H. Pylori Possible Culprit?

  I recently had an upper endoscopy which diagnosed both gastritis and duodenitis.  Multiple biopsies were taken, and no sign was found of viral occlusions, H. Pylori, fungus or Giardia.  Nevertheless, I had similar symptoms four years ago, tested negative for H. pylori at that time, and yet was able to eliminate all symptoms after a 7 day regimen of Flagyl I.V. and Pepto.
  Is it necessarily the case that one will test positive for H. pylori in all such biopsy situations?  Doesn't this bacterium colonize, so biopsy might be hit or miss?
  I'm taking Pepcid, which is improving the duodenal symptoms, but continue to struggle with dyspepsia-like upper stomach symptoms even after 10 days (rumbling, slight burning, excess acid-like symptoms, funny taste in the mouth) - almost always after lunch and dinner, but seldom after breakfast or between meals.  
  Sound like it might be worth trying another round of Flagyl?
  But - is viral infection-related irritation also a possibility?  I've had a lingering one for a few months now, tho it's better.  
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DEar rick,
An individual biopsy may not detect H. pylori.  If multiple biopsies, however, are negative then it is very, very unlikely that you have H. pylori infection. There is currently a debate in the medical literature whether H. pylori can cause non ulcer dyspepsia, that is symptoms suggestive of acid-related disease but thewith the absence of objective findings of disease.  In your case you do not appear to have any objective signs of H. pylori infection.  therefore, I do not beklieve that you will benefit from another course of treatment for H. pylori.  Parenthetically, the regimen that you described ( 1wk of IV Flagyl and pepto) is not approved for the treatment of this infection.  Two regimens proven effective and accepted by the FDA are a combination of oral treatments.  Good eradication rates have been achieved with
a) Peptobismol, Flagyl and tetracycline administered orally for three weeks
or
b) prilosec ( for 28 days), and Clarithromycin (an antibiotic) for 14 days.  Both drugs are given by mouth.  In our institution we add metronidazole to this regimen in an attempt to increase the eradication rate.
I hope that this information is helpful.  As always, this material is presented for educationbal pirposes only.  Always ask your personal physician specific questions pertaining to your medical condition.
HFHSM.D.-rf
*keywords: dyspepsia, H. pylori,
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