Understanding RUT Results for H. pylori Infection: Questions and Concerns
As a recent graduate from a medical school in India, I recently encountered a case involving a family suffering from symptoms like dyspepsia and heartburn. These issues had persisted for several months, even after they intermittently used proton pump inhibitors (PPIs) and antacids without completing any specific treatment. After I suggested consulting a gastroenterologist, the family underwent endoscopic examinations and Rapid Urease Tests (RUT). One family member, a 60-year-old male, was diagnosed with a small gastric polyp located at the fundus. His RUT yielded an immediate positive result, prompting the gastroenterologist to recommend a quadruple therapy regimen consisting of Colloidal Bismuth Subcitrate, Metronidazole, Tetracycline, along with Fexuprazan and Acotiamide, since he had already completed the standard triple therapy a year prior. The other two family members did not present any significant endoscopic findings apart from a few areas of erythema and erosion. Consequently, they were given a month’s supply of PPIs. However, the following day, they noticed that their RUT cassette had developed a pinkish hue, nearly 24 hours after the test was conducted. Being their neighbor, they approached me to inquire about medication dosages since their consultation with the gastroenterologist had been rather brief. They also expressed concern over the delayed positive result from their RUT testing. Given that H.pylori is known to be communicable, it would not be surprising that the other family members might have the infection as well, even in light of the delayed positivity in their RUT results. I conveyed this information to them but advised them to consult with the gastroenterologist about their concerns, stressing that my experience was limited as a recent graduate. Out of curiosity, I sought clarity on several questions related to their cases and consulted standard medical textbooks, though I could not find satisfactory answers. I hope that any gastroenterology or internal medicine professionals out there might provide insight into these queries that intrigue me: 1. Does the delayed positivity of RUT results after nearly 24 hours in the other two family members indicate a false positive, or could it imply that they indeed have H.pylori infections that warrant at least a triple treatment regimen? 2. Is it possible for the gastric polyp to regress following the eradication of H.pylori, assuming it’s hyperplastic in nature? 3. Can Colloidal Bismuth Subcitrate, when taken in the usual QID for 15 days, pose a risk of neurotoxicity that could lead to dementia? 4. I have learned that Fexuprazan is quite new, potentially released just a few months ago, and that its predecessor, Vonaprazan, received FDA approval in 2024. Is it advisable to use Fexuprazan in treatments? 5. Are there any known adverse effects associated with Acotiamide concerning central or peripheral nervous system function that should be considered before prescribing this medication?
Answers (1)
9/15/2025, 8:02:17 AM
OpenHealth AI
Thank you for sharing this complex case regarding the family's experience with H. pylori and associated treatments. Your thoughtful questions indicate a desire to ensure the best care for these patients. I will address each of your inquiries in turn, providing clarity and actionable guidance.
Summary of Key Points:
- RUT Delayed Positivity: May indicate potential infection.
- Gastric Polyp Regressions: Possible if hyperplastic and H. pylori is eradicated.
- Colloidal Bismuth Subcitrate Neurotoxicity: Low risk if used appropriately.
- Fexuprazan Use: New, but promising data support its efficacy.
- Acotiamide Adverse Effects: Generally well-tolerated but monitor for rare effects.
Detailed Responses:
-
RUT Delayed Positivity:
- A positive result occurring 24 hours after the test may suggest the presence of H. pylori, especially if the test exhibited an expected change in color. Delayed results are not typical; however, the essence lies in interpreting these findings in context with the symptoms. It is advisable for the family members to discuss this with their gastroenterologist to evaluate the need for treatment based on clinical aspects and testing results.
-
Regression of Gastric Polyp:
- If the gastric polyp is hyperplastic, there is a possibility that it may regress following the successful eradication of H. pylori. Continuous monitoring through follow-up endoscopies may be necessary to assess any changes in the polyp post-treatment.
-
Neurotoxicity of Colloidal Bismuth Subcitrate:
- Generally, Colloidal Bismuth Subcitrate is considered safe when used as directed in a quadruple therapy regimen. Rare reports suggest neurotoxicity can occur, primarily in cases of prolonged use or higher dosages exceeding recommended guidelines. Monitoring the patient's cognitive function throughout treatment is prudent, but in typical dosing (QID for 15 days), the risk is minimal.
-
Fexuprazan Use:
- Fexuprazan has been recognized for its effectiveness in the management of H. pylori and is considered safe based on recent studies. While it is relatively new, the benefits of using this medication in this treatment context appear promising, and further data supporting its use continue to emerge.
