MALT Lymphoma

After many years of H.pylori infection a cancer can develop in the stomach. This is particularly common in Latin America and Asia (esp. Japan). It is believed that lifelong inflammation of the stomach lining causes low acidity which then allows carcinogens to be active in the stomach. These then cause stem cells (part of the healing process) to mutate and become cancer cells.

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ML-HELLico_Bacttle
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Re: MALT Lymphoma

Post by ML-HELLico_Bacttle » Sat Dec 15, 2018 7:07 pm

Doing it concurrently: the susceptibility test involves biopsies.
I will have to do a follow up endoscopy some time after this therapy.
When I personally talked to the gastroenterologist she seemed to be unfamiliar to that procedure, not knowing exactly where they would do that susceptibility test but certainly not at the institute.
I have recently found an article that mentioned that the European directive is to do that test before the 2nd line of treatment!…

Today I started the 3rd line therapy/attempt.
The Amoxicillin 1g box has 16 so I'll try to do 3x daily for 5 days, as you suggested.
I'm 1.74m (5.7f) tall & around 62Kg (136p). Is that dosage Ok?
Important: I have seen some references — and the Amoxicillin's insert also states this — that the dosage specifically for H. Pylori should be 1g 2x a day, whereas other infections have superior dosage recommendations. Could there be a reason why in this particular case oh H.P. more Amox is less?
I need the most efficacy.

If H. Pylori is unlikely to gain resistance to Amoxicillin then why did my 1st triple therapy (20170806SUN—20170820SUN Triple Therapy: 14+1 days of Cipamox (Amoxicillin) 500mg + Klacid (Clarithromycin) 500mg + Omeprazole 20mg) fail?

The pharmacist gave me a generic Amoxicillin. The package insert mentions its active substance is Amoxicillin in the form of Amoxicillin Trihydrate. Is this Ok?

Regarding the addition of Bismuth: I found Ranitidine (Bismuth Citrate) 150mg, a little expensive but sold without a prescription. Is this Ok?
I'm taking the Rabeprazole in the morning & evening. How can I fit the Ranitidine?

You've said before that you didn't do any changes to your patients diet & still got high success rates.
The thing is: what is your average patient's diet like?
Mine is plant-based so it may contain a lot of calcium & iron. Maybe I should mimic a poorer diet when I take antibiotics.
Last edited by ML-HELLico_Bacttle on Fri Dec 21, 2018 7:25 am, edited 1 time in total.

Helico_expert
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Re: MALT Lymphoma

Post by Helico_expert » Sun Dec 16, 2018 10:01 am

If H. Pylori is unlikely to gain resistance to Amoxicillin then why did my 1st triple therapy (20170806SUN—20170820SUN Triple Therapy: 14+1 days of Cipamox (Amoxicillin) 500mg + Klacid (Clavulanic Acid) 500mg + Omeprazole 20mg) fail?
Good question. In fact, this had been asked many many times over many decades. Nobody actually know why. We only know that when Amoxicillin is used alone with PPI, the cure rate is 50% or less. Some studies are still on trial to see how to boost Amoxicillin cure rate to above 80%. Nevertheless, earlier trial had shown that PPI + Amox + Clarithromycin, the cure rate can go up to above 80%. Hence, this became the standard therapy for effectively eradicating H. pylori. Then over the years, the cure rate of this standard therapy has dropped in many countries. In Europe, triple therapy had already been abandoned and replaced by quadruple therapy.


Generic Amoxicillin would be fine.
Ranitidine + bismuth citrate combo would be fine too. However, each pill has about 160mg of bismuth. Prof Marshall normally prescribes 960mg per day. So it's probably better to get bismuth itself at a more reasonable price. Try search pepto-bismol.
https://www.ncbi.nlm.nih.gov/pubmed/9640487

our patients are very diverse. only about 50% of our patients are European. The rest are from all around the world (Asian about 30%).

