H. Pylori/Ulcers follow-up

[De__0__0]

  Two years ago I was treated with Flagyl & Biaxin upon a positive H. Pylori blood test.  Intermittent pain returned and I recently had an EGD which also tested positive for H. Pylori.  According to my chart I have "Multiple Gastric ulcers and multiple gastric erosions in the body of the stomach and antrum with size and shape varying, severe duodenitis and flecks of blood noted." "The entire appearance was consistent with severe acid peptic disease." He also ordered serum gastrin levels for possible ZE Syndrome.  The only biopsy report in my chart was for the H. Pylori, which was positive, so I do not know the result of the gastrin level.  I just finished Helidac Therapy and had a follow-up visit with my physician.  I asked if he could be sure that this bacteria was gone and he said I had received the two most common treatments and a third one was uncommon in this country.  I cannot say I feel better since not enough time has passed since treatment.  I do know I had excrutiating pain during treatment, but decided it had to get worse before it got better, so stuck with it.  He said facilities are not available in our area to do the breath test and didn't feel follow-up tests were necessary to see if the bacteria was gone.  He said his main concern was the fact I had lost weight, (eight pounds since May with three of those in the last two weeks).  I said the medicine took away my appetite and to give me a chance to see if things get better.  My question is this, based on the condition of my stomach is a follow-up called for to see if the bacteria is gone?  I told him I could not say for certainty whether I felt better since the therapy made me so sick to begin with.  I only had intermittent pain previously, but each episode would last a few days and were quite painful.  Rest of the time I ignored everything else.  What should I do?
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Dear Dee:
It is not unusual for patients to fail therapy for H, pylori i.e. not eliminate the organism.  The best treatment results report 10-15% failure rates.  Often but not always, a second course of therapy will eradicate the H. pylori.  Failure to eliminate H, pylori can be due to not taking all the medications ( and you are entirely correct that most of the regimens make you ill with symptoms of nausea, loss of appetite and abdominal pains) or resistance of the H. pylori to the antibiotics, an increasingly common problem.  
In view of your recurrent ulceration, I think that you would benefit from knowing your H. pylori status after treatment.  A breath test or repeat endoscopy with CLO test is needed.  Because H. pylori can be suppressed but not eradicated by antibiotic therapy,  you should not have a repeat test until you have been ‘off’ the antibiotics and Prilosec for 30 days.  During this period, you could take Pepcid, Tagamet or another H2 receptor antagonist to inhibit acid secretion and control symptoms.  If you still fail to eradicate the H. pylori infection, you may require long term acid suppression to prevent recurrent ulcers.
There are two other points to emphasize.  Although  uncommon, some people can be re-infected with H. pylori after eradication of the organism.  The second point is that there are other causes of recurrent ulcers e.g. Zollinger Ellison syndrome.   You should ask your physician about the serum gastrin results.  Finally, you should avoid alcohol, stop smoking and do not take non-steroidal antiinflammatory agebts e.g. Aspirin, Motrin, etc.
this information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-jg
*keywords; H. pylori, ulcer
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