Background: Mongolia has a high prevalence of Helicobacter pylori infection and gastric cancer. We conducted a prospective, randomized, single-blind study to evaluate the efficacy of common regimens in Mongolia and to obtain specimens for susceptibility testing. Methods: Empiric treatments: 270 patients with confirmed H. pylori infection were randomized to receive 10 days clarithromycin-triple therapy (Clari-TT) ( n = 90), modified bismuth quadruple therapy (M-BQT) ( n = 90), or sequential therapy (ST) ( n = 90). A second group of 46 patients received susceptibility-based Clari-TT. H. pylori was cultured from 131 patients and susceptibility testing was performed. H. pylori eradication was confirmed by stool antigen 4 weeks after the therapy. Results: Intention-to-treat (ITT) analysis cure rates were 71.1% (95% CI = 61.7–80.5%) for Clari-TT, 87.8% (95% CI = 81–94.6%) for M-BQT, 67.8% (95% CI = 58.1–77.5%) for ST vs. 89.1% (95% CI = 86–98.2%) for susceptibility-based Clari-TT. Per-protocol (PP) analysis results for these therapies were 72.7% (63.4–82%), 89.8% (83.5–96.1%), 68.5% (58.8–78.2%), and 97.6% (89.5–99.8%), respectively. Among 131 cultured H. pylori , resistance rates to amoxicillin, clarithromycin, and metronidazole were 8.4, 37.4, and 74%, respectively. Conclusion: In Mongolia, the prevalence of H. pylori resistance is high requiring bismuth quadruple therapy or susceptibility-based therapy to obtain acceptable cure rates.

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Hepatitis D is a liver disease in both acute and chronic forms caused by the hepatitis D virus (HDV) that requires hepatitis B virus (HBV) for its replication. In other words, HDV infection occurs only simultaneously or as a superinfection with HBV [1]. The estimated worldwide prevalence of HDV infection was 5% among hepatitis B virus patients. Unfortunately, Mongolia is one of the high-prevalence hotspots for HDV infection worldwide [2]. Our study showed that the HDV co-infection rate in Mongolia was 80.1% among patients with chronic hepatitis B [3]. According to the WHO, the Republic of Moldova and countries in Western and Middle Africa are other geographic hotspots [2].Since parenteral transmission is the primary route of spreading the virus, intravenous drug users, patients on hemodialysis [4], men who have sex with men, and commercial sex workers [5] are considered high-risk groups. Also, familial clustering indicates that HDV is transmitted by personal contacts, presumably through permucosal or percutaneous passage during close or intimate contact [6].The high rates of HBV and HDV infection in Mongolia now result from the epidemic of acute hepatitis B in 1950-1980, caused by the widespread use of boiled syringes in medical practice and vaccination programs [7]. Approximately 400,000 acute hepatitis cases and 7,000 deaths were registered from 1952 to 1986 [8]. Davaalkham et al. reported that past medical history of acute hepatitis, surgery, blood transfusion and being a family member of patients with chronic viral hepatitis were the main risk factors for HDV infection in Mongolia [9].Chronic hepatitis Delta is considered the most aggressive form of chronic viral hepatitis due to a much higher risk of developing liver cirrhosis, more rapid progression towards liver-related death, and hepatocellular carcinoma. About 70% of HDV infected patients were diagnosed with liver cirrhosis within ten years [10] and liver cancer risk was 3-fold higher than in HBV-infected patients [11]. Our study demonstrated similar findings. Patients with chronic hepatitis D had more aggressive disease, including higher transaminase and lower platelet levels than patients with HBV [12]. We previously found that the number of cirrhotic patients was significantly higher in the HDV group vs. HBV group (44.8% vs. 10.8%, p < 0.001) [3]. Oyunsuren et al. reported that HDV infection is strongly associated with liver cancer development in younger patients [13]. These facts imply that Mongolia's large burden of chronic HBV and HDV infection, with its subsequent liver cirrhosis and hepatocellular carcinoma, are priority issues requiring the attention of public health and healthcare providers in general.In 2017, the Mongolian Government initially launched the nationwide program Viral Hepatitis Prevention, Control, and Elimination. Since then, we have successfully implemented broad programs, such as performing mass screening tests among the populations at risk for

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Objectives: Mongolia is known as one of the countries with a high prevalence of hepatitis B and D virus infection. Although the number of acute hepatitis D cases is decreasing since the national vaccination program against HBV launched in 1991, it is still a main cause of acute liver failure (ALF) in Mongolia. The aim of this study is to determine the prognostic value of an ALBI score in patients with acute hepatitis B with or without D. Methods: A total of 114 patients (58 patients with acute hepatitis B (AHB), five patients with HBV/HDV co-infection, and 51 patients with HBV/HDV superinfection), who were admitted to the National Center for Communicable Diseases between 2017 and 2019 were enrolled into this study. Results: We compared the AHB group to the HBV/HDV superinfection group. The mean age was 25.8±6.5 years in the AHB group vs. 28.9±7.4 years in the HBV/HDV superinfection group (p = 0.019). Also, a majority of patients live in Ulaanbaatar (87.5% vs. 62.7%, p = 0.037). The mean hospitalization days was 23± 11 in the AHB, on the other hand it was 28± 13 in the HBV/HDV superinfection group (p = 0.022). The ALF patients had a higher ALBI score, total bilirubin, transaminase, and INR compared with the non-ALF group. The platelet count was significantly lower in the AHB and HBV/HDV infection group with ALF compared with AHB and HBV/HDV infection without ALF. This study showed that the ALBI score in AHB with ALF patients was significantly higher than in AHB without ALF (p = 0.001 ), and H BV/HDV superinfection with ALF had a higher ALBI score than HBV/HDV superinfection without ALF (p = 0.041 ). The area under the curve (AUC) value was 0.766 for ALBI scores. The cut-off value, sensitivity and specificity of ALBI score values were -1. 71, 72.2%, and 75.6%, respectively. Conclusions: ALBI score determined on admission indicates the likelihood of survival of patients with AHB and AHD.