“
“Carolinas Medical

Center, Charlotte, NC Retrospective studies suggest that subjects with chronic hepatitis C and advanced fibrosis U0126 in vitro who achieve a sustained virological response (SVR) have a lower risk of hepatic decompensation and hepatocellular carcinoma (HCC). In this prospective analysis, we compared the rate of death from any cause or liver transplantation, and of liver-related morbidity and mortality, after antiviral therapy among patients who achieved SVR, virologic nonresponders (NR), and those with initial viral clearance but subsequent breakthrough or relapse (BT/R) in the HALT-C (Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis) Trial. Laboratory and/or clinical outcome data were available for 140 of the 180 patients who achieved SVR. Patients with nonresponse (NR; n = 309) or who experienced breakthrough or relapse (BT/R; n = 77) were evaluated every 3 months for 3.5 years and then every 6 months thereafter. Outcomes included death, liver-related death, liver transplantation, decompensated liver disease, and HCC. Median follow-up for the SVR, BT/R, and NR groups of patients was 86, 85, and 79 months, respectively. At 7.5 years, the adjusted cumulative rate of death/liver transplantation and of liver-related morbidity/mortality in the SVR

group (2.2% and 2.7%, respectively) was significantly lower than that of the NR group (21.3% and 27.2%, P < 0.001 for both) but not the BT/R group (4.4% 上海皓元医药股份有限公司 and 8.7%). The adjusted hazard ratio (HR) for time to death/liver transplantation (HR = 0.17, 95% confidence interval selleck chemicals [CI] = 0.06-0.46) or development of liver-related morbidity/mortality (HR = 0.15, 95% CI = 0.06-0.38) or HCC (HR = 0.19, 95% CI = 0.04-0.80) was significant for SVR compared to NR. Laboratory tests related to liver disease severity improved following SVR. Conclusion: Patients with advanced chronic hepatitis C who achieved SVR had a marked reduction in death/liver transplantation, and in liver-related morbidity/mortality,

although they remain at risk for HCC. (HEPATOLOGY 2010;) Chronic hepatitis C virus (HCV) infection is a common cause of cirrhosis, hepatocellular carcinoma (HCC), and liver transplantation. Follow-up studies of patients who achieved a sustained virological response (SVR) after antiviral therapy have demonstrated that the majority of patients continue to have undetectable serum HCV RNA, improvement in liver fibrosis, including reversal of cirrhosis, and a reduction in the incidence of decompensated liver disease and HCC compared with subjects who did not achieve an SVR.1-3 These studies notwithstanding, the beneficial effect of achieving an SVR on the outcome of patients with advanced chronic hepatitis C remains incompletely defined because prior studies were retrospective4-7 and included a small number of patients with cirrhosis2 and a relatively limited period of follow-up.

The incidence of HCC may be higher for children with vertically transmitted hepatitis B who seroconverted from hepatitis B e-antigen to hepatitis B e-antibody before the age of 3 years.[192] For the majority of adults, HCC is identified in cirrhotic livers; the opposite is true for children, as 60-70% of HCC cases are found in a noncirrhotic liver.[193] HCC is rare and often advanced and inoperable at the time of diagnosis.[194] Screening procedures for HCC are not uniform, but alpha-fetoprotein is typically elevated over 400 ng/dL, often reaching over 1,000 ng/dL.[195, 196] Cure is accomplished only

with complete surgical resection, although chemotherapy may be more effective in children than adults.[193] High recurrence rates in adults fell when LT was restricted to individuals who met the Milan criteria: a single tumor diameter less http://www.selleckchem.com/Wnt.html than 5 cm, no more than 3 foci with each one not exceeding 3 cm, and absence of vascular invasion, or extrahepatic involvement.[197] However, Milan criteria may not be applicable in children and recommendations must be individualized.[190, 193, 195, 198] Successful LT outcomes have been achieved even for those children who did not meet the more liberal University of California San Francisco Criteria (single tumor <6.5 cm or maximum of three

tumors with none >4.5 cm and cumulative tumor size <8 cm) or the “up-to-seven” criteria (absence of angioinvasion, number of nodules plus the maximum size of the largest nodule equal or lower than 7).[144] Satisfactory LT outcomes www.selleckchem.com/products/Everolimus(RAD001).html have been achieved in some children with large, multifocal tumors, with some having microscopic blood vessel invasion or limited local extrahepatic

