消化性溃疡患者幽门螺杆菌感染治疗的临床分析

目的研究消化性溃疡患者幽门螺杆菌感染治疗的临床疗效。方法搜集本院2019年01月-2020年06月收治48例消化性溃疡患者,抽签法划分为参照组与试验组(n=24),参照组患者选择泮托拉唑治疗方法,试验组患者选择根治幽门螺杆菌感染治疗,对比临床疗效与不良反应、溃疡直径等。结果治疗后参照组患者有效率75%,不良反应发生率33.33%,溃疡直径(0.87±0.18)cm,试验组患者有效率95.83%,不良反应发生率8.33%,溃疡直径(0.31±0.07)cm,对比有统计学意义(P<0.05)。结论为消化性溃疡患者进行幽门螺杆菌感染治疗,可以提升患者临床疗效,降低不良反应发生率,以促进患者早日恢复。

中医辩证治疗慢性胃炎幽门螺杆菌感染

目的:探索中药治疗慢性胃炎幽门螺杆菌感染的疗效。方法:通过中医辩证运用中药治疗慢性胃炎并观察治疗前后幽门螺杆菌的感染情况。结果:脾胃湿热型有效率91.7%,肝脾不和型有效率83.3%,胃络瘀血型有效率87.5%,脾胃虚寒型有效率92.9%,胃阴亏虚型有效率90%,总有效率87.5%。提示:中医治疗慢性胃炎幽门螺杆菌感染疗效可观,与西医组无显著性差异。

抗幽门螺杆菌感染在缺铁性贫血中的意义

目的 研究抗幽门螺旋杆菌 (HP)感染在缺铁性贫血中的重要性。 方法 共观察缺铁性贫血患者 71例 ,正常对照 6 9例 ,贫血组、对照组均做14 C -尿素呼气试验 (14 C -UBT)检测HP ,对贫血组中HP阳性者又随机分为A、B两组 ,其中A组给予硫酸亚铁及抗HP治疗 ,B组给予硫酸亚铁及安慰剂治疗。 结果 贫血组HP阳性4 7例 ,占 6 6 .2 % ,对照组HP阳性 2 1例 ,占 30 .4 % ,两者间差异有显著意义 ,P <0 .0 1;接受治疗的A、B两组贫血均有显著改善 ,但A组血红蛋白 (Hb)上升更明显。 结论 HP感染与缺铁性贫血关系密切 ,抗HP治疗可加快提升贫血患者Hb的水平 。

不同抗生素组合的四联疗法根除幽门螺杆菌疗效比较

目的评估4种不同抗生素组合的四联疗法根除幽门螺杆菌(Hp)的疗效及安全性。方法选取该院2015年2月至2016年3月收治的251例Hp阳性、内镜检查确诊的消化性溃疡、非溃疡性消化不良、慢性非萎缩性胃炎、慢性非萎缩性胃炎伴糜烂、十二指肠球炎患者,运用随机数字表法分为A、B、C、D四组(A组62例,B组64例,C组63例,D组62例),在服用埃索美拉唑+枸橼酸铋钾的基础上,A组加服阿莫西林+克拉霉素,B组加服阿莫西林+左氧氟沙星,C组加服阿莫西林+呋喃唑酮,D组加服四环素+呋喃唑酮。每种药物均使用推荐剂量,每天2次,疗程均为10 d。记录治疗期间发生的不良反应。疗程结束4周后,应用13C-尿素呼气试验(13C-UBT)和胃镜观察Hp根除情况。结果 A、B、C、D四组患者的Hp根除率分别为90.00%(54/60)、90.48%(57/63)、91.94%(57/62)、93.44%(57/61),组间两两比较,差异均无统计学意义(P>0.05);A、B、C、D四组患者的不良反应发生率分别为8.33%(5/60)、6.35%(4/63)、6.45%(4/62)、8.20%(5/61),组间两两比较,差异均无统计学意义(P>0.05)。结论 4种方案的Hp根除率接近且满意,都可作为根除Hp可供选择的一线治疗方案。

Effect of Clostridium butyricum on fecal flora in Helicobacter pylori eradication therapy

