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INTRODUCTION Helicobacter  is spiral  flagellum, gram-negative, microaerophilic organism in the gastroduedenal mucosal layer, It is a common bacterial infestation and a tremendous alert for developing gastric malignancy in 90 percent of the people all over the world. Also it is accompanied with other diseases, as gastric ulcer ,  crcinoma and MALT ( lymphoid tissue lymphoma).( Lee HS. Histopathologic Diagnosis………). Testing for H. pylori is urgently recommended in patients with ; GIT ulcer disease , After resection of early stomach malignancy, epigastric pain investigated by endoscopy , MALT lymphoma,  thrombocytopenic purpura (ITP),Unexplained microcytic hypochromic anemia, Family history of gastric malignancy , familial GIT polypii and MALT. Transmission is via feco-oral , mouth to mouth. 85 percent of patients associated by peptic ulcerations are associated with H. pylori infections. Modern  investigations  revealed that extra gastric diseases are also associated with H. pylori infections, such as unexplained iron deficiency, ITP, unexplained megaloblastic anemia . ( Vítor JM,…….) Urea breath test : is considered the gold  method of diagnostic value in both pre- and post-eradicated cases. It does not involve endoscopic invasion, almost maximum non faulty resuls ,  has a sensitivity of 98% and specificity of 99% , also is  the most reliable method of diagnosing HP infection in pre- and post-treated cases ( Osaki T……….)Stool antigen test The stool antigen test provides precise and delicate diagnosis in pre and post treated cases of H. pylori infections. A duration of one to two months post eradication evaluation has excellent result but an evaluation before one month post-treatment gives faulty negative results. (Lario S,  Junquera F………..) IgG serology  Serum antigen marker G antibodies is a very easy testing for diagnosis of H. pylori infection. Its presence denotes that the patient has the infection but remains positive after ttt. However, it does not give false negative results in patients taking Proton pump inhibitors or antibiotics  so it is an excellent negative test as an exclusion of infection. (Marchildon PA……….. )Rapid urease test (RUT)RUT is a characteristic urease reaction applied upon a fresh biopsy. It is simple and rapid, with very good detectibility and adequacy , even in posteradicated cases. The sensitivity accounts for 95-98% and specificity varies from 95-100%. However it also gives false positive results in non-helicobacter urease producing organisms and  achlorhydria cases. (Calvet ………..)HistologyHistology using geimsa stained biopsy remains the most gold standard for diagnosis with a sensitivity and specificity more than 95%. Immunostaining helps to increase the detectability rate to 100% and accuracy to 99%. (Buharideen S………..)Culture and sensitivityThe role of culture and sensitivity has a gargantuan and leading role in increasing H. pylori eradication as it not only diagnoses H. pylori infection but also guides clinicians on using the best effective regimen according to the sensitivities of drugs in specific regions where antibiotic resistance is high and that is the AIM OF THIS PILOT THAT WE WILL APPLY TO PATIENTS IN AGOUZA HOSPITAL.AVAILABLE DRUG THERAPIES used in eradication. (Kim SG, , Kim CG, et al. Guidelines for the diagnosis and treatment………….)Standard therapyStandard triple therapy (PPI+ amoxicillin+ clarithromycin) for 7 days is the worldwide followed first line treatment regimen. However, IT fails in up to 30% of cases due to increased resistance to clarithromycin. (Yoon H, Kim N, Lee BH…………) REGIMENS THERAPIES ACCORDING TO THE RECENT GUIDELINES  (Malfertheiner , Management of Helicobacter pylori infection……………..)1st line regimen therapies include;  in high resistant areas to clarithromycin   we can use Bismuth quadruple therapy referred to as PBMT PPI + Bismuth + Metronidazole + Tetracycline or Concomitant quadruple therapy referred to as PAMC PPI + Amoxicillin + Metronidazole + Clarithromycin The challenge of Helicobacter pylori resistance to antibiotics: the comeback of bismuth-based quadruple therapy.).  