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Suggest treatment for H. pylori infection

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Posted on Tue, 29 Mar 2016
Question: HELLO Doctor i have a long list of concerns. Please go through my queries with patience. I am here to discuss about my problems related to (1)H Pylori infection (2)Thyroid Gland (3)Respiratory Alkolisis (4)Anxiety

(1)H PYLORI INFECTION

I tested positive for H Pylori Infection 2 months back. Since then my doctor has completed 2 rounds of Pantocid Hp kit . First round of treatment comprised of 14 days pantocid hp along with 15 days Pantocid 40 mg on an empty stomach. After first round of treatment i started to feel better but unfortunately bad days came back to haunt me. I went back to my doctor with my stomach complaints. After investigation he advised Pantocid Hp for another 14 days along with 1 month Pantocid 40 mg on an empty stomach. I finished the treatment few days back and then for my convenience had a stool test (H Pylori Antigen test, Stool Elisa method) which came back positve. Now my doctor has advised a 3rd round of treatment. He told me to take pantocid hp for another 15 days and pantocid for 1 month on empty stomach. My questions are

(a)How long will it take to eradicate H Pylori completely and what will happen if stool test keep coming back positive after completing the antibiotic course?
(b)Please suggest some good probiotics which can be avaliable in XXXXXXX stores to improve function of the stomach? Is it advisable to take probiotics in between the treatment or after the treatment?
(c)I have also heard that H Pylori is resistant to antibiotics, if this is true then why isnt my doctor changing the medicines to treat the infection?

(2)THYROID GLAND

Recently i had an USG of my thyroid gland. The report as stated by my doctor is normal but still i am finding it suspicious. On my report something about nodules have been written in bold letters. I dont understand what does it mean. I wanted to know whether nodules grow because my doctor has told me to repeat USG of thyroid after 6 months. I also wanted to know can nodules shrink on its own if its benign?

(3)RESPIRATORY ALKOLISIS

Recently i had ABG test done and my carbon dioxide levels were low. Doctor told i have respiratory alkolisis and this is the second time my co2 levels have become low. Can you tell me why co2 level falls?. My doctor instructed me to breathe into a paper bag to restore the normal levels of co2. Well the first time when i did it the level did balance but now again my co2 levels have gone below range. Please let me know a way by which respiratory alkolisis can be prevented in the future?

(4)ANXIETY

Sometimes the portion of my head just above the right ear starts feeling tight as if somebody is pressing it hard over that region. Although i dont experience any pain i would like to know if this episode is caused by anxiety or due to some other underlying problem or its because of alkolisis

These are my questions. I thank you for taking time to addressing my queries
doctor
Answered by Dr. Ratnakar Kini (8 hours later)
Brief Answer:
Need more information

Detailed Answer:
Hi,
Thanks for posting your query.
I am Dr.R.K and I am pleased to assist you.

I need some more information before I can assist you.

1. How many days after completing anti H.pylori treatment you did the stool antigen test?
2. What is the endoscopy report?

3. Why was USG of neck and ABG done?

When was ABG done?
Upload the ABG report also.

Reports,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ratnakar Kini (4 hours later)
Hello Doctor

(1) i started taking pantocid hp from 17th November 2015 till 2nd December (15 days). Then i took pantaprazole 40 mg for 15 days. After the first round the symptoms didnt subside so i started second round of triple therapy from 20 december till 2nd January.(15 days) Since 2nd January i was taking pantaprazole 40 mg till 17th January. After which i experienced too much stomach heat all the time so my doctor advised to continue pantaprazole for another 20 days. I had stool antigen test on 30th January while i was on medicines. Now the stool test has come out to be positive so he has advised 3rd round of treatment

(2)Sorry Endoscopy was not done in my case therefore i dont have the report

(3)USG of neck was done because i was suffering from hypocalcemia. Doctor wanted to find the exact cause of the problem that is why i had an USG done. He ordered PTH, LFT and KFT too. I have attached the reports with the response.

(4)ABG was done on 28th January. It was done for a follow up treatment because i had alkolisis a month back.

Please let me know about the thyroid report too because i am tensed about the report. Thanks
doctor
Answered by Dr. Ratnakar Kini (20 hours later)
Brief Answer:
Upload thyroid function test report

Detailed Answer:
Hi,
Stool antigen testing should be done done one week after the completing the treatment and not while on treatment.
So you repeat the test, one week after stopping pantoprazole.