extension.[186, 190, 193] 44. Prompt referral to a liver transplant center should occur for children with or suspected to have hepatocellular carcinoma. (2-B) 45. As the Milan criteria may not be applicable to children, transplantation for hepatocellular carcinoma must be individualized and should be considered in the absence of radiological evidence of extrahepatic disease or gross vascular invasion, irrespective of size of the medchemexpress lesion or number of lesions. (2-B) 46. Absolute contraindications to transplant include radiological evidence of extrahepatic disease (1-B); relative contraindications to transplant include major venous invasion, or rapid disease progression despite chemotherapy. (2-B) 47. Hepatocellular carcinoma (HCC) is uncommon among children and there are no current data to support general screening for HCC in children; children with bile salt excretory pump disease and tyrosinemia are at higher risk for developing HCC and should undergo periodic screening. (2-B) Infantile hemangioma (IH), the most common pediatric tumor, has three categories: 1) focal lesions, 2) multifocal lesions, and 3) diffuse lesions.[199] All focal and most multifocal lesions are asymptomatic and involute spontaneously.

The incidence of HCC may be higher for children with vertically transmitted hepatitis B who seroconverted from hepatitis B e-antigen to hepatitis B e-antibody before the age of 3 years.[192] For the majority of adults, HCC is identified in cirrhotic livers; the opposite is true for children, as 60-70% of HCC cases are found in a noncirrhotic liver.[193] HCC is rare and often advanced and inoperable at the time of diagnosis.[194] Screening procedures for HCC are not uniform, but alpha-fetoprotein is typically elevated over 400 ng/dL, often reaching over 1,000 ng/dL.[195, 196] Cure is accomplished only

with complete surgical resection, although chemotherapy may be more effective in children than adults.[193] High recurrence rates in adults fell when LT was restricted to individuals who met the Milan criteria: a single tumor diameter less see more than 5 cm, no more than 3 foci with each one not exceeding 3 cm, and absence of vascular invasion, or extrahepatic involvement.[197] However, Milan criteria may not be applicable in children and recommendations must be individualized.[190, 193, 195, 198] Successful LT outcomes have been achieved even for those children who did not meet the more liberal University of California San Francisco Criteria (single tumor <6.5 cm or maximum of three

tumors with none >4.5 cm and cumulative tumor size <8 cm) or the “up-to-seven” criteria (absence of angioinvasion, number of nodules plus the maximum size of the largest nodule equal or lower than 7).[144] Satisfactory LT outcomes www.selleckchem.com/products/DAPT-GSI-IX.html have been achieved in some children with large, multifocal tumors, with some having microscopic blood vessel invasion or limited local extrahepatic

extension.[186, 190, 193] 44. Prompt referral to a liver transplant center should occur for children with or suspected to have hepatocellular carcinoma. (2-B) 45. As the Milan criteria may not be applicable to children, transplantation for hepatocellular carcinoma must be individualized and should be considered in the absence of radiological evidence of extrahepatic disease or gross vascular invasion, irrespective of size of the 上海皓元医药股份有限公司 lesion or number of lesions. (2-B) 46. Absolute contraindications to transplant include radiological evidence of extrahepatic disease (1-B); relative contraindications to transplant include major venous invasion, or rapid disease progression despite chemotherapy. (2-B) 47. Hepatocellular carcinoma (HCC) is uncommon among children and there are no current data to support general screening for HCC in children; children with bile salt excretory pump disease and tyrosinemia are at higher risk for developing HCC and should undergo periodic screening. (2-B) Infantile hemangioma (IH), the most common pediatric tumor, has three categories: 1) focal lesions, 2) multifocal lesions, and 3) diffuse lesions.[199] All focal and most multifocal lesions are asymptomatic and involute spontaneously.