ML-HELLico_Bacttle
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Re: MALT Lymphoma

Post by ML-HELLico_Bacttle » Sun Dec 16, 2018 7:07 pm

So do you know why they only recommend Amoxicillin 1g 2x a day for H. Pylori?
Nobody actually know why.
The pharmacist said something that is strange to me but I'd like to confirm:
he said that maybe I (my body, not my H. Pylori) is resistant to antibiotics.
Is this possible?

Another theory I've read somewhere, if I understood well, is that for the Amoxicillin to work the bacteria have to be in a phase of detachment from the stomach cells, which I believe is not my case.

We only know that when Amoxicillin is used alone with PPI, the cure rate is 50% or less.
Wow!… So I'm going nowhere with either the 1st or the 2nd part of this therapy besides damaging my microbiome…
I feel completely lost in this… They should have tailored a custom therapy for my case based on updated studies…

Regarding prof Marshall's concern to neutralize all stomach acid:

- I don't seem to find Pepto-Bismol anywhere near. I have already started the therapy so it's too late for ordering it online…
However Pepto-Bismol has only 262mg of Bismuth Subsalicylate. Quite far from Dr Marshall's 960mg.
Shall I buy the Ranitidine and take 2 pills before I take that 3rd Amox?
Considering the poor chances of my therapy is this any worth at all?…

- Rabeprazole's half-life is 1H.
Does this mean that within 1H I should take it, eat & have the Amoxicillin 1g?
I've been taking it about 30min before breakfast & dinner so that I can still slip some probiotic capsules in the hope the ppi will create an acid-free-way for them. But I've also read that the ppi is only activated when people start to eat.

- Drinking at meals is exactly what people should not do because it dilutes stomach acid.
What if I drank a lot of pH9.5 water with the Amoxicillin in order to alkalinise the environment?

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Re: MALT Lymphoma

Post by Helico_expert » Sun Dec 16, 2018 10:47 pm

Amoxicillin 1g, 2x a day is normally work for general public. But when dealing with resistant case, it can be increased to 1g, 3x a day.

Amoxicillin is an antibiotic that inhibit the cell membrane synthesis. So you can imagine that the bacteria cell duplicating itself without a cell membrane, hence burst and died. Antibiotics like this are called bactericidal.

Some antibiotics, eg tetracycline, actually target bacteria protein synthesis. So bacteria cells are not duplicating. Strategy like this is delaying the bacteria load going up and depending on the human immune system to fight back and kill off the bacteria. Antibiotics like this are called bacteriostatic.

So you can imagine when these two types of antibiotics, bactericidal and bacteriostatic, are used together. The bacteriostatic can interfere with the bacericidal and reduce the efficacy.

I think that's what you read somewhere. In your case, it doesnt matter.

Since you cannot find bismuth now, I think you just follow your doctor's current protocol and finish the treatment. See how it goes. meanwhile, get ready for Plan C when this treatment fail.

In regards to Rabeprazole, just take it consistently everyday. The effective dose will maintain your blood stream and your stomach acid will be controlled. it doesnt matter if it is taken before or after meal. Taking it consistently daily is the key.

I have no experienced with alkaline water. But I would believe that whatever alkaline based food base product would be weak base. It wont have impact when it mix with stomach acid, which is a strong acid.

ML-HELLico_Bacttle
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Re: MALT Lymphoma

Post by ML-HELLico_Bacttle » Mon Dec 17, 2018 12:51 am

Yes, that was it, now I remember: Amoxicillin acted IF the bacteria were in a duplication phase.
Ok, so the Amoxicillin I'm taking just stops the bacteria population from growing. It does nothing to the ones that are already established, right?

And is the Levofloxacin 500mg, which I'm supposed to take on the 2nd half of the therapy, a bactericidal or a bacteriostatic?

Yes, I keep taking Rabeprazole consistently 2x day but: even though I'm taking Amoxicillin 3x a day?
I thought Rabeprazole, with its 1H half-life, always preceded Amox to protect it from stomach acid.

