H Pylori image

Helicobacter Pylori

My long-standing digestive issues already caused me regular grief, but I began noticing new symptoms in the fall/winter of 2019. In particular, frequent severe heartburn without any change in diet, intermittent stomach pain that got worse when I was hungry, and belching. My new heartburn was very localized to the top of my gut, in the area where the esophagus and stomach meet. It was also present several times a day.

Actually, H Pylori’s full name is Helicobacter Pylori (a better name would be “Hell”icobacter) and as many as 2/3 of us have this spiral shaped bacteria in our gut. Most of us will never have symptoms, but sadly I did. They can include abdominal pain, heartburn, stomach bloat and belching, nausea and even weight loss. When H Pylori causes these symptoms, it’s a result of it attacking your stomach lining. If left untreated it can cause ulcers and, in some cases, can lead to stomach cancer. In fact, experts now think ulcers are caused almost entirely by H Pylori and not by consumption of spicy or acidic foods.

Diagnosis

I waited until we got to Vancouver in mid-January before our Australia trip, and went to my GP. He ordered a urea breath test and it came back positive. Treatment for an H Pylori infection is a pretty challenging 10-14 day triple regimen of antibiotics, a Proton Pump Inhibitor (PPI) and probiotic, with no alcohol. As I was leaving for a planned seven week trip to Australia and Asia in a few days, we opted for just the PPI to treat the heartburn while away, with antibiotic treatment to begin upon my return.

PPIs, by the way, are essentially extreme antacids. However, where Rolaids or Gaviscon just subdue symptoms, PPIs work by reducing the production of stomach acid in the first place. I was prescribed Pantoprazole. While away, my usual IBS stuff was tolerable and the Pantoprazole killed my acid reflux and heartburn almost completely, allowing me to enjoy the Aussie craft beer and coffee.

Antibiotic hell

By the time we returned from Bali mid-March due to COVID, in addition to all the paranoia, quarantining, and realization that our year of travel was toast, my heartburn was beginning to bother me more. I quickly obtained the antibiotic prescriptions I’d been given at the end of January and began my two-week, beer-free, eight pill a day regimen. It was brutal. While the worst H Pylori symptoms disappeared relatively quickly, the medications caused a host of new unpleasantries. A persistent strong metallic taste, stinging tongue and a special brand of black curdled diarrhea (all documented and to be expected).

After I finished the regimen and quit the PPI completely, things were pretty good for a month or so. I had no gut problems, including total remission of my heartburn. However, by sometime into May my symptoms had returned and the heartburn was as bad as it was before I used the PPI. I went back on the Pantoprazole, but I still had the gut aches and excessive gas. So, I arranged a phone consult with my doctor to discuss.

The thing with H Pylori is that it’s a tough little bacterium. Not only is it specifically suited to live in stomach acid, but it tends to become antibiotic-resistant. By the time you get symptoms, you’ve probably had it many years. As such, if you’ve been prescribed antibiotics for something in the past – many times in my case for sinus infections – one round often doesn’t get rid of it. So, my doctor prescribed another urea breath test to determine if I still had it. That would have been great, except that when I went to the lab the breath tests had been suspended due to COVID, so testing would need to take one of the other forms.

Of the remaining options, only a stool test would be possible. A blood antibody test only shows if you’ve ever been infected and a stomach biopsy is only possible during an upper endoscopy. Sadly, a stool antigen test required being off all medications for 3-4 weeks, and my heartburn was bad enough that I really didn’t want to stop the Pantoprazole for three weeks, then wait up to another two for results. Luckily, based on my symptoms, my doctor agreed to put me on another antibiotic regimen. It still included two-a-day PPIs, but a smaller antibiotic cocktail for only ten days this time. I found it much easier on my system and, again, it worked well for month or so, but I remained on the Pantoprazole.

By mid-to-late June I was, yet again, dealing with symptoms. After another consult with my doctor he referred me to a Gastroenterologist to arrange for an upper endoscopy. I get into a little more detail on my scopes (yes, plural) here if you’re interested, but as with most medical services, COVID was making these referrals take a long time and completed entirely by phone.

In the end

It would be August before the referral came through, September 22nd before my phone consult and October 15th before I had an upper endoscopy and colonoscopy. I remained on Pantoprazole (and still am as of this writing in November) and in the meantime, dealt with the stress of a positive FIT.

While it didn’t feel like it initially, obviously my two rounds of antibiotics did ultimately work. I suspect some of my residual stomach issues were stress-related, or possibly due to not being as careful with trigger foods as I should have been. Since the system clean-out and scopes, I’ve had no H Pylori symptoms and the biopsy taken during my endoscopy indicated that it’s gone.

Considerations

All I can really say is, if you experience the sudden onset of heartburn and gut pain for no apparent reason, ask your doctor to get you tested for H Pylori. As well, if you test positive, ask about the quadruple therapy with bismuth, because it’s supposed to be much better at fighting antibiotic resistance, and it’s a difficult infection to get rid of.

Finally, while there are potential side-effects of long-term use, a PPI like Pantoprazole can be very effective at dealing with chronic heartburn and acid reflux. When I “treated” my acid reflux, for years I used Pepcid or Pepto Bismal. These do nothing but mask symptoms, but are probably fine if you have rare acid and heartburn due to things like spice or coffee. However, if your condition is chronic, then you might find more relief from a PPI prescription. I’m not suggesting you want to take these long-term, because they can have side effects.

In particular, long-term PPI use can be associated with magnesium deficiency, so in addition to my B complex and probiotic, I take 200mg of magnesium while I’m on Pantoprazole. Whether during our Australia trip or since, the reduction of stomach acid has made a huge improvement to my gut health. At present I am still on Pantoprazole, but very soon I’m going to test weaning myself off again.