In areas of low resistance to clarithromycin, The following are the preferred clarithromycin triple therapy regimens: Clarithromycin triple therapy (referred to as PAC PPI + Amoxicillin + Clarithromycin or PMC PPI +Metronidazole + Clarithromycin for 14 days The following are alternatives in case of failure of at least 2 previous first-line regimens: (Zagari RM…………)1.PAM (PPI + Amoxicillin + Metronidazole) for 2 weeks days  PPI:  omeprazole 20 mg twice , Amoxicillin 1000 mg twice, Metronidazole 500 mg twice2. Sequential therapy :PPI:  omeprazole 20 mg twice daily for five to seven days, then Amoxicillin 1000 twice daily for five to seven days, Followed by ppi +metronidazole +clarithromycin for five to seven days (Jung S, Comparing Concomitant Therapy with Sequential Therapy …………..)3.Hybrid therapy : PPI:  omeprazole 20 mg twice daily  tfor seven days ,then Amoxicillin 1000 mg twice daily for seven days Followed by ppi+metronidazole+amoxcicillin+clarithromycin for seven days4. Levofloxacin triple therapy for two weeks :  omeprazole 20 mg twice dailyI, Amoxicillin 1000 mg twice daily, andLevofloxacin 500 mg once daily (Yoon H, Ki, et levofloxacin Triple Therapy……. )5. Levofloxacin sequential therapy : omeprazole 40 mg twice daily for one week ,then  Amoxicillin 1000 mg twice for a week, Followed by a week of omeprazole 40 mg twice daily plus Amoxicillin 1000 mg twice daily plus Levofloxacin 500 mg once daily plus Metronidazole 500 mg twice daily6.LOAD therapy (Levofloxacin + Omeprazole +alinia( nitazoxanide) + Doxycycline) therapy for ten days. (Basu ,rishnaswamy  The American journal of gastroenterology………)II. Materials And Methods All patients undergoing endoscopy for whatever reason in the agoza hospital, will be the test subjects of the pilot . All the biopsy samples from gastric and duedunal lesions will be gathered  without application of formalin followed by biopsy processing using  hematoxylin with eosin staining, In addition, Geimsa staining will be added for evaluation of  the presence of helicobacter Pylori . Biopsies confirmed positive to helicobacter pylori infection will be selected for culture and sensitivityIII. Aim of the pilot: to overcome the problem of Antibiotic resistance and eradication failure , by applying the culture and sensitivity testing ,before any medical approach will allow to use the most appropriate eradication regimen from the start .The high rate of clarithromycin resistance  made us prevent  its  empirical  use  in standard triple anti-H pylori  regimens. resistance  rates  of  metronidazole  and clarithromycin are significantly elevating allover wide world followed by levofloxacin. Therefore, the culture-guided therapy for H. pylori is currently mandatory specifically in well-known antibiotic resistant countries. IV. INCLUSION CRITERIA: these conditions will determine the candidate patients1. Patients with long term dyspepsia especially those who developed alarming signs as cachexia2. All patients undergoing endoscopy are not diagnosed or known to be infected with helicobacter pylori3. Patients wheather received  PPI or antibiotic therapy or both and the patients whom didn’t take any therapy will be included4. Patients providing full consent5. Biopsies will be mainly taken from the antrum of the stomach and the 1st part of duodenum6. Full medical examination along lab investigations as CBC ,liver and renal function tests7. Age of the patients will range from late twenties up to early fifties, pediatrics and geriatrics will be excluded.REFRENCES1. Vítor JM, Vale FF. Alternative therapies for Helicobacter pylori: Immunology & Medical Microbiology. 