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From: Ron ronh8semail@netscape.net
Date: 12/26/01
Time: 00:34:32 -0600
Hi Syd,
There ae those who have doubts in a report dated 1995 so here is a newer one, with the referrences grouped for easier counting.
Another has kept on saying that eradicaion of Hp can make symptoms worse. If that were a major problem, the FDA might already be warning sufferers to be careful and to expect this.
If Dr Mirkin had such results with his patients, I am sure that he is caring enough to warn us in his reports. He is not one to hide something as important as this, since he does not benefit from the sale of the meds that he prescribes.
The biopsies for HP are less than perfect because the infection is usually in patches and not all tissue is going to be affected. The blood test, does not diferentiate. If you test positive for HP, you test positive for HP. The more difficult cases are those with a variant of Helicobacter that does not show up in blood tests. If your doctor does not want to treat you after a positive test, just think what he would do if you had a different variety of Helicobacter.
Note: that the mention of burning in the stomach becoming worse after taking aspirin (asa) is a strong indication of helicobacter that is likely to progress to ulcers.
It is your body and as long as the risks of various treatments are fully disclosed, the ultimate treatment decision is yours to make. One thing for sure is that if you continue in the present direction, you may be on meds for a very long time.
If you are treated and should feel worse afterward, you could always get into some serious saliva swapping to get reinfected... :)
Ron ---------------------------------------------------- G123 -- updated 1/17/01
HELICOBACTER AND STOMACH ULCERS
Gabe Mirkin, M.D.
If you have belching, burping, a sour taste in your mouth, mouth odor, a white coated tongue or a burning pain in your stomach or chest, that gets worse when you are hungry and better when you eat, you probably have too much stomach acid. Doctors also call it ulcers, esophagitis, gastritis, duodenitis, achalasia, chalazia, hiatal hernia, reflux, etc. These terms mean that stomach acid is burning your gastrointestinal tract.*** Most people who have these symptoms have an infection with a bacteria called helicobacter pylori.***
If you have these symptoms, you need a blood test to see if you have helicobacter and a special x ray called an upper G.I. Series to rule out a cancer. Most gastroenterologists recommend that you have a tube inserted into your stomach to check for cancer. ****Since there are several bacteria that cause stomach ulcers, a negative blood test does not rule out a stomach infection. So I usually treat all people with gastritis symptoms with a one-week course of antibiotics: metronidazole 250 mg four times a day, clarithromycin 500 mg twice a day and omeperazole 20 mg once a day for one week. ****
At least 12 weeks later, you need a follow up blood test for helicobacter. If your symptoms are gone and the titre drops, you are probably cured. If your helicobacter titre is still high, your helicobacter is probably resistant to metronidazole and you need to be treated for at least ten days with amoxacillin 500 mg four times a day, tetracycline 500 mg three times a day and omeperazole 20 mg once a day (1). If you still have symptoms, you may need to have a tube put down your throat by a gastroenterologist. If you have regurgitation of stomach acid into your esophagus (reflux, hiatal hernia), you may need to be treated with 20 mg omeperazole once a day. ****Helicobacter is not the only bacteria that causes stomach symptoms, so some people who are not infected with helicobacter may benefit from taking clarithromycin or other antibiotic for a longer period of time.****
Helicobacter may also cause liver disease, blood vessel diseases such as clotting and heart attacks, and certain skin conditions such as rosacea.
1)Highly effective second-line anti-Helicobacter pylori therapy in patients with previously failed metronidazole-based therapy. Scandinavian Journal of Gastroenterology 32:12(Dec 1997):1209-1214.
* Blood tests are more dependable than endoscopy (having a tube put down your throat) to treat and follow helicobacter infections.
1) NA Alsomal, KE Coley, PC Molan, BM Hancock. Role of Helicobacter Pylori Serology in Evaluating Treatment Success. Digestive Diseases and Sciences 1993 (Dec);38(12): 2262-2266.
2) WM Wang, CY Chen, CM Jan, LT Chen, DS Perng, SR Lin, CS Liu. Long term follow up and serological study after triple therapy of Helicobacter pylori associated duodenal ulcer. American Journal of Gastroenterology 89: 10(OCT 1994):1793-1796.
