No abstract

H. pylori is one of the most prevalent antibiotic-resistant bacteria worldwide. Clarithromycin-based triple therapy had achieved suboptimal cure rate. To evaluate safety and efficacy of adding nitazoxanide as adjuvant therapy to the standard clarithromycin-based therapy versus other standard clarithromycin-based triple therapies, a single-center phase 4 prospective superiority parallel open-label randomized controlled trial was done. Two hundred patients were included in the study and were randomly distributed into 4 groups: Group 1: 50 patients were treated by clarithromycin 500mg bid, amoxicillin1gm bid, omeprazole 20 mg bid for 14 days, Group 2: 50 patients were treated by clarithromycin 500mg bid, metronidazole 500mg bid bid, omeprazole 20 mg bid for 14 days, group 3: 50 patients were treated by clarithromycin 500mg bid, nitazoxanide 500mg bid bid, omeprazole 20 mg bid for 14 days, and group 4: 50 patients were treated by clarithromycin 500mg bid, amoxicillin1gm bid, nitazoxanide 500mg bid bid, omeprazole 20 mg bid for 14 days. All patients were assessed after 4 week post treatment. Our trial showed that patients in group 4 had achieved the highest eradications rate: N=42, 84% in intention to treat analysis (ITT), and 89.36% in per protocol (PP) analysis, followed by group 1 which achieved eradication rate of 64% in ITT and 69.56% in PP, while in group 3 the eradication rate was 56% in ITT, and 56.25% in PP, and finally, group 2 achieved the least eradication rate 36% in ITT and 40.90% in PP, with significant difference between the studied groups (P 0.01). Furthermore, adding nitazoxanide to standard clarithromycin based triple therapy is effective than other used triple regimens and could be used as a first-line regimen for the eradication of H. pylori.

Background: computed tomography (CT) of the abdomen with contrast is the gold standard method for the evaluation of pancreatic cancer concerning staging and vascular assessment. however, not all patients can be evaluated by contrast-enhanced CT abdomen as those with an allergy to the contrast agent, pregnancy, and renal impairment, in addition to hazards of radiation and non-availability of tissue sampling in CECT abdomen .so this study was designed to evaluate the diagnostic ability of Endoscopic Ultrasound for staging and vascular assessment of pancreatic cancer in comparison to CT abdomen with contrast. Method: fifty patients with cancer pancreas were evaluated by CECT and EUS as regard staging and vascular invasion. The vascular assessment was done by dividing the EUS findings into three types by the relationship between tumors and major vessels, type 1, clear invasion, encasement of the vessel by a tumor or tumor that contacts a vessel wall more than 180o; type2, Abutment, a tumor that contacts a vessel wall but less than 180o and type 3, clear non-invasion, the existence of distance between a tumor and a vessel. We regarded type 1 and type 2 as signs of vascular invasion and type 3 as a sign of vascular non-invasion, these findings were compared with the findings of the CECT abdomen. The endoscopist was blind to the CT result before the EUS examination. Result: as regards staging of pancreatic cancer EUS showed sensitivity, specificity, and accuracy of 100% for all. and as regard vascular invasion EUS showed sensitivity, specificity, and accuracy of 100%,95.93%, and 96% respectively for venous invasion and 95.65%,100%, and 99.5% for arterial invasion. Conclusion: EUS can evaluate staging and vascular invasion of pancreatic cancer with very high sensitivity, specificity, and accuracy to the extent it can replace CT in evaluation, with the superiority of EUS due to tissue sampling.

Background: computed tomography (CT) of the abdomen with contrast is the gold standard method for primary evaluation of pancreatic cancer as regard to staging and vascular assessment. however, not all patients can be evaluated by contrast enhanced CT abdomen as those with allergy to the contrast agent, pregnancy, renal impairment, in addition to hazards of radiation and non-availability of tissue sampling in CECT abdomen .so this study was designed to evaluate the diagnostic ability of Endoscopic Ultrasound for staging and vascular assessment of pancreatic cancer in comparison to CT abdomen with contrast. Method: fifty patients with cancer pancreas were evaluated by EUS as regard staging and vascular invasion. Vascular assessment was done by dividing the EUS findings into three types in accordance with the relationship between tumors and major vessels, type 1, clear invasion, encasement of vessel by a tumor or tumor that contact a vessel wall more than 180o; type2, Abutment, a tumor that contacts a vessel wall but less than 180o and type 3, clear non-invasion, existence of distance between a tumor and a vessel. We regarded types 1 and type 2 as signs of vascular invasion and types 3 as sign of vascular non-invasion, these findings were compared with the findings of CT abdomen with contrast. The endoscopist was blind to CT result before EUS examination. Result: as regard to staging of pancreatic cancer EUS showed sensitivity, specificity and accuracy of 100% for all. and as regard vascular invasion EUS showed sensitivity, specificity and accuracy of 100% ,95.93% and 96% respectively for venous invasion and 95.65% ,100% and 99.5% for arterial invasion. Conclusion: EUS can evaluate staging and vascular invasion of pancreatic cancer with very high sensitivity, specificity and accuracy to the extend it can replace CT in primary evaluation, with superiority of EUS due to tissue sampling.