has tighten up alot after the treatment as well. It has been three years but antibiotics side effects are still affecting my life immensely.
If you don't have to, I will really think about avoiding them.
Some people on this board long time ago suggested Mastic Gum may be effective with this bacteria. So look into some alternate treatment method first before you embark on this treatment.
jong
which 14 days treatment did you get??prev pac or the other one called heli dac??
in about 7 days,you may start to experience runs/diarhea as the antibiotics alter the flora system in your body,so be sure you have some good yogurt around to add the good bacteria back.
I have the Prev Pac, but haven't taken it yet.
Kate
If the breath test is positive, and I do decide to do treatment with the Prev Pac, is there anything I can do to protect myself from a return of c diff, other than taking probiotics during antibiotic treatment?
One last question: Can h pylori cause an increase in acid reflux symptoms?
Thank you.
Kate