Confused about H. Pylori - Please help!

[mia28]

I am a 36 year old female who began to have neurological & stomach problems six months ago. No previous health issues. Neurological problems consist of headaches, numbness, and occasional aches & pains.  Stomach problems consist of chronic stomach aches in upper area and loss of appetite and weight (15 pounds in 4 months).  Tested low positive for H. Pylori (reading of 114) through a blood test.  All other blood tests were fine.

Endoscopy this month indicated mild hiatal hernia and gastritis.  Biopsy revealed no H. Pylori.

Gastro doctor prescribed Nexium, which I started a week ago.  Symptoms still exist.  

Doctor did not prescribe treatment for H. Pylori since biopsy was negative.  I asked him why the blood test was positive if biopsy was negative and he explained that a strong regimen of penicillian I was on back in September (for treatment of a high ASO blood test) most likely destroyed the H. Pylori.  Is this possible?

Also, I have researched H. Pylori on the internet and discovered that long term, untreated H. Pylori can cause neurological problems and possibly a stroke.  Is this also possible?

I was also told that a mild hiatal hernia is common and benign and would not be causing my symptoms and would not require treatment.  Is this true?

Any advice and or information would be very much appreciated.  Thank you so much!

[Kevin Pho, MD]

Erin, GI PA has kindly addressed your question in her comments below and I agree with her assessment.

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.

[kevinmd]

I will be away until January 4th. I will answer your question when I return.

Happy holidays,
Kevin, M.D.

[adiavel]

Hi there. I'm a 31 year old male and I am experiencing nearly  the same simptoms like you.
Headaches are not very often but 2 months ago it all started with burning feeling in the upper part of stomach, left and then right side. The burning sensation extended few days later to whole my stomach. I tryied usual medication available in Superdrug shops without any good efect.
After 1 month of struggling with my problem I decided to see a private specialist doctor. I paid a lot of money and he performed an endoscopy. The results are: moderate hiatus hernia with gastritis, and an iflamated stomach. Good duoden and no ulcers. Biopsy test for H.pylori bacteria was NEGATIVE. Also, ultrasound-scanning reavealed NO problems with my GALL BLADDER.
The specialist said he reckons my inflamated stomach may be the result of the stress at my work-place (i cannot accept this explanation!). Hi prescribed me Nexium for 1 month which I have done it... but without any good. My symptoms stil persist. Now I don't have anymore the same acute burning feeling in the upper part of the stomach, it is been replaced by an very uncomfortable feeling in the lower part of my stomach and a lot of gas bulding in stomach and bowels after meals (30mins-1hour or so after meals).
I refuse to believe this is caused by stress, and I'm upset that he never performed any blood tests. I may see him again shortly.
Also he said that my moderate hiatus hernia cannot be treated succesfully. It is an unusually disease for a young person like me and I cannot do anything about that. It will help me if I sleep gradiently (with the head slightly up) to prevent the content of the stomach coming back to my throat while I am asleep, and to lose some weight. He said that the hiatus hernia will get eventually worse with the age, and after years, if the worse comes it exists some medication for that and even a "small" surgery which can be performed in connection with that.
I lost indeed about 12 pounds in the last month, but I don't know if it is the result of my diet or the result of my disease.
I'm desperate to find an answer for my problem and I'll be watching closely this forum. It may help me a lot.
Thanks for listening me and sorry for my bad english.

[GI.PA]

The "blood test" for h-pyrlori will remain positive years after you actually have it.  So, in your case where you were treated with a large dose and duration of antibiotics a few months ago and now your stomach biopsy (the BEST way looking for a h-pylori infection) is negative, I agree with your doctor that treatment of the h-pylori with antibiotics is unneccessary.

If the endoscopy did not show the reason why you are having weight loss and upper abdominal pain, a CT scan of the abdomen (looking at the Pancreas) and perhaps a gallbladder work-up (ultrasound and maybe even a functional test) can be the next steps.  Your doctor may also consider raising your dose of Nexium to twice day dosing for a few weeks to see if this is helpful.

GI.PA

[GI.PA]

"The specialist said he reckons my inflamated stomach may be the result of the stress at my work-place (i cannot accept this explanation!). Hi prescribed me Nexium for 1 month which I have done it... but without any good. My symptoms stil persist. Now I don't have anymore the same acute burning feeling in the upper part of the stomach, it is been replaced by an very uncomfortable feeling in the lower part of my stomach and a lot of gas bulding in stomach and bowels after meals (30mins-1hour or so after meals)."