3)MA Mendall, RP Jazrawi, JM Marrero, N Molineaux, J Levi, JD Maxwell, TC Northfield. Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy. Gut 36:3 (MAR 1995):330-333.
4) Z Maratka. Endoscopic diagnosis of gastritis: Pros and Cons. Journal of Clinical Gastroenterology 20:2(MAR 1995):92-93. The endoscopic characteristics of inflammation in the stomach, in contrast to those of the esophagus and colon, are inconspicuous or lacking, ''Endoscopic gastritis'' does not correlate sufficiently with ''histologic gastritis'' and the term ''gastritis'' is to be limited to cases confirmed histologically.
5) CA Fallone, GE Wild, CA Goresky, AN Barkun. Evaluation of IgA and IgG serology for the detection of Helicobacter pylori infection. Canadian Journal of Gastroenterology 9: 2(MAR-APR 1995):105-111.
6) TU Kosunen. Antibody titres in Helicobacter pylori infection: Implications in the follow-up of antimicrobial therapy. Annals of Medicine 27: 5 (OCT 1995):605-607. Success in eradication is reflected in 40-50% decrease of antibody titres within 5-6 months. The decrease continues and most patients have normal titres within 2 years.
7) RJF Laheij, JBMJ Jansen, EH Vandelisdonk, ALM Verbeek. Review article: Symptom improvement through eradication of Helicobacter pylori in patients with non-ulcer dyspepsia. Alimentary Pharmacology & Therapeutics 10: 6(DEC 1996):843-850. 8)M Feldman, B Cryer, E Lee, WL Peterson. Role of seroconversion in confirming cure of Helicobacter pylori infection. JAMA 280:4(JUL 22 1998):363-365
*Helicobacter negative people do not need endoscopy.
1) MA Asante, M Mendall, P Patel, L Ballam, TC Northfield. A randomized trial of endoscopy vs no endoscopy in the management of seronegative Helicobacter pylori dyspepsia. European Journal of Gastroenterology & Hepatology. 10: 12 (DEC 1998):983-989.
* Treat all stomach pain even if no ulcer is present.
1) McCarthy, C et al. Digestive Diseases and Sciences 1995;40:114-119.
2) Kuipers EJ at al. Atrophic gastritis and helicobacter pylori infection in patients with reflux esophagitis treated with omeperazole or fundoplication. NEJM 1996(April 18);334(16):1018-1022.
3) C Omorain, M Buckley. Helicobacter pylori and dyspepsia. Scandinavian Journal of Gastroenterology. 31: Suppl. 214 (1996):28-30. 6778 4/7/96
4) BS Sheu, CY Lin, ZX Lin, SC Shiesh, HB Yang, CY Chen. Long-term outcome of triple therapy in Helicobacter pylori-related nonulcer dyspepsia: A prospective controlled assessment. American Journal of Gastroenterology 91: 3 (MAR 1996):441-447. Compared with control therapy at 1 yr, triple therapy showed greater symptomatic, serological, and histological improvements. Therefore, triple therapy is beneficial to symptomatic HP-related NUD.
5) S Khulusi, S Badve, P Patel, R Lloyd, JM Marrero, C Finlayson, MA Mendall, TC Northfield. Pathogenesis of gastric metaplasia of the human duodenum: Role of Helicobacter pylori, gastric acid, and ulceration. Gastroenterology 110: 2 (FEB 1996):452-458. This study shows that the extent of duodenal GM is unrelated to the presence or absence of ulceration but is partly due to H. pylori and partly due to acid.
6) This study shows that blood tests to diagnose helicobacter are also more cost effective and save a hell of a lot of money. Annals of Internal Medicine August 15, 1995;123:260-268.
7) BJ Marshall. Managing acid peptic disease in the Helicobacter pylori era. Journal of Clinical Gastroenterology 21: Suppl. 1(1995):S155-S159. The advent of new diagnostic and therapeutic modalities for Helicobacter pylori allows any physician to offer curative antibiotic regimens to patients with peptic ulcer disease and gastritis. In the new strategy, patients with dyspepsia are investigated with serology to detect those with H. pylori and potentially curable peptic ulcers. Only those who are H. pylori-negative undergo endoscopy.
8)AF Cutler, VM Prasad. Long-term follow-up of Helicobacter pylori serology after successful eradication. American Journal of Gastroenterology 91: 1 (JAN 1996):85-88. A 20% decline in IgG concentration has an overall sensitivity of 93 % for determining H. pylori eradication 12-21 months after H. pylori treatment.
