ABSTRACT
Introduction: Helicobacter pylori is the most common prevalent chronic human bacterial infection estimated in 50% of the global population but only induces clinical diseases in 10-20% of infected individuals. These include peptic ulcers, acute and atrophic gastritis, intestinal metaplasia, gastric adeno-carcinoma and gastric Bcell lymphoma. H. pylori infection has become highly resistant to traditional first-line treatment regimens because of antibiotic resistance coupled with poor patient compliance with completing the treatment course. Many clinical studies proved that nitazoxanide [NTZ] was found to be well tolerated by humans, with an encouraging rate of eradication when it was administered with omeprazole
Aims: The aim of the work is to compare between the efficacy of traditional triple therapy and nitazoxanidebased quadruple therapy in treatment of H. pylori and to evaluate the efficacy of nitazoxanide-based regimens as a rescue regimen for H. pylori eradication in resistant patients
Methodology: This study was carried out on 85 Helicobacter pylori [H. pylori] infected patients; Patients were classified in to 3 groups: Group 1: 60 patients with positive H. pylori Ag taking 14 days triple therapy composed of amoxicillin [1 gm twice daily], clarithromycin [500 mg twice daily] and omeprazole [40 mg once daily].; Group 2: 25 patients with positive H. pylori Ag [naïve: not having previously taken or received a particular treatment for H. pylori] taking 14 days quadruple therapy composed of nitazoxanide [500 mg twice daily], in addition to triple therapy.; Group 3: 22 patients with positive H. pylori Ag after treatment [resistant for triple therapy from group 1] taking 14 days nitazoxanide-based quadruple therapy
Results: This work recorded the best results for H. pylori eradication [92%] in group II who received nitazoxanide based quadruple therapy compared with group I eradication rate [63.3%], who received traditional triple therapy regimen and better results [77.3%] in group III [resistant patients from group I]
Conclusion: This study could state that, using nitazoxanide can overcome traditional triple therapy resistance; in addition to its efficacy in treating naïve patients who didn't take any medical treatment for H. pylori
Recommendations: Nitazoxanide [NTZ] based regimen namely NTZ/ clarithromycin / PPIs and amoxicillin is a recommended H. pylori therapeutic regimen in our community
ABSTRACT
To determine the effect of endoscopic variceal sclerotherapy [ES] on the hemodynamic of portal venous system, 40 patients with intrahepatic cause of portal hypertension and bleeding oesophageal varices [OV] were enrolled in this study. Assessment of main portal vein [MPV], its right and left branches [RPV], [LPV], splenic vein [SV] and superior mesenteric vein [SMV] by duplex [DU] and color coded Doppler sonography [CCDS] were done before and after complete obliteration of OV by ES to determine their diameters, patency, pattern and direction of flow, blood flow velocity, blood flow volume and congestion index. 28 patient were effectively treated by ES, 5 cases died after uncontrolled hemorrhage and 7 cases escaped before complete obliteration of OV. Coronary veins showed no flow in 65% of cases after ES. Incidence of reappearance of OV and recurrent attacks of bleeding were significantly lower in these cases than those with patent one. Child-Pugh's classification and hemodynamic parameters of studied vessels showed insignificant difference before and after complete obliteration of OV. We found that Duplex and CCDS are valuable, rapid, noninvasive screening procedure for monitoring hemodynamics of portal venous system. ES seems to be suitable method for patient with PH and bleeding OV. It preserves the relationship between the factors interacting in the portal venous system hemodynamic