The Nexium treated what Nexium is suppose to treat (stomach inflammation...in your stomach proper and duodenum, the "acute burning" to quote which has improved).  The gas/pressure sensation in the lower abdomen after eating is most bowel in origin and the Nexium will not treat this.  The discription you give is very consistant with an underlying irritable bowel, but it should be investigated further.  I would stay on the Nexium, and see your specialist again.  Keep an open mind about the fact that there may be more than one thing going on...OR that the symtoms may all be consistant with dypepsia/irritable bowel picture and may need treated along the same lines.

GI.PA

[mia28]

Thank you for your replies.

Adiavel- I'm sorry you are experiencing the same symptoms.  I know how horrible they can be.  I have not had an ultrasound yet, perhaps this will be next.  I just have this chronic (everyday, from morning to night) moderate ache in the same spot (upper middle part of my stomach).  It's literally driving me crazy.  Nexium doesn't seem to help much, nor does antiacids like TUMS.  There has to be more of an explanation for both of us.  Hang in there - hopefully we will have answers soon.

GIPA - Thanks for the information.  I do not want to treat the H. Pylori if it is not necessary.  Still, just wondering why I am experiencing these stomach problems.  I have always been a very healthy person until now.  Yes, my doctor did explain that the H. Pylori blood test could remain high for a long time, even if H. Pylori is not present.  I never thought to consider problems with my pancreas of gall, so thank you for suggesting this.  Thanks again for your reply - I appreciate it.

[Toeboy]

At the age of 25 when I was experiencing zero stress in my life and in very good health I suddenly developed ulcer like symptoms plus IBS for no apparent reason. The doctors didn't believe I had an ulcer and blamed the whole lot on IBS (they tend to use IBS as an easy get-out when they can't be bothered to investigate further). I had two negative blood tests for HP but after months on Nexium had lost a lot of weight. I had an endoscopy that revealed inflammation and a duodenal ulcer. The biopsy performed at the time also came back negative for HP.

They treated me for HP anyway but it didn

[mia28]

hi Toeboy - I'm sorry you too are experiencing stomach problems.  Like you, I have been very healthy without any stomach problems my entire life.  I think I need to go back to my gastro because I am still experiencing chronic stomach discomfort everyday.  I do not have any bowel problems so I do not think I have IBS.  What is odd is that my discomfort is always in the same spot (upper middle abdominal directly below my breast bone).  It feels like pressure or that something is actually there (strange, I know).  I thought perhaps it was due to my hiatal hernia but I was told this does not cause any other symptoms other than GERD.  Anyone know if this is this true?  

My endoscopy showed no signs of any ulcer, just inflamation.  I am on a slow release Nexium (40) once a day.  After taking this for nine days now, I do not see any difference.  The fact that nothing seems to alleviate my discomfort is driving me crazy.  Not sure what to do.

[Toeboy]

I would give it at least a month to work although after 18 months on Nexium I still have some tenderness but it's barely noticeable. I have to say that after 6 weeks to 2 months I reached a situation where it was as good as it was going to get as I never saw any further improvement after that.

I did originally try Nexium 20mg once a day and from that moved to Lansoprazole 30mg once a day. However these doses were only enough to just slightly take the edge off the pain of the ulcer and still left me unable to eat and losing weight. I also felt very ill and feverish.

My HP treatment involved taking Lansoprazole 30mg twice a day along with antibiotics and I saw an improvement over that 7 day course but relapsed when the treatment ended. I therefore moved to taking 20mg of Nexium at breakfast or with my mid-day meal and another 20mg with my evening meal - the Docs wouldn't let me have Lansoprozole twice a day for some reason. The pain gradually subsided and over time my appetite came back. Guess it may depend on the individual though. Why don

[adiavel]