AIM： To investigate the effect of probiotic bacterium, Clostridium butyricum MIYAIRI 588 strain （CBM） on the changes of the fecal flora in Helicobacter pylori （H pylon） treatment. METHODS： Thirty-five patients with gastric or duodenal ulcers positive for H pylori were randomized either to 1 wk amoxicillin, clarithromycin, lansoprazole （Group 1） or to the same regimen supplemented with CBM 7 d ahead of the triple therapy （Group 2）. Stool samples were collected before and 2, 4, 7, 15, and 22 d after the starting eradication therapy, and were examined intestinal flora. Patients were required to keep a diary record of their condition. RESULTS： Obligate anaerobes decreased significantly on d 2, 4, 8 and 15 in Group 1. On the other hand, they did not decrease significantly in Group 2. The Escherichia coli was dominant bacterium in Enterobacteriaceae, but that was replaced by other species such as Klebsiella and Enterobacter after eradication in Group 1. The change was suppressed in Group 2. Abdominal symptoms were less frequent in Group 2 than in Group 1. CONCLUSION： The combined use of CBM reduced the changes in the intestinal flora and decreased the incidence of gastrointestinal side effects.

H pylori and gastric cancer: Shifting the global burden

Infection with H pylori leads to a persistent chronic inflammation of the gastric mucosa, thereby increasing the risk of distal gastric adenocarcinoma. Numerous studies have determined a clear correlation between Hpylori infection and the risk of gastric cancer; however, general eradication is not recommended as cancer prophylaxis and time points for treatment remain controversial in different areas of the world. Prevalence rates in Western countries are decreasing, especially in younger people （〈 10%）; and a decline in distal gastric adenocarcinoma has been observed. Risk groups in Western countries still show considerably higher risk of developing cancer, especially in patients infected with cagA^＋ strains and in persons harboring genetic polymorphism of the IL-1B promoter （-511T/T） and the corresponding IL-1 receptor antagonist （IL-1RN^＊2）. Thus, general eradication of all infected persons in Western countries not recommended and is limited to risk groups in order to achieve a risk reduction. In contrast, infection rates and cancer prevalence are still high in East Asian countries. A prevention strategy to treat infected persons may avoid the development of gastric cancer to a large extent and with enormous clinical importance. However, studies in China and Japan indicate that prevention of gastric cancer is effective only in those patients that do not display severe histological changes such as atrophy and intestinal metaplasia. Thus, prophylactic strategies to prevent gastric cancer in high risk populations such as China should therefore especially aim at individuals now at younger age when the histological alterations caused by the bacterial infection was still reversible. In countries with a low prevalence of gastric cancer, risk groups carrying cagA^＋ strains and IL-1 genetic polymorphisms should be identified and treated.

Eradication of H pylori infection in a rural population: One-day quadruple therapy versus 7-day triple therapy

AIM： To compare the one-day quadruple therapy with a standard 7-d triple therapy for H pylori eradication in a rural population of China. METHODS： A total of 396 patients with 13C-urea breath test positive for H pylori were assigned into two groups： 239 patients received one-day quadruple therapy （amoxicillin 2000 mg qid; metronidazole 500 mg qid; bismuth citrate 900 mg qid and lansoprazole 60 mg once daily） and 157 patients received 7-d standard triple therapy （amoxicillin 1000 mg bid; clarithromycin 500 mg bid and lansoprazole 30 mg bid）. All the patients underwent a 13C-UBT to assess the eradication of Hpylori infection six weeks after treatment. RESULTS： Two hundred and twenty-nine patients completed the one-day therapy （95.8%） and 148 patients completed the 7-d therapy （94.2%）. The oneday therapy eradicated H pylori infection in 64 patients （27.95%）. In contrast, 103 patients （69.59%） were Hpylori negative after the 7-d therapy （P 〈 0.01）. CONCLUSION： This pilot study suggests there is no beneficial effect of the one-day therapy in treatment ofHpylori infection compared with the 7-d standard therapy.

