الفهرس 
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Abstract
Summary and conclusion
The present work evaluated the response to the different regimens used for H. pylori treatment. It compared the standard triple therapies (for different durations 10 vs. 14 days vs. the sequential therapy as a first line for H. pylori eradication to assess their efficacy, side effects and their eradication rates.
In total, 120 patients with GI symptoms were evaluated for H pylori testing. Thirty patients were negative for infection and fifteen patients did not fulfill the protocol criteria and were excluded. seventy five patients mean age 43+/- 15 years, 41 males and 34 females with GIT manifestations suggesting dyspepsia and indication for EGD were H. pylori positive using rapid urease test (RUT) of the gastric biopsies obtained during upper endoscopy patients.
H Pylori positive patients (75) were randomly classified into three groups according to the regimens they received; each group contained 25 patients whom have been randomly chosen. Patients in group A were assigned for receiving standard triple therapy of omeprazole 40 mg, amoxicillin 1 gm and clarithromycin 500 mg all given orally twice daily for 10 days. Patients of group B has received the same triple regimen but for 14 days, while group C patients received sequential therapy of omeprazole and amoxicillin twice daily for the first 5 days, then omeprazole, clarithromycin and metronidazole for the other 5 days.
After completing the treatment course in the three groups, assessment of eradication was done using HpSA in stool to exclude false results.
In general, (except for significant rural resident and nausea improvement of group B patients, p-value = 0.001 and 0.04 respectively), there were no significant differences between the three groups regarding most of the baseline characteristic data, symptoms, signs, ultrasound examination, EGD examination, response to treatment and the reported side effects.
Epigastric pain was the most dominant complaint and gastroduodinitis was the most prominent finding in the EGD examination before treatment.
The overall eradication rate among the study group of the 75 patients was 85%.
The sequential therapy showed an eradication rate 92%, the standard triple therapy for 14% showed an eradication rate of 84% and the standard triple therapy for 10 days showed an eradication rate of 80%, however, no significant statistical difference was found between the three groups.
We noticed a satisfactory significant improvement of the symptoms of most of the patients. Most of the patients complaining from epigastric pain, heart burn, GI bleeding, post meal fullness, nausea and vomiting and aphthus ulcer and hiccough, have been significantly improved.
In group A, there was significant improvement of the initial symptoms of heart burn (p-value 0.038), nausea (p-value = 0.004) and post meal fullness (p-value = 0.020) of patients of group. Although epigastric pain and vomiting was not found to have a significant difference after treatment (p value = 0.183 and 0.146) respectively, yet they were markedly improved (84% and 89%) respectively.
In group B, Heart burn (p-value = 0.013) and post meal fullness (p value = 0.003) were significantly improved after treatment. Although epigastric pain did not have a statistical significant difference regarding improvement (p value = 0.088) but it improved in 67% of the patients.
In group C, Heart burn (p-value = 0.036) was significantly improved after treatment but epigastric pain (p-value = 0.077) and nausea (p-value = 0.219) did not have a significant difference in improvement statistically although they improved markedly (74% and 92%) respectively.
No statistical significance between the 3 groups except for improvement of nausea in group B (p-value = 0.04).
In group A and C, a significant positive correlation was detected between eradication of treatment and improvement of epigastric pain and heart burn which were the main complaints before treatment.
Regarding drugs side effects, no significant statistical differences were found between the three groups except for metallic taste of metronidazole complain of some patients of group C.
Regarding general complains from the treatment as duration, cost and difficult instructions, no significant statistical differences were found between the patients of the three groups except for complaining from difficult instructions of the sequential therapy group (group C) in shifting to new antibiotics on the 6th day of the regimen.
To assess factors predicting failure, no factors were found to predict failure in this study group of patients.
Patients with GU and patients with upper GI bleeding were instructed to follow up EGD to assess their endoscopic response to treatment.
This study have some limitations , the small number of the study cohort, absence of the histological diagnosis of H pylori infection before treatment, follow up after treatment with EGD and testing for antibiotic resistance for each drug regimen to evaluate for factors associated with failure.