I'm very sure that my problem started with stomach burning sensation.
In the meantime a noticed some other simptoms: stool yellow and very acid (sorry, high PH?), not feeling much better under Nexium treatment(still uncomfortable stomach sensation and lot of bloating), actually stomach burning returned few days after I stopped the Nexium (1 x 20mg per day), 40%-50% improvement as I started to take 2 X Pepcid-2 tablets a day (I cannot stay on Pepcid forever). Still got that bloating in the stomach and bowels. Increasing the dose of Nexium to 2 x 20mg a day may be the next step. But I'm very affraid of depending on Nexium for the rest of my life!!!! I'm very scarred actually!
The main question is: if the biopsy tested negative for H.pylori it is possible that to still have infection with H.pylori? Is anyone there who reckons I should do a breath test or blood test to be 100% sure?
Actually I am not sure if the burning sensation in the stomach is the result of the higher quantity of acids or the result of my stomach losing the defence against the gastric acids (which is another question). But the way I feel that increased PH (acid)in my stool, it may be the quantity of acid which became large for unknown reason.
Also I heard about the Zollinger-Ellison disease which it is a tumour relising acids. Where can be located a such of tumour? Does the endoscopy of stomach rulling out a such possibility in my case?(my stomach it is shown to be only inflamated in my case).

[Toeboy]

Your symptoms sound very similar to mine.

Blood tests are easy to perform and inexpensive so you would have nothing to lose. As for the biopsy - I was told to stop using PPI's prior to the test as this may cause a false negative result?

I think with the breath test you have got to stop taking PPI's for some time prior to the test for an accurate result and I certainly couldn't last that long without Nexium.

I started off with a sensation of something burning or churning in my stomach. I wasn't producing too much acid in my opinion as it was never that strong when I brought my food up and I never suffered from heartburn - although I do now if I stop taking Nexium due to the rebound effect.

I am certain that my stomach lost its ability to protect itself against normal levels of acid. Seems as though a lot of people are in this situation and negative when tested for HP but no one has been given an answer as to why. My doctor just said that "sometimes there isn't an explanation"

[TJV]

  H pylori can be-- and is missed on endoscopy frequently if the wrong spot is biopsied.  It is also now reccomended by many GIs that you be off of PPIS 2 weeks prior to endoscopy-- as this can also cause a false negative result when biopsies are lab tested.

   If you have ulcer symptoms you definately should be treated -- although hp rarely causes symptoms-- it normally takes years for hp gastritis to cause problems- so treatment may not necessarily alleiviate symptoms.

  The most important reason to treat it if you test positive-- is-- it can eventually lead to stomach cancer. -- I have gone through 3 or 4 treatments myself and still test positive on a breath test -- but have no symptoms- so it's not something i'm terribly concerned or care about.-- in the near future anyway

[TJV]

  A breath test will accurately tell you if you are presently infected with hp or not. That is the test given to see if eradication is successful-- as mentioned above -- a blood test is no good-- it will show positive for years regardless.-- but a breath test is accurate

  If you want to be sure you don't have hp, request a breath test Mia

[mia28]

Thanks everyone- I am really confused by all this.  So, since my blood test was positive, but my biopsy was negative, I should request a breath test to see if I am still infected by H. Pylori?

My next questions are:  would H. Pylori cause a constant, chronic (everyday - 24 hours a day) ache in the middle, upper abdominal (same spot all the time).  Or, would a hiatal hernia be causing this symptom?  If neither, then what else?  Endoscopy should no signs of ulcers.

Thank you all so very much - I appreciate all the information.

[mia28]

Thanks for all of your replies - I am just very confused by all this.  So, if my blood test was positive, and my biopsy was negative, I should request a breath test to see if I am still infected by H. Pylori?

I was not on any meds during my blood test or biopsy so that did not effect the results.

My questions are:  If I am infected by H. Pylori, would it cause the chronic, constant ache in my middle, upper abdominal (always the same spot)?  I do not have ulcers.  Or, would my hiatal hernia be causing this symptoms?

Also, I researched H. Pylori and found that it can cause neurological symptoms (which I have) and even stroke.  Is this true and why does this happen?  I'm really worried about this.

I really appreciate everyone's help.  Thank you so much.

[Katenyc]

Hi Mia,

Just read your post.  I just finished a two-week treatment for h pylori.  I had an endoscopy a few months ago [my complaints were severe acid reflux burning and pain in my stomach].  I tested negative for hp and ulcers, and showed mild gastritis and esophagitis.   I was basically sent away with ppi drugs to try -- which I did -- I went through all of them and nothing was helping me.  After a couple of months, I went back to my doc and insisted on an hp blood test -- which shocked me when it came back positive.  Before I took the treatment for it, though, I wanted to make sure it was an active infection, so I requested a breath test.  This took a little longer because I had to be off ppi's for two weeks before I could take this test.  They told me within 1/2 of the test that it was a positive, active infection.