2. Choi YJ: Diagnosis of H. pylori Infection 3. Helicobacter, Group CC. Gastric cancer and Helicobacter pylori 20154. Kim SG, Jung HK et al. Guidelines for the diagnosis and treatment of Helicobacter pylori infection  20175. Tonkic , Mégraud F. Epidemiology and diagnosis of Helicobacter pylori infection 20086. Hun Van Der Merwe S. World gastroenterology organisation global guideline of gastrointestinal and liver disease. 20097. Zhang Yang Y, et al. Seroepidemiology of Helicobacter pylori infection. World journal of gastroenterology8. Kato M,  Recent knowledge of the relationship between Helicobacter pylori and gastric cancer and recent progress of gastroendoscopic diagnosis and treatment for gastric cancer. Japanese journal of clinical oncology. 9. Lee S-Y. Current progress toward eradicating Helicobacter pylori , differences in the 2013 revised guidelines between China, Japan, and South Korea. World journal of gastroenterology. 201410.Cancer Research UK: Information resource center 2004. 11 .Suzuki , Wakai K, et al. Smoking increases the treatment failure for Helicobacter pylori eradication. The American journal of medicine. 2006 12. Malfertheiner P,Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus 201213. Ekström AM, Held Nyrén O. Helicobacter pylori in gastric cancer established by CagA immune-Gastroenterology. 200114. Zagari RM, Romano B, et al. Guidelines for the management of Helicobacter pylori infection in Italy: the III Working Group Consensus Report 201515. Cid TP, Fernández MC, Jones NL. Pathogenesis of Helicobacter pylori infection. Helicobacter. 201316. Machado JC, Yamaoka Y. Pathogenesis of Helicobacter Pylori infection Helicobacter.200517.  Costa AC. Pathogenesis of Helicobacter pylori infection. Helicobacter 2009 18. Backert S, Clyne M. Pathogenesis of Helicobacter pylori infection. Helicobacter. 201119. Zou QH, Li RQ. Helicobacter pylori in the oral cavity and gastric mucosa: a meta?analysis. Journal of Oral Pathology & Medicine. 201120. Mentis A. Epidemiology and Diagnosis of Helicobacter pylori infection. Helicobacter. 201521. Lario A Ju F, Martinez-Bauer E, accuracy of three monoclonal stool tests in a large series of untreated Helicobacter pylori infected patients. Clinical biochemistry.201622. Calvet ,Lázaro MJ, Quesada M, et al. Accuracy of diagnostic tests for Helicobacter pylor. Clinical Infectious Diseases. 200923. Vaira D, Gci C. Diagnosis of Helicobacter pylori infection. Alimentary pharmacology. 200224. Ferwana M, Abdulmajeed , Firwana B, Hasan R, et al. Accuracy of urea breath test in Helicobacter pylori infection: Meta-analysis. World journal of gastroenterology 200925. Osaki T , Urease-positive bacteria in the stomach induce a false-positive reaction in a urea breath test for diagnosis of Helicobacter pylori infection. Journal of medical microbiology. 200826. Braden B. Diagnosis of Helicobacter pylori infection. 201227. Buharidee . Journal of Diagnostic Pathology. 201628. Lee HS. Histopathologic Diagnosis of H. pylori Infection and Associated Gastric Diseases. 201629.Black DD, Casteel HB et al. Comparison of immunohistochemistry and silver stain for the diagnosis of pediatric Helicobacter pylori infection in urease-negative gastric biopsy.200130. Uchida T al. Immunohistochemical diagnosis of the cagA?gene genotype of Helicobacter pylori with anti CagA?specific antibody. Cancer science. 200731. Allahverdiyev AM, et al. Isolation and diagnosis of Helicobacter pylori by a new method: microcapillary culture. World J Gastroenterology. 201532 Sato Y, Hayakawa M, et al. Detection of Helicobacter pylori (H. pylori) DNA in digestive systems by real- time PCR, Legal Medicine.200933. Kabir S. Detection of Helicobacter pylori DNA in feces and saliva by polymerase chain reaction: 200434. Glocker E, Kist M. Rapid detection of point mutations in the gyra gene of Helicobacter pylori conferring resistance to ciprofloxacin. Journal of clinical microbiology. 200435. Oleastro M, et al. 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