ABSTRACT
Aim: This study was aimed to evaluating the efficacy of levofloxacin based sequential therapy vs clarithromycin based sequential therapy in h.pylori [HP] eradication
Background: Several therapeutic regimen were investigated to treat HP infection. Sequential therapy is an alternative to classic triple therapy
Methods: In this randomized clinical trial, 200 HP infected patients randomly divided into two therapeutic groups .1-Levofloxacin based sequential regimen [group A]; omeprazole and amoxicillin for 7days followed by omeprazole, amoxicillin and levofloxacin for 7days. 2-clarithromycin based sequential regimen [group B]: omeprazole and amoxicillin for 7days followed by omeprazole, amoxicillin and clarithromycin for 7days. HP eradication was evaluated with urea breath test with carbon 13 [UBT] 6 weeks after the end of treatment
Results: Per protocol eradication rates of group A and B were 87.6% and 76% respectively. By intention to treat analysis, eradication rate of group A and B groups were 85.1% and 73% respectively. Levofloxacin based sequential regimen was more effective than clarithromycin based sequential regimen [Pv=0.028]. Adverse events were seen in 19.6% and 15.6% in group A and B respectively. Drug compliance was 97% in group A and 96% in group B. There was no significant difference between two groups in term of adverse events [p=0.470] and compliance [p=0.651]
Conclusion: Levofluxacin based sequential therapy was more effective than Clarithromycin based sequential therapy in HP eradication. The suggested Levofluxacin based sequential therapy could be an alternative therapy in area with high clarithromycin resistance. Further studies are needed to confirm these findings
ABSTRACT
IgG4-associated cholangitis [IAC] is a subgroup of IgG4-related disease, which is more common in elderly men. IAC is frequently coincident with autoimmune pancreatitis [AIP]. However, some IAC cases do not have other organs involvement. The diagnosis of IAC is based on biochemical, radiological, and histological features. Among these, elevated serum levels of IgG4, extra- and intrahepatic biliary strictures [as visualized by cholangiography], lymphoplasmacytic infiltrations in the liver and bile duct tissue, and association with AIP are of key importance. IAC may mimic primary sclerosing cholangitis or cholangiocarcinoma [CC]. It is classically a corticosteroid-responsive condition and corticosteroid is regarded as the initial treatment of choice in this disease. However, relapse following corticosteroid withdrawal is a frequent event