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Re: MALT Lymphoma

Post by Helico_expert » Mon Dec 17, 2018 9:24 am

Amoxicillin is a bactericidal. It kills bacteria that is actively dividing. H. pylori is a very slow grower, perhaps that explain a little why Amoxicillin alone is not enough to kill it.

Levofloxacin, is also a bactericidal, targets the bacterial enzyme that is needed for DNA replication. So as the cells are actively dividing, there is no DNA available, hence the cells died.

Dont worry about the rabeprazole half life. here is a 24 hr monitor of 1 dose 20mg rabeprazole.

Image
https://img.medscapestatic.com/fullsize ... 23.fig.gif

as you can see from the graph, rabeprazole is slightly better than other PPI in maintaining the pH higher. So by taking 2 doses of rabeprazole day and night, that would be sufficient in holding the acid secretion.

ML-HELLico_Bacttle
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Re: MALT Lymphoma

Post by ML-HELLico_Bacttle » Tue Dec 18, 2018 3:45 am

Considering the progress of my stomach since the 1st therapy, which featured Amoxicillin: it does seem to have done something; It apparently wiped out some load of H. Pylori because the initial ulcer I had on the Greater Curvature healed and the atrophic gastritis on the Fundus got better.

But if H. Pylori replicates too slowly for bactericidals then I really don't understand what this new therapy is trying to do with 5 days of Amoxicillin alone...
Today I went to the institute but because the oncologist is always busy I've left him a note.
He was supposed to call me but he didn't... They're simply ignoring me…
All I have is your answers.

You wrote that bacteriostatic antibiotics target bacteria protein synthesis.
Is this protein synthesis part of their replication process or do you mean that those antibiotics can attack non-replicating bacteria?
You also wrote that those delay the propagation of the bacteria and depend on the immune system to fight them back.
That's not the case with H. Pylori's because the immune cells are disarmed, right?

There's something regarding bactericidal antibiotics I didn't fully understand:
Let's say that HP-A is trying to replicate itself to HP-B.
Amoxicillin only inhibits cell membrane synthesis in HP-B or does it also destroy HP-A because it's trying to replicate?
If it is the latter: I've read that H.P. uses iron to proliferate, hence Anemia being a symptom of the infection. I wonder if increasing the iron intake, away from Amoxicillin dose of course, would incite H. Pylori to replicate.

Thanks for the graph. I'll only take Rabeprazole 2x daily then.
But what do you think of Dr Marshall's statement to someone else "If you can take extra PPI then quadruple the omeprazole dose to 80 mg per day as it strengthens the amoxicillin effect." (20100406TUE)? Is it outdated?

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Re: MALT Lymphoma

Post by Helico_expert » Tue Dec 18, 2018 9:17 am

Considering the progress of my stomach since the 1st therapy, which featured Amoxicillin: it does seem to have done something; It apparently wiped out some load of H. Pylori because the initial ulcer I had on the Greater Curvature healed and the atrophic gastritis on the Fundus got better.
Your ulcer healed because the acid is blocked. In olden days, before the discovery of H. pylori, patients rely on long term PPI to heal ulcers. So I dont think it's the contribution of Amoxicillin.
But if H. Pylori replicates too slowly for bactericidals then I really don't understand what this new therapy is trying to do with 5 days of Amoxicillin alone...
Somebody developed this strategy to use PPI + Amox to kill off majority of the H. pylori. Then boost the treatment with another 2 antibiotics to kill off the rest.
Is this protein synthesis part of their replication process or do you mean that those antibiotics can attack non-replicating bacteria?
the protein synthesis is part of life. it could be for replicating and it could be for its survival. eg. digesting nutrient, processing other proteins, etc. So non replicating bacteria doesnt mean it's not doing anything else. The bacteriostatic antibiotics will halt everything the bacteria cell is doing. of course, not 100%. some enzymes may still escape the antibiotics and mutate and become resistant.
You also wrote that those delay the propagation of the bacteria and depend on the immune system to fight them back.
That's not the case with H. Pylori's because the immune cells are disarmed, right?
it is true that the immune system is not able to get rid of H. pylori normally. However, I am not sure what if the H. pylori is "disarmed" by bacteriostatic antibiotics. Perhaps the immune system can regain some activity to kill off some H. pylori. This area is not being investigated.
Let's say that HP-A is trying to replicate itself to HP-B.
Amoxicillin only inhibits cell membrane synthesis in HP-B or does it also destroy HP-A because it's trying to replicate?
when HP-A is divided into HP-A and HP-B, both cells will be destroyed because of lacking cell membrane. You can imagine that during cell replication, the membrane is being stretched too thin and burst.
But what do you think of Dr Marshall's statement to someone else "If you can take extra PPI then quadruple the omeprazole dose to 80 mg per day as it strengthens the amoxicillin effect." (20100406TUE)? Is it outdated?
The key is keep the stomach acid as neutral as possible. omeprazole is not a very good PPI because some people has very quick metabolic rate on omeprazole. So the time omeprazole is actually doing work in the body is less.