9) M Buckley, C Omorain. Prevalence of Helicobacter pylori in non-ulcer dyspepsia. Alimentary Pharmacology & Therapeutics 9: Suppl. 2(1995):53-58.
10) AF Cutler, VM Prasad. Long-term follow-up of Helicobacter pylori serology after successful eradication. American Journal of Gastroenterology 91: 1 (JAN 1996):85-88. A 20% decline in IgG concentration has an overall sensitivity of 93 % for determining H. pylori eradication 12-21 months after H. pylori treatment.
11) PA Testoni, E Colombo, L Cattani, M Longhi, F Bagnolo, F Lella, M Buizza, R Scelsi. Helicobacter pylori serology in chronic gastritis with antral atrophy and negative histology for Helicobacter-like organisms. Journal of Clinical Gastroenterology 22: 3 (APR 1996):182-185.
12) M Plebani, D Basso, M Cassaro, L Brigato, M Scrigner, A Toma, F Dimario, M Rugge. Helicobacter pylori serology in patients with chronic gastritis. American Journal of Gastroenterology 91: 5 (MAY 1996):954-958. Helicobacter pylori (Hp) serum IgG and Pepsinogen most accurately indicated Hp infection, and their product mag he proposed as an aid in diagnosing Hp infection in dyspeptic patients.
13)H Kawaguchi, K Haruma, K Komoto, M Yoshihara, K Sumii, G Kajiyama. Helicobacter pylori infection is the major risk factor for atrophic gastritis. American Journal of Gastroenterology 91: 5 (MAY 1996):959-962. 14)J Labenz, T Rokkas. Helicobacter pylori and dyspepsia. Current Opinion in Gastroenterology 13: Suppl. 1(1997):A Heaney, JSA Collins, RGP Watson, RJ McFarland, KB Bamford, TCK Tham.A prospective randomised trial of a ''test and treat'' policy versus endoscopy based management in young Helicobacter pylori positive patients with ulcer-like dyspepsia, referred to a hospital clinic.Gut, 1999, Vol 45, Iss 2, pp 186-190.
*Antibiotics will not cure reflux.
1) S Tefera, JG Hatlebakk, A Berstad.The effect of Helicobacter pylori eradication on gastro-oesophageal reflux. Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 915-920.Twelve weeks after H. Pylori eradication there was no consistent change in gastro-oesophageal acid reflux in patients with mild or moderate reflux oesophagitis.
2)FTM Peters, EJ Kuipers, S Ganesh, WJ Sluiter, EC KlinkenbergKnol, CBHW Lamers, JH Kleibeuker.The influence of Helicobacter pylori on oesophageal acid exposure in GERD during acid suppressive therapy.Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 921-926.
*A blood test for helicobacter is dependable, but can miss other bacteria that also cause stomach ulcers.
1) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.
2)MJ Blaser. Heterogeneity of Helicobacter pylori. European Journal of Gastroenterology & Hepatology. 9:Suppl.1 (APR 1997)S3-S6.
3) C Seidl,V Grouls,HJ Schalk.Bulboduodenitis associated with Helicobacter heilmannii (Gastrospirillum hominis) infection. A rare cause of duodenal ulcer. Leber Magen Darm 27: 3 (MAY 1997):156-159.
4)H Yoshida,K Hirota,Y Shiratori,T Nihei,S Amano, A Yoshida,O Kawamata,M Omata. Use of a gastric juice-based PCR assay to detect Helicobacter pylori infection in culture-negative patients. Microbiology 36:1(JAN1998):317-320.
5) C Dieterich, P Wiesel, R Neiger, A Blum, I Corthesytheulaz. Presence of multiple ''Helicobacter heilmannii'' strains in an individual suffering from ulcers and in his two cats. Journal of Clinical Microbiology 36: 5 (MAY 1998):1366-1370.
6) M Giladi, A Lembo, BL Johnson. Postural epigastric pain: A unique symptom of primary cytomegalovirus gastritis? Infection 26: 4 (JUL-AUG 1998):234-235.
7) RJ Owen. Helicobacter - species classification and identification. British Medical Bulletin 54: 1 (1998):17-30.