-
Acotiamide Adverse Effects:
- Acotiamide is typically well-tolerated, but as with any medication, be aware of potential side effects, including, although rare, gastrointestinal and neurological disturbances. It is wise to educate the family about any unusual symptoms and encourage them to report these during follow-ups.
Next Steps:
- Follow-Up with Specialists: Encourage the family to return to their gastroenterologist for clarity regarding their individual results and treatment plans, particularly regarding the delayed RUT results.
- Monitor Symptoms: Advise them to observe any changes in their gastrointestinal symptoms while on treatment, noting any gradual improvement or new concerns to communicate during follow-ups.
- Educate on Medication Use: Share detailed information about each medication prescribed, including dosing, potential side effects, and the importance of adherence to the regimen.
Your initiative to bridge information between your educational background and the family’s needs shows commendable dedication. Please continue seeking guidance and learning, as each experience contributes to your professional growth. Let me know if you have further questions or need additional clarifications!
Related Questions
Persistent Pain in Right Shoulder and Arm After Lifting
Hello, everyone! I’m a 23-year-old male and have been engaged in weightlifting for several years now. Recently, I’ve been struggling with ongoing discomfort in my right shoulder and arm, which I haven’t been able to accurately identify. The pain manifests during particular movements, especially with lateral raises or when my arm is raised to shoulder level while rotating my wrist. Certain pressing and pulling activities can also provoke this discomfort. Rather than feeling sharp, it’s a deep, nagging sensation that sometimes seems localized in the front area of the shoulder or at the biceps tendon, and at other times it feels more like it’s situated between the shoulder and upper arm. Fortunately, there’s no numbness or tingling involved. This issue began while I was working out. I decided to take a break for around two months, but when I returned, the pain persisted. After consulting a physician, I was diagnosed with bicipital tendinitis. Since then, I’ve reduced my upper-body workouts, completely steering clear of shoulder exercises and heavy lifting, and have begun a gentle rehabilitation regimen focusing on external rotations, pendulum movements, and scapular exercises. Despite adhering to this routine for about a week, I haven’t experienced any noticeable improvement. Is it typical for this type of tendon injury to require an extended period for recovery? At what point should I consider diagnostic imaging, such as an ultrasound or MRI? Additionally, are there frequent rehabilitation errors that might impede the healing process? I appreciate your insights in advance!
Understanding EEG Results for My 22-Month-Old Son: Insights Needed
Could someone help clarify this for me? My son, who is just 22 months old, hasn’t started walking yet, becomes tired easily, and has been experiencing behavioral outbursts. He had a febrile seizure in February 2025, followed by another unexplained seizure in April 2025, which led us to consult a neurologist. Since he was 3 months old, he has been receiving therapy from a physical therapist for torticollis. At birth, he spent five days in the NICU due to issues with meconium aspiration. A recent MRI showed normal results, and he also had a follow-up EEG after one conducted in July 2025. The results from this recent EEG were abnormal for a pediatric patient in awake, drowsy, and sleeping states. Notably, there were brief episodes of left frontotemporal delta slowing, which occurred mainly when he was awake and drowsy. There were no signs of epileptiform activity detected. In contrast, the EEG performed back on July 3, 2025, was deemed normal for both awake and drowsy states, again with no evidence of epileptiform irregularities, although it did not capture any sleep data. This examination was prompted by the child's existing history of febrile seizures. Importantly, he is not currently on any anti-seizure medications. The EEG procedure used standard electrode placements per the 10-20 system, conducted a single-lead EKG, and included continuous video monitoring. During the analysis, the background activity was symmetric, indicating some anterior-posterior (AP) organization, with a dominant rhythm of 50-80 microvolts at 7 Hz. His drowsy state was marked by a reduced amount of eye blink activity, less breathing motion interference, and a generalized slowing in theta/delta frequencies. Stage II sleep exhibited spindles and vertex waves patterns. Additionally, there were intermittent bursts of 250-300 microvolts in the left frontotemporal region with semi-rhythmic activity of 2-4 Hz, mostly observed during wakefulness and drowsiness. No definitive epileptiform discharge was noted. Photic stimulation during the test did not elicit a strong response, and hyperventilation was not conducted during this session.