Azithromycin in one week quadruple therapy for H pylori eradication in Iran

AIM： To investigate eradication rates, patient compliance and tolerability of a 1-wk Azithromycin-based quadruple therapy versus the 2-wk conventional therapy. METHODS： A total of 129 Hpylori-positive patients were randomized to either omeprazole 20 mg, bismuth subcitrate 240 mg, azithromycin 250 mg, and metronidazole 500 mg, all twice daily for 1-wk （B-OAzM） or omeprazole 20 mg, bismuth subcitrate 240 mg, amoxicillin lg, and metronidazole 500 mg all twice daily for 2-wk （B-OAM）. Hpylori infection was defined at entry by histology and rapid urease test and cure of infection was determined by negative urea breath test. RESULTS： Hpylori eradication rates produced by B-OAzM and B-OAM were 74.1% and 70.4% respectively based on an intention to treat analysis, and 78.1% versus 75.7% respectively based on a per-protocol analysis. The incidence of poor compliance was lower, although not significantly so, in patients randomized to B-OAzM than for B-OAM （3.5% versus 4.3%） but intolerability was similar in the two groups （ 35% versus 33.3%）. CONCLUSION： 1-wk azithromycin based quadruple regimen achieves an Hpylori eradication rate comparable to that of standard 2-wk quadruple therapy, and is associated with comparable patient compliance and complications.

Role of Helicobacter pylorieradication in aspirin or non-steroidal anti-inflammatory drug users

Helicobacter pylori (H pylori) infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin at any dosage and formulation represent well-established risk factors for the development of uncomplicated and complicated peptic ulcer disease accounting for the majority of such cases. Although the interaction between H pylori and NSAID/aspirin use in the same individuals was questioned in some epidemiological studies, it has now become widely accepted that they are at least independent risk factors for peptic ulcer disease. According to data from randomized intervention trials, naive NSAID users certainly benefit from testing for H pylori infection and, if positive,H pylori eradication therapy prior to the initiation of NSAID. A similar strategy is also suggested for naive aspirin users, although the efficacy of such an approach has not been evaluated yet. Strong data also support that chronic aspirin users with a recent ulcer complication should be tested for H pyloriinfection and, if positive, receive H pylori eradication therapy after ulcer healing, while they appear to benefit from additional long-term therapy with a proton pump inhibitor (PPI).A similar approach is often recommended to chronic aspirin users at a high risk of ulcer complication. H pylori eradication alone does not efficiently protect chronic NSAID users with a recent ulcer complication or those at a high-risk, who certainly should be treated with long-term PPI therapy, but H pylori eradication may be additionally offered even in this setting. In contrast, testing for H pylorior PPI therapy is not recommended for chronic NSAID/aspirin users with no ulcer complications or those at a low risk of complications.

Enhanced plasma ghrelin levels in Helicobacter py/ori-colonized, interleukin-1-receptortype 1-homozygous knockout (IL-1R1-/-) mice

AIM： Ghrelin is an endogenous ligand for the growth hormone secretagogue receptor, and it plays a role in stimulating the growth hormone secretion, food intake,body weight gain and gastric motility. Eradication of Helicobacterpylori （H pylon） was shown to be associated with increase of the body weight. On the other hand, Hpylori infection evokes the release of gastric IL-1β. The present study was designed to investigate the involvement of the gastric IL-1 signal in the ghrelin dynamics in Hpyloricolonized mice.METHODS： Twelve-week-old female IL-l-receptor type 1-homozygous-knockout mice （IL-1R1^-/-） and their wild-type littermates （WT） were orally inoculated with H pylori （Hp group）, while other cohorts received oral inoculation of culture medium （Cont group）. Thirteen weeks after the inoculation, the mice were examined. The plasma and stomach ghrelin levels and the gastric preproghrelin mRNA were measured.RESULTS： Although the WT mice with Hpyloriinfection showed a significantly decreased body weight as compared with that of the animals without HpyloriinfecUon,Hpyloriinfection did not influence the body weight of the IL-1Rl-knockout （IL-1R1^-/-） mice. In the Hpylori-infected IL-1R1＋ mice, the total and active ghrelin levels in the plasma were significantly increased, and the gastric ghrelin level was decreased. No significant differences were noted in the gastric preproghrelin mRNA expression.CONCLUSION： Ghrelin secretion triggered by H pylori infection might be suppressed by IL-1β, the release of which is also induced by the infection, resulting in the body weight loss of mice with Hpyloriinfection.