I just finished with two weeks of what is called PrevPac, which are antibiotics and Prevacid twice/day to eradicate hp.

If you want to put your mind at ease, I'd go for the breath test.  Otherwise, as long as you continue to have symptoms, it will always be in the back of your mind if h pylori could be present or not.  Erin GI is right -- that the infection could show positive in bloodwork long after it has been eradicated.  But a breath test will let you know for sure and won't keep you guessing.  

Good luck, and I hope you find some relief soon.  

Kate

[TJV]

Hello Mia  Katenyc is right. The only way to know for sure if you have an active hp infection is to request a breath test That is the only way to tell if you have an active infection-- if you have previously been on antibiotics--you may or may not. -- but keep in mind an endoscopy can be a false negative if on PPIS or the wrong spot is biopsied.

   There is no evidence that h pylori can cause any neurological problems or stroke at all  You have to be wary of what you read on the internet -- H Pylori initially produces a superficial gastritis and over time can penetrate causing ulcers or stomach cancer in a small proportion in the population  Most people with hp do not have symptoms and it is considered an incidental finding when someone gets checked out for another GI problem.

   Hiatal hernias cannot be classified by size in diagnostic testing -- as you are looking at one angle. Mild or not --some people's  hiatal hernias can be symptomatic

   If nexium isn't working, you could try a different ppi-- everyone is different -- and there is always one ppi that works better than the others in each individual--  or up the dose of nexium or add an H2 blocker at night. You should have a CT scan as well-- -- to make sure -- but your discomfort could be just due to gerd --  or non ulcer dyspepsia etc

Sometimes people have an abnormal sensitivity to acid-- or problems with muscle or nerve function. Antispasmodics or Low dose antidepressants are often prescribed for this -- having nothing to do with depression but the same nerves control the brain and gut. If it's some type of motility problem -- a motility drug will be prescribed.

  Also remember - PPIS do not stop all of the acid -- nor pepsin or bile.

[TJV]

   You should also cut down on your fat intake and acidic foods.

[mia28]

TJV  -  THANK YOU! You answered all of my questions.  I will request a breath test - as it will ease my mind to know once and for all.

Yes, I do need to watch what I read on the internet.  I know it is not always accurate.  Which is one reason I posted here - to hopefully have an explanation for a doctor.

I hope I am not being a pain in the neck with all of these questions.  I have never had any stomach problems until now.  And now, it is a constant problem.  Thanks again - I so much appreciate your help!

[kevinmd]

Hello,
The comments posted on this thread are accurate.  To summarize - the blood test would remain positive with past H Pylori infection.  The breath test would be helpful in diagnosing active infection - this is recommended if you are still experiencing symptoms.

The sensitivity of biopsy urease tests is approximately 90 to 95 percent, and specificity is 95 to 100 percent - thus there is still room for false negatives.

If you are still infected by H Pylori, it is possible that it may be causing your continued symptoms.

Regarding the hiatal hernia.  They are common and in most cases benign.  The problem arises when it causes significant gastric reflux.  A 24-hr pH study can be considered to determine the severity of this.

Thanks,
Kevin, M.D.

[yoshi]

prilosev and nexxium seem to be similar,and do not work that well for me,but prevacid does but there are side effects.
while in asia,i found a japanese drug over the counter called
WEISEN-U which seems to work well for me.
you have to find the one which works for you and watch your diet.

[TJV]

  Good luck to you Mia -- remember - you should be off of PPIS for 2 weeks before the breath test. Hope you feel better soon

[Gez]

Also confused.  Our 13 year old daughter  had an endoscopy and gastric mucosa biopsy showed that there were evidence of mild superficial gastritis and they found colonies of H pylori-like organism.  She has had a 7 day course of triple therapy which has now finished and is on 20 mg of Omeperazole.  She is now suffering with hot flushes, belching and constant regurgitation.  She has been off school now since July and due to a completely seperate problem has has a major operation cancelled.  We are due to go back to clinic for this other problem but am worried that they will not go ahead again as this problem has not gone.  Prior to the endoscopy she had a barium meal which showed nothing, blood tests that also showed nothing.

[Gez]

Bad night last night - daughter awake - belching, feeling hot, etc.  Does anyone know if this is a side effect of erradicating treatment for h pylori?  Finished triple therapy over a week ago and now on omeperazole 20 mg daily.  Not much advice given from doctors.  Due to see doctor again at end of month.