ABSTRACT
Background: the prevalence of esophageal varices [OV] in newly diagnosed cirrhotic patients is approximately 60-80% and the 1-year rate of first variceal bleeding is approximately 5% for small esophageal varices and 15% for large esophageal varices. Non invasiveness has become a major goal in hepatology in the latter years, several serum markers and imaging methods have been tried for the non invasive assessment of portal hypertension or presence of esophageal varices
Aim of the work: this study aimed to compare ALBI, MELD and Child-pugh scores in prediction of esophageal varices and for discrimination between risky and non risky esophageal varices
Methods: in this Prospective study evaluation of of ALBI, MELD And Child-Pugh Scores As non-Invasive Predictors of Esophageal Varices was done in 80 patients with liver cirrhosis. They were divided into 2 groups, Group I: included 60 patients with liver cirrhosis and esophageal varices diagnosed by upper GIT endoscopy and will be divided into 3 subgroups 20 patients each as described below: Small, Moderate and Large esophageal varices. Group II: included 20 patients with liver cirrhosis with no esophageal varices as the control groupg
Results: the current study showed that ALBI score could be used as a non invasive predictor of esophageal varices with a cut-off value > - 2.2, with 96.7% sensitivity, 100% specificity, Child score could be used with a cut-off value > 5.5, with 93.3% sensitivity, 100% specificity, and MELD score could be used with a cut-off value > 8.5, with 90% sensitivity, 95% specificity
Conclusion: ALBI score is more accurate than Child and MELD scores as non invasive predictor of esophageal varices and its grading
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