H pylori eradication:A randomized prospective study of triple therapy with or without ecabet sodium

AIM: To investigate whether adding ecabet sodium to the standard triple therapy for H pylori infection improve eradication rate. METHODS: Two hundred and fifty-seven H pylori-infected patients were randomly assigned to standard triple therapy (group A, n = 129) or triple therapy plus ecabet sodium (group B, n = 128). Successful eradication was defined as a negative 13C-urea breath test 6-8 wk after completion of treatment. RESULTS: After completion of therapy, 194/257 patients showed negative 13C-urea breath test results. According to intention-to-treat analysis, the infection was eradicated in 93/129 (72.1%) patients in group A and 101/128 (78.9%) in group B (P = 0.204). Per-protocol analysis showed successful eradication in 93/118 (78.8%) patients from group A and 101/114 (88.6%) from group B (P = 0.044). There were no significant differences in the side effects experienced by the patients in the two treatment groups. CONCLUSION: Our results suggest that the addition of ecabet sodium improves the efficacy of the standard triple therapy for H pylori.

Stool antigen tests in the diagnosis of Helicobacter pylori infection before and after eradication therapy

Aim： To evaluate two enzyme immunoassay-based stool antigen tests, Premier Platinum HpSA and Amplified IDEIA HpStAR, and one rapid test, ImmunoCard SLAT! HpSA, in the primary diagnosis of Helicobacter pylon （H pylori） infection and after eradication therapy. METHODS： Altogether 1 574 adult subjects were screened with a whole-blood H pylori antibody test and positive results were confirmed with locally validated serology and ^13C-urea breath test. All 185 subjects, confirmed to be H pylori positive, and 97 H pylorinegative individuals, randomly selected from the screened study population and with negative results in serology and UBT, were enrolled. After eradication therapy the results of 182 subjects were assessed. RESULTS： At baseline, the sensitivity of HpSA and HpStARwas 91.9% and 96.2%, respectively, and specificity was 95.9% for both tests. ImmunoCard had sensitivity of 93.0% but specificity of only 88.7%. After eradication therapy, HpSA and HpStAR had sensitivity of 81.3% and 100%, and specificity of 97.0% and 97.6%, respectively. ImmunoCard had sensitivity of 93.8% and specificity of 97.0%. HpSA, HpStAR, and ImmunoCard had PPV 77%, 80%, and 75%, and NPV 98%, 100%, and 99%, respectively. CONCLUSION： In primary diagnosis, the EIA-based tests performed well. After eradication therapy, negative results were highly accurate for all the three tests. HpStAR had the best overall performance.

A systematic review of treating Helicobacter pylori infection with Traditional Chinese Medicine

AIM: To evaluate the efficacy and safety of Traditional Chinese Medicine (TCM) in the treatment of Helicobacter pylori (H pylori) infection. METHODS: We electronically and manually searched electronic databases, references lists and conferences compilations, and included all randomized clinical trials comparing the treatment of H pylori using TCM with proton pump inhibitor or colloidal bismuth subcitratebased triple therapy as controls. The Jadad score was used to assess trial quality, H pylori eradication rate and the incidence of side effects were taken as outcome measurements, and heterogeneity analysis, meta-analysis and funnel plot analysis were conducted. RESULTS: Sixteen trials were included. The Jadad scores of all the trials were not more than 2. Clinical heterogeneity and substantial statistical heterogeneity existed among the trials (P = 0.001, I 2 = 59%) and meta-analysis was not conducted. The average eradication rates following TCM and triple therapy were 72% and 78% and the incidence of side effects were 2% and 29%, respectively. The funnel plot was obviously asymmetric. CONCLUSION: Available evidence is not convincing enough to show that TCM has the same efficacy as triple therapy in H pylori treatment. TCM may be safer than triple therapy. TCM should not be recommended as monotherapy in H pylori infection.

