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SUMMARYBackground: Helicobacter pylori infection may persist after both first-and second-line current treatments. Aim: To assess the efficacy of a third-line, cultureguided treatment approach for the eradication of H. pylori. Methods: Patterns of resistance were analysed in H. pylori isolates from 94 consecutive patients in whom H. pylori infection had persisted after two eradication attempts. Using the epsilometer test, susceptibility analysis was performed for amoxicillin, clarithromycin, metronidazole, tetracycline and levofloxacin. Patients were then treated with a culture-guided, third-line regimen: 89 patients with a 1-week quadruple regimen including omeprazole, bismuth, doxycycline and amoxicillin, and five patients with a 1-week triple regimen

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This study demonstrated the feasibility and the high level of accuracy of the immersion technique in predicting the histological recovery of duodenal villi in patients with celiac disease who are following a gluten-free diet. An endoscopy-based approach that avoids the need for biopsy could be useful for monitoring the dietary adherence and/or response of patients with an initial diagnosis of celiac disease based on total villous atrophy.

Probiotics are defined as live, nonpathogenic microbial feeds or food supplements that exert a positive influence on their host by altering his microbial balance. As shown in several studies, probiotics also possess a direct antimicrobial effect; for this reason, several authors have tested a possible application in patients with Helicobacter pylori infection. In particular, probiotics may compete directly with H. pylori, possibly through the inhibition of adherence, as well as produce metabolites and antimicrobial molecules, properties supported only by animal or in vitro data. Moreover, implementation of standard anti-H. pylori regimens with probiotics can also improve patients' compliance to therapy, reducing the occurrence of antibiotic-related adverse events. The same effect was also reported after using a combination of two different prebiotics such as butyric acid and inulin in patients who underwent H. pylori eradication treatment. Based on current data, even though an effect against H. pylori has been described, probiotics cannot be considered as an alternative to standard anti-H. pylori treatment. Nevertheless, their use in association with standard anti-H. pylori treatment may be advisable, as they are able to improve patient compliance by reducing antibiotic-related adverse events, thus increasing the number of patients completing the eradication therapy.