H. pylori infection or atrophic Gastritis?

A 28 years old lady presented to my clinic with c/o epigastric burning sensation, nausea and vomiting particularly with spicy food. She also visited many doctors and evaluated with routine investigation. everything was normal. I started with PPI and antacid syrup. I have sent for endoscopy after 1 month of my treatment with no improvement. Endoscopy finding s/o small erosion over fundal area and 3 biopsy was taken for H. pylori but it was normal. At last even with normal report I have given 14 days course of Anti pylori drug regimen. patient improved and after 4 months also she didn't have any complaint which she had. Kindly comment on what I have missed as Even with negative H pylori test patient improved with anti Hpylori drug only. what to be done in this type of patient?



If patient would not have stopped PPI 2 weeks before rapid urease test it will come false negative. And biopsy is very specific but sensitivity is very low.

Rapid urease test was not done which I have advised but due to some technical issue it was not done. After 4 months if patient come to me, can I do it now as patient is not on any treatment at present?

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Many said peptic disease patient have underlying Gastrointestinal dysmotility disorder Therefore, they often respond to combination of proton pump inhibitor with motility agent such as Itopride Giving Antibiotic changes intestinal microbial flora, which results in loose motion, which indirectly improves GI motility, it gives rise to improvement in symptoms which we falsely attribute to antibiotics use Actually, addition of gastrointestinal motility agent would improve symptoms without any need of addition of Antibiotic

Thank you Doctor! Patient didn't have symptoms like loose stool even on antibiotics but your opinion is valuable.

This patient probably has gastritis with hyperacidity, causing erosions . Usual Anti HP drugs contain 1) PPI , which alleviate hyperacidity. 2) Metronidazole or tinidazole, which are effective against amoebiasis and giardiasis, which often cause gastritis. 3) Antibiotics, which steriles the gut and give relief from flatulence. So ,the so called Anti HP drugs can give relief to non HP cases also .

I agree

PPI. Esoprenazole BD. Pl.dont add Sucrafate wirh this PPI. Supimentry Megnesium should bd given.

Valuable opinion of yours. I have given combination of PPI and syp sucralfate but specifically advised pt to take both at different time as taking both togather can nullify the effect of each other. Thanks for your suggestions

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