H pylori are associated with chronic cholecystitis

AIM： To study whether H pylon are associated with chronic cholecystitis. METHODS： The subjects were divided into three groups： H pylori-infected cholecystitis group, H pylorinegative cholecystitis group and control group. Pathologic changes of the gallbladder were observed by optic and electronic microscopes and the levels of interleukin-1, 6 and 8 （IL-1, 6 and 8） were detected by radioimmunoassay. RESULTS： Histological evidence of chronic cholecystitis including degeneration, necrosis, inflammatory cell infiltration, were found in the region where H pylori colonized. Levels of IL-1, 6 and 8 in gallbladder mucosa homogenates were significantly higher in H py/oriinfected cholecystitis group than those in Hpylorinegative cholecystitis group and control group. CONCLUSION： H pylon infection may be related to cholecystitis.

Trends in the eradication rates of Helicobacter pylori infection for eleven years

AIM:To evaluate the trends in the eradication rate of Helicobacter pylori(H.pylori) over the past 11 years in a single center.METHODS:This retrospective study covered the period from January 2000 to December 2010.We evaluated 5746 patients diagnosed with gastric ulcers(GU),duodenal ulcers(DU),GU + DU,or nonpeptic ulcers associated with an H.pylori infection.We treated them annually with the 2 wk standard first-line triple regimen,proton pump inhibitor(PPI) + amoxicilin + clarithromycin(PAC;PPI,clarithromycin 500 mg,and amoxicillin 1 g,all twice a day).The follow-up test was performed at least 4 wk after the completion of the 2 wk standard H.pylori eradication using the PAC regimen.We also assessed the eradication rates of 1 wk second-line therapy with a quadruple standard regimen(PPI b.i.d.,tripotassium dicitrate bismuthate 300 mg q.i.d.,metronidazole 500 mg t.i.d.,and tetracycline 500 mg q.i.d.) after the failure of the first-line therapy.Statistical analysis was performed with 95%CI for the differences in the annual eradication rates.RESULTS:A total of 5746 patients [2333 males(58.8%),1636 females(41.2%);mean age of males vs females 51.31 ± 13.1 years vs 52.76 ± 13.6 years,P < 0.05,total mean age 51.9 ± 13.3 years(mean ± SD)] were investigated.Among these patients,1674 patients were excluded:35 patients refused treatment;18 patients ceased H.pylori eradication due to side effects;1211 patients had inappropriate indications for H.pylori eradication,having undergone stomach cancer operation or chemotherapy;and 410 patients did not undergo the follow-up.We also excluded 103 patients who wanted to stop eradication treatment after only 1 wk due to poor compliance or the side effects mentioned above.Finally,we evaluated the annual eradication success rates in a total of 3969 patients who received 2 wk first-line PAC therapy.The endoscopic and clinical findings in patients who received the 2 wk PAC were as follows:gastric ulcer in 855(21.5%);duodenal ulcer in 878(22.1%);gastric and duodenal ulcer in 124(3.1%),erosive,atrophic gastritis and functional dyspepsia in 2055(51.8%);and other findings(e.g.,MALToma,patients who wanted to receive the therapy even though they had no abnormal endoscopic finding) in 57(0.5%).The overall eradication rate of the 2 wk standard firstline triple regimen was 86.5%.The annual eradication rates from 2000 to 2010 were 86.7%,85.4%,86.5%,83.3%,89.9%,90.5%,88.4%,84.5%,89.1%,85.8%,and 88.3%,sequentially(P = 0.06).No definite evidence of a significant change in the eradication rate was seen during the past eleven years.The eradication rates of second-line therapy were 88.9%,82.4%,85%,83.9%,77.3%,85.7%,84.4%,87.3%,83.3%,88.9%,and 84%(P = 0.77).The overall eradication rate of 1 wk quadruple second-line therapy was 84.7%.There was no significant difference in the eradication rate according to the H.pylori associated diseases.CONCLUSION:This study showed that there was no trend change in the H.pylori eradication rate over the most recent 11 years in our institution.