8) N Kitamoto, H Nakamoto, A Katai, N Takahara, H Nakata, H Tamaki, T Tanaka. Heterogeneity of protein profiles of Helicobacter pylori isolated from individual patients. Helicobacter 3: 3 (SEP 1998):152-162.
*Helicobacter is in the saliva of most people with stomach ulcers and is transmitted by kissing (2-11). so all people and their partners with belching and burning in the stomach should be given a 7-day course of antibiotics to cure their stomach irritation. It's also found in pets.
2) CF Li, TZ Ha, DA Ferguson, DS Chi, RG Zhao, NR Patel, G Krishnaswamy, E Thomas. A newly developed PCR assay of H-pylori in gastric biopsy, saliva, and feces: Evidence of high prevalence of H-pylori in saliva supports oral transmission. Digestive Diseases and Sciences 41: 11 (NOV 1996):2142-2149.
3) K Schutze, E Hentschel, B Dragosics, AM Hirschl. Helicobacter pylori reinfection with identical organisms: Transmission by the patients' spouses. Gut 36: 6 (JUN 1995):831-833.
4) Infection and Immunity 1994;62:2367-74.
5) K Shankaran, HG Desai. Helicobacter pylori in dental plaque. Journal of Clinical Gastroenterology 21:2(SEP 1995):82-84.
6) F Parente, G Maconi, O Sangaletti, M Minguzzi, L Vago, E Rossi, GB Porro. Prevalence of Helicobacter pylori infection and related gastroduodenal lesions in spouses of Helicobacter pylori positive patients with duodenal ulcer. Gut 39: 5 (NOV 1996):629-633.
7) SD Georgopoulos, AF Mentis, CA Spiliadis, LS Tzouvelekis, E Tzelepi, A Moshopoulos, N Skandalis. Helicobacter pylori infection in spouses of patients with duodenal ulcers and comparison of ribosomal RNA gene patterns. Gut 39: 5 (NOV 1996):634-638.
8) C Dieterich, P Wiesel, R Neiger, A Blum, I Corthesytheulaz. Presence of multiple ''Helicobacter heilmannii'' strains in an individual suffering from ulcers and in his two cats. Journal of Clinical Microbiology 36: 5 (MAY 1998):1366-1370.
9)Meining, G Kroher, M Stolte. Animal reservoirs in the transmission of Helicobacter heilmannii - Results of a questionnaire-based study. Scandinavian Journal of Gastroenterology 33: 8(AUG 1998):795-798.
10) J Fox. Helicobacters: the next generation. Baillieres Clinical Infectious Diseases 4: 3(NOV 1997):449-471V Singh, B Trikha, K Vaiphei, CK Nain, K Thennarasu, K Singh.Helicobacter pylori: Evidence for spouse-to-spouse transmission.Journal of Gastroenterology and Hepatology, 1999, Vol 14, Iss 6, pp 519-522.
N Chiba, ABR Thomson, P Sinclair. From bench to bedside to bug: An update of clinically relevant advances in the care of persons with Helicobacter pylori-associated diseases. Canadian Journal of Gastroenterology, 2000, Vol 14, Iss 3, pp 188-198.
*2% of Helicobacter stomach ulcer patients will develop stomach cancer. Helicobacter also increases heart attacks risk. However, stomach cancer risk is not increased in people who have duodenal ulcers.
1) NEJM July 25, 1996
2) R Barretozuniga,M Maruyama,Y Kato, K Aizu, H Ohta, T Takekoshi, SF Bernal.Significance of Helicobacter pylori infection as a risk factor in gastric cancer:Serological and histological studies. Journal of Gastroenterology 32: 3 (JUN 1997):289-294.
3)JH Siman,A Forsgren,G Berglund,CH Floren.Association between Helicobacter pylori and gastric carcinoma in the city of Malmo, Sweden-A prospective study. Scandinavian Journal of Gastroenterology 32: 12(DEC 1997):1215-1221.
4) E Ierardi, R Francavilla, C Panella. Effect of Helicobacter pylori eradication on intestinal metaplasia and gastric epithelium proliferation. Italian Journal of Gastroenterology and Hepatology. 29: 5 (OCT 1997):470-475.