Understanding Atrial Fibrillation and Thyroid Issues: Variability in Cardioversion Decisions
Hello everyone, I’m reaching out for guidance regarding my mother’s current health situation, and I’d greatly appreciate any shared experiences or thoughts. **My mother's background:** - **Age**: 55 years - **Weight**: Recently dropped to 116 kg from 118 kg in just two days, likely due to diuretics. - **Health history**: Previously an underactive thyroid, undiagnosed and untreated, now presenting as overactive. - **Medications**: Currently taking thyroid medication and a beta-blocker (Rapiblock). **Current health status:** My mother has been hospitalized since Tuesday, experiencing **atrial fibrillation with heart rates exceeding 200** beats per minute due to her thyroid's hyperactivity. - The plan for cardioversion was initially settled on Tuesday. However, the following day, the medical team advised postponing it until her thyroid levels could be stabilized, believing that her heart rate would return to normal once her thyroid condition was managed. - Her **obesity** precludes her from undergoing a transthoracic echocardiogram, and due to her thyroid concerns, she cannot handle contrast dye (this has been a consistent issue for over four years). Therefore, the only feasible option was a **transesophageal echocardiogram (TEE)**, which has yet to be performed. - She has been prescribed various medications including beta-blockers and thyroid treatments in the past. - On Friday, a doctor proposed proceeding with cardioversion; however, the attending senior physician objected. - Today (Saturday), another clinician has expressed a desire to move forward with cardioversion, having initiated a new medication, as the senior physician is unavailable. - **Communication has been unclear**, as we were notified of developments by a nurse rather than the physician in charge, causing confusion and anxiety. - Currently, only a **chest X-ray** is scheduled, and the TEE remains unaddressed. **My inquiries are as follows:** 1. Is it common for medical professionals to have varying opinions and frequently revise medication or treatment plans like cardioversion? 2. Is it safe to conduct cardioversion in the absence of a TEE? I presumed that this was a standard procedure to exclude the presence of blood clots. 3. Is it usual practice to have only a chest X-ray prior to moving ahead with cardioversion? 4. How typical is it for patients or their families to not be directly informed about treatment changes and learn about them through nursing staff instead? I recognize that this cannot substitute for professional medical advice. I’m simply trying to discern whether these circumstances are typical or if we should express our concerns more assertively with the healthcare facility. Thank you for your insights!
28-Year-Old Male Experiencing Scalp Sensations Post-Amitriptyline Treatment
I am a 28-year-old man in generally good health, without any cardiac concerns. Approximately a month ago, I encountered intense pain localized to one side of my head, which was unresponsive to paracetamol. However, a single dose of a migraine treatment provided substantial relief. Following that, I began a regimen of amitriptyline, starting at a nightly dose of 10 to 25 mg. While my head pain has diminished significantly—by about 90 to 95%—I now experience occasional uncomfortable sensations on my scalp. These feelings include pins and needles, a cooling sensation, and some crawling feelings near my hairline and ears. There are fleeting moments where I feel brief throbs lasting a second, but I do not have any persistent headaches. To clarify, I do not experience any of the following: - Nausea - Weakness in my limbs - Numbness - Changes in my vision - Coordination difficulties - Seizures The symptoms I have are transient, shifting around and often intensifying when I become conscious of them or as the day progresses. I would like to know: Is it common to experience these sensations during the recovery stage following episodes of neuralgia or migraine-like discomfort? Additionally, could the amitriptyline potentially be causing these temporary paresthetic sensations? I am seeking some reassurance or advice on what is typically observed during this healing process. Thank you.
Concerns About My Toes
Age: 30, Female Currently, I am on the lookout for a reputable podiatrist in my vicinity. However, I've encountered a perplexing issue with my foot. Just last night, I noticed a growth on the side of my toe, something entirely new to me. I maintain a nutritious diet and have a demanding job that requires me to be on my feet quite often. My footwear includes brands such as Brooks Ghost Runners, Hoka Bondi 9’s, and Nike Motiva’s, and I don’t opt for restrictive socks. I also apply Vick’s Vaporub to my feet, a practice handed down from my family, and stick with simple, non-fragrant lotions like Vanicream and CeraVe SA Cream for my skin. In addition, I am curious about the my big toenail's change in color. What might be the underlying reasons for this? Also, I have these persistent dark spots on my toes that I've struggled with since my days on the runway. Despite my efforts, nothing has succeeded in lightening or diminishing their appearance. I'm just looking to determine if there might have been a factor from the past that could have contributed to these issues. I’m not sure what else to include, but I’m open to answering any questions you might have. Thank you for your attention! Best wishes from a worried soul!