ML-HELLico_Bacttle
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Re: MALT Lymphoma

Post by ML-HELLico_Bacttle » Thu Dec 20, 2018 4:02 am

Your ulcer healed because the acid is blocked.
After the 1st therapy I did keep taking Esomeprazole for about a month or so. Then I called the institute to ask if I could quit taking it.
I'm not sure if one month would be enough time to heal an ulcer. And from then on I never again took a PPI except for the duration of Pylera, in May, and now this 3rd therapy.
If Amoxicillin did little about H. Pylori: wouldn't it have had time by now to have caused another ulcer?
(Probably it doesn't need to, I suppose, because it's already on the inside...)

Somebody developed this strategy to use PPI + Amox to kill off majority of the H. pylori. Then boost the treatment with another 2 antibiotics to kill off the rest.
Ok, I'm about to enter phase 2 of the therapy:
Day 06 to 10: Rabeprazole 20mg 1Capsule 2x-A-Day + Levofloxacin 500mg 1Capsule 1x-A-Day + Tinidazole 500mg 1Capsule 2x-A-Day

I'm not sure if I should take Levofloxacin at the same time as Tinidazole... I couldn't reach the oncologist...

Although I'm supposed to take Tinidazole 1Capsule 2x-a-day its insert actually advises for most infections to start with the double dose.
As I have 12Capsules for the 5 days I guess that's what I'll do; so instead of taking just 2Capsules on the first day I'll take 4Capsules.
I'm hoping that they advise this in order to hit the bacteria with a bigger dose right from the start.

Following the same logic:
The Levofloxacin box has 7Capsules.
As it's a 5 day treatment: can I start it heavier taking 2Capsules on the first 2 days instead of just 1?
As its a fluoroquinolone I better ask first. The insert lists several dosages for several sorts of infections (except H.P.) but never above 500mg.

I found Ranitidine 300g.
Do you think it could still boost the efficacy of the 2nd phase of the treatment?

Also: no one warmed about this but the Levofloxacin insert mentions that it should not be taken with antacids containing magnesium. Well, Rabeprazole seems to contain magnesium so I guess I better get both apart.

If so: what if I did it this way?:
Morning: Rabeprazole 20mg + Tinidazole 500mg
Afternoon: Ranitidine 300g + Levofloxacin 500mg
Night: Rabeprazole 20mg + Tinidazole 500mg

some people has very quick metabolic rate on omeprazole. So the time omeprazole is actually doing work in the body is less.
Normally it is said that when the stomach pH is higher the esophagus sphincter relaxes and causes some reflux or heartburn, even minor.
If Rabeprazol is actually working in raising my stomach pH shouldn't I be feeling something like that?

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Re: MALT Lymphoma

Post by Helico_expert » Thu Dec 20, 2018 8:52 am

For dosage of antibiotics, you better ask your doctor before changing it yourself.

to boost cure rate, you can continue amoxicillin on phase 2 if you want.

when pH is low, it's acidic. When pH is up, it's alkaline. So Rabeprazole stop acid production and your stomach pH will rise from acidic to neutral.

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