5) S Tsuji, M Tsujii, WH Sun, ES Gunawan, H Murata, S Kawano, M Hori. Helicobacter pylori and gastric carcinogenesis. Journal of Clinical Gastroenterology. 25: Suppl. 1(1997):S186-S197.
6) R Cheli, M Crespi, G Testino, F Citarda. Gastric cancer and Helicobacter pylori: Biologic and epidemiologic inconsistencies. Journal of Clinical Gastroenterology 26: 1 (JAN 1998):3-6.
7) V Pasceri, G Cammarota, G Patti, L Cuoco, A Gasbarrini, RL Grillo, G Fedeli, G Gasbarrini, A Maseri. Association of virulent Helicobacter pylori strains with ischemic heart disease. Circulation 97: 17 (MAY 5 1998):1675-1679.48-51. J Danesh. Helicobacter pylori infection and gastric cancer: systemic review of the epidemiological studies.Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 851-856.
K Haruma, K Komoto, T Kamada, M Ito, Y Kitadai, M Yoshihara, K Sumii, G Kajiyama. Helicobacter pylori infection is a major risk factor for gastric carcinoma in young patients. Scandinavian Journal of Gastroenterology, 2000, Vol 35, Iss 3, pp 255-259.
*Treat a positive blood test for Helicobacter in people who have burning only when they take aspirin.
1) JW Konturek, A Dembinski, SJ Konturek, J Stachura,W Domschke. Infection of Helicobacter pylori in gastric adaptation to continued administration of aspirin in humans. Gastroenterology 114: 2 (FEB 1998):245-255.
2) RI Russell. Helicobacter pylori eradication may reduce the risk of gastroduodenal lesions in chronic NSAID users. Italian Journal of Gastroenterology and Hepatology. 29: 5 (OCT 1997):465-469.
3) CY Wu, SK Poon, GH Chen. Is Helicobacter pylori a risk factor for NSAID- associated gastric ulcer bleeding? A sex- and age-matched case-control study. Advances in Therapy 15: 2 (MAR-APR 1998):85-91.
*All people with stomach burning should receive antibiotics.
1) H. helmannii, H. felis, H. rappini, H. cinaedi, H. fennelliae and H. pullorum, cytomegalovirus and mycoplasma.1)JG Kusters, EJ Kuipers. Non-pylori Helicobacter infections in humans. European Journal of Gastroenterology & Hepatology. 10: 3 (MAR 1998):239-241.
2) JC Debongnie, M Donnay, J Mairesse, V Lamy, X Dekoninck, B Ramdani. Gastric ulcers and Helicobacter heilmannii. European Journal of Gastroenterology & Hepatology. 10: 3 (MAR 1998):251-254.
3) MA Stone, DB Barnett, JF Mayberry. Lack of correlation between self-reported symptoms of dyspepsia and infection with Helicobacter pylori, in a general population sample. European Journal of Gastroenterology & Hepatology. 10: 4 (1998):301-304.
4) 1) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.
5) MJ Blaser. Hetero- geneity of Helicobacter pylori. European Journal of Gastroenterology & Hepatology. 9:Suppl.1 (APR 1997)S3-S6.
6) C Seidl,V Grouls,HJ Schalk.Bulboduodenitis associated with Helicobacter heilmannii (formerly Gastrospirillum hominis) infection. A rare cause of duodenal ulcer. Leber Magen Darm 27: 3 (MAY 1997):156-159.
7) H Yoshida,K Hirota,Y Shiratori,T Nihei,S Amano, A Yoshida,O Kawamata,M Omata. Use of a gastric juice-based PCR assay to detect Helicobacter pylori infection in culture-negative patients. Microbiology 36:1(JAN1998):317-320.
The antibiotics are effective only with ulcer medication.
1) D Scott, D Weeks, K Melchers, G Sachs. The life and death of Helicobacter pylori. Gut 43: Suppl. 1 (JUL 1998):S56-S60. In the absence of division, antibiotics such as clarithromycin and amoxycillin are ineffective. Proton pump inhibitors, by elevating gastric pH, would increase the population of dividing organisms and hence synergise with these antibiotics.
Health Reports from The Dr. Gabe Mirkin Show and DrMirkin.com
Transcripts of segments of The Dr. Gabe Mirkin Show are provided as a service to listeners at no charge. Dr. Mirkin's opinions and the references cited are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.