Immune response to H pylori

The gastric mucosa separates the underlying tissue from the vast array of antigens that traffic through the stomach lumen. While the extreme pH of this environment is essential in aiding the activation of enzymes and food digestion, it also renders the gastric epithelium free from bacterial colonization, with the exception of one important human pathogen, Hpylori. This bacterium has developed mechanisms to survive the harsh environment of the stomach, actively move through the mucosal layer, attach to the epithelium, evade immune responses, and achieve persistent colonization. While a hallmark of this infection is a marked inflammatory response with the infiltration of various immune cells into the infected gastric mucosa, the host immune response is unable to clear the infection and may actually contribute to the associated pathogenesis. Here, we review the host responses involved during infection with Hpylori and how they are influenced by this bacterium.

Kang Wei Granules in Treatment of Gastropathy Related to Helicobacter Pylori Infection

Kang Wei Granules,a granular preparation for strengthening the spleen and replenishing Qi and for clearing away heat and resolving dampness,was used in the treatment of 288 cases of gastropathy related to Helicobacter pylori infection.The effects were compared with De Nol^(?) triple therapy in the control group of 74 cases.The therapeutic results showed that Kang Wei Granules was superior to the western drugs in improving the principal symptoms of deficiency of the spleen and stomach,and retention of damp-heat in the interior (P<0.05).

Gastrin and antral G cells in course of Helicobacter pylori eradication: Six months follow up study

AIM： To assess long-term effects of Helicobacter pylori （H pylon} eradication on antral G cell morphology and function in patients with and without duodenal ulcer （DU）.METHODS： Consecutive dyspeptic patients referred to the endoscopy entered the study. Out of 39 Hpylori positive patients, 8 had DU （Hpylori ＋DU） and 31 gastritis （Hpylori＋G）. Control groups consisted of 11 uninfected dyspeptic patients （CG1） and 7 healthy volunteers （CG2）. Basal plasma gastrin （PGL）, antral tissue gastrin concentrations （ATGC）, immunohistochemical and electron microscopic characteristics of G cells were determined, prior to and 6 mo after therapy.RESULTS： We-demonstrated elevated PGL in infected patients compared to uninfected controls prior to therapy.Elevated PGL were registered in all Hpylori＋patients （Hpylori＋DU： 106.78＋22.72 pg/mL, Hpylori＋G： 74.95＋15.63,CGI： 68.59＋17.97, CG2：39.24＋5.59 pg/mL, P〈0.01）.Successful eradication （e） therapy in Hpylori＋patients lead to significant decrease in PGL （Hpylori＋DU： 59.93＋9.40 and Hpylori＋Ge： 42.36＋10.28 pg/mL, P〈0.001）. ATGC at the beginning of the study were similar in infected and uninfected patients and eradication therapy lead to significant decrease in ATGC in Hpylori＋gastritis, but not in DU patients. In the Hpylori＋DU patients, the mean number of antral G cells was significantly lower in comparison with all other groups （P〈0.01）, but after successful eradication was close to normal values found in controls. By contrast, G cell number and volume density were significantly decreased （P〈0.01） in Hpylori＋Ge group after successful eradication therapy （294＋32 and 0.31＋0.02,respectively）, in comparison to values before eradication （416~40 and 0.48~0.09）. No significant change of the G cell/total endocrine cell ratio was observed during the 6 mo of follow up in any of the groups. A reversible increase in G cell secretory function was seen in all infected individuals, demonstrated by a more prominent secretory apparatus. However, differences between DU and gastritis group were identified.CONCLUSION： H py/oriinfection induces antral G cell hyperfunction resulting in increased gastrin synthesis and secretion. After eradication therapy complete morphological and functional recovery is observed in patients with gastritis. In the DU patients some other factors unrelated to the Hpyloriinfection influence antral G cell morphology and function.

Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection

AIM: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication. METHODS: From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test(UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d. RESULTS: Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. "Per protocol" eradication rates for first, second and thirdline therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate. CONCLUSION: First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and secondline treatment can still be triple therapy with amoxicillin and tinidazole.