If still positive there are other modes of treatment like rescue therapy about which you can discuss with you doctor.

You can get an upper GI endoscopy done and see if you have any lesions inside caused by H.pylori.

You have only colloid goiter. Use iodine fortified salt for cooking.
I do not find thyroid function test in the attached reports. Please upload it.

Regards,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ratnakar Kini (11 hours later)
Hello Doctor

I have uploaded the Thyroid Report(T3 T4 TSH). I have few questions

(1)Since my thyroid is functioning properly as per the report and the nodules are benign there is no reason to worry at this moment. BUT I AM ASKING YOU FROM FUTURE POINT OF VIEW. Will my collide nodule on left lobe and cystic nodule on right lobe increase in size?
(2)Is there any way by which the nodules can shrink on there own?. If yes then please do give me some satisfactory explanation on what should be done to shrink the nodules on its own. I also heard that if nodules grow so large that it causes trouble while speaking or swallowing then during that stage the entire thyoroid is surgically removed. I am scared of surgery and i am very young and want to live a peaceful life. SO please give me some advice on this thyroid problem with future point of view.
(3)Thirdly, what should i do for H Pylori. On evaluating the stool test report My brother in law who is a doctor has advised to start third round of PANTOCID HP for 15 days. In the past i have already finished 1 month course of Pantocid Hp and 1 month of Pantaprazole (i am still taking pantaprazole on empty stomach ) But even today I do experience some symptoms like mild burning sensation in stomach, flatulence and bloating .. So after seeing the stool test report what can we conclude about H Pylori and what should be done at this moment?
(4)Fourthly, i am having a muscle tension headache since yesterday. I feel like something is pressing my right head above my ear all the time. So please advice treatment

Regards
XXXX
doctor
Answered by Dr. Ratnakar Kini (19 hours later)
Brief Answer:
Answer given below

Detailed Answer:
Hi,
They will not increase in size unless there is iodine defiency.
Yes, if the size increases and causes symptoms, surgery is the treatment.
For more on thyroid issues, you can post your question separately in Endocrinology section and our Endocrinology expert would answer your questions.

There is failure of treatment of H.pylori twice. So you need to change the treatment. As mentioned earlier you need to switch to rescue therapy. Consult your doctor to discuss about it and get a prescription for rescue therapy for H.pylori.

For simple headache with no other symptoms , you can take Dolo- 650 thrice a day.

Let me know if you have any more questions.
Regards,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ratnakar Kini (3 hours later)
Hello Doctor

Thanks for the response. I would like to know

(1) How do i increase iodine in my diet. I dont have time to cook so i want to quicker and easy method to fulfill the total daily requirements of iodine. Please do mention how much amount of iodine is required for men everyday

(2)Since 2 days i have been feeling too much fatigue. Its like i need to force myself to walk. I get easily tired when climbing upstairs or after doing any simple physical activity. Right now i am doing nothing apart from watching tv and browsing the net. I stat at home all day but in the past i used to be physically active. So I think its because of my lethargic lifestyle because all my tests have been evaluated and they were reported to be normal. Can you suggest some way by which i can revive my energy levels to become alright.. Any supplements that i can take to recover from this fatigue like situation. I am having a tough time therefore i request you to give me the best advice for this problem

Regards
XXXX
doctor
Answered by Dr. Ratnakar Kini (24 hours later)
Brief Answer:
Consult endocrinologist

Detailed Answer:
Hi,
Just use iodized salt.
It has adequate iodine.
I really wonder how you developed colloid goiter at this age as it is not very common in males. As advised earlier you can consult an endocrinologist for proper evaluation.

Since the tests are normal, the fatigue is due to poor/lethargic lifestyle.
You can indulge is some sports activities or go for walk or jog every day.

Regards,
Dr.R.K.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ratnakar Kini

Gastroenterologist

Practicing since :1994

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Suggest treatment for H. pylori infection

Brief Answer: Need more information Detailed Answer: Hi, Thanks for posting your query. I am Dr.R.K and I am pleased to assist you. I need some more information before I can assist you. 1. How many days after completing anti H.pylori treatment you did the stool antigen test? 2. What is the endoscopy report? 3. Why was USG of neck and ABG done? When was ABG done? Upload the ABG report also. Reports, Dr.R.K.