Continuous variables were expressed as median (interquartile range) and data compared with Mann–Whitney U-test. Categorical variables were expressed as percentages and data compared using χ2-test. A P < 0.05 was considered statistically significant. Variables with a P-value of less than 0.20 in the univariate analysis and with clinical relevance were subsequently introduced to a multiple linear regression model to modulate the behavior of the dependent variable (quality of life). A multivariate analysis

was performed to confirm that the relationship found between HRQL and associated variables (MHE and appetite) remains besides the differences observed among both groups of patients Dabrafenib clinical trial (with and without MHE) at baseline. Two models of multiple linear regressions were

performed. The first model included the laboratory and clinical components of the Child–Pugh score, whereas the second model included the Child–Pugh score. The aim was to analyze if both models had the same effect on HRQL. The independent variables were eliminated and reconsidered from the analysis if the P-value was greater than 0.05. This procedure was developed step-by-step until no variable could be included or removed according to the above criteria. All data were analyzed using SPSS version 19 (SPSS, Kinase Inhibitor Library manufacturer Chicago, IL, USA). One hundred and twenty-five patients with a diagnosis of decompensated hepatic cirrhosis were selected, of whom 55 (44.0%) presented MHE. The median age of the patients with MHE and without MHE was 59 and 53 years, respectively. When comparing clinical and demographic characteristics of both groups, significant differences were observed in age, 上海皓元医药股份有限公司 Child–Pugh index, leukocytes, platelets, creatinine, hematocrits, albumin and prothrombin time (Table 1). Forty-one patients (58.6%) without MHE had moderate malnutrition, similar to the group with MHE (n = 31, 56.4%). When appetite was evaluated by VeAS (Table 2), 21.8% of the patients with MHE endorsed having little appetite and 23.6%

endorsed having good appetite, compared with 11.4% and 37.1%, respectively, in patients without MHE (P = 0.108). When comparing the medians obtained with the ViAS, a reduction in appetite was observed in patients with MHE, although this difference was not statistically significant. Nevertheless, upon stratifying the patients according to the Child–Pugh score, among those with MHE a reduction in appetite was observed as the degree of hepatic damage increased (Child A 5.6 [5.1] vs Child B 4.5 [2.2] vs Child C 4.4 [3.2]; P = 0.074), a situation that was not present in patients without MHE (Child A 4.8 [1.5] vs Child B 4.6 [2.1] vs Child C 6.1 [3.3]). In the MHE group, a significant reduction was observed in appetite (P = 0.027) in patients with Child B compared with those classified as Child A. Table 3 shows the medians of the six domains and the overall score of the CLDQ.

Previous studies have neither classified nor considered as part of the selection criteria the degree of decompensation, so it is unknown if the frequency of MHE is lower in patients with compensated cirrhosis. Health-related quality of life in patients with MHE has been evaluated with various ICG-001 questionnaires and in various populations.[5, 7, 8, 13, 14, 32, 42, 43]

To date, results are not consistent in regards to the effect of this complication on the daily life of patients with cirrhosis. Based on the results of this study, MHE is a factor that deteriorates HRQL in patients with decompensated cirrhosis, showing significant difference in the domains of fatigue, systemic symptoms, emotional function, activity and overall score, independent of the scoring obtained in the Child–Pugh index. The multivariate analysis confirms that MHE is a complication that impaired the domains of activity, emotional function and global scoring on the CLDQ questionnaire. Perhaps one of

the main causes of inconsistent results in patients with MHE is the inclusion in the analysis of heterogeneous groups of patients. Up to now, this is the first article that includes only patients with decompensated cirrhosis, who have a greater risk of mortality and who develop different complications than patients with compensated cirrhosis.[18, 40, 41] Therefore, it is important to classify patients not only according to the Child–Pugh score, but also to the degree of decompensation. Besides Gefitinib the inclusion of patients with alcoholic cirrhosis in our study, the multivariate analysis shows that MHE is an independent factor that deteriorates HRQL. However, to confirm that the relationship between these two variables remains, we performed an analysis excluding patients with alcoholic cirrhosis and HRQL was significantly MCE lower in the domains of activity, emotional function, worry and overall score in patients with MHE compared with non-MHE patients (data no shown). It

is worth mentioning that not all previous studies have excluded patients with a history of OHE, which increases the frequency of MHE because some patients have persistent cognitive impairments after the treatment and resolution of OHE, which has a negative impact on HRQL of patients with liver cirrhosis.[13, 36] In addition, various questionnaires have been used to evaluate quality of life, both generic and specific, which makes results difficult to compare. The specific questionnaire for hepatic failure approaches aspects of the social environment, hepatic encephalopathy and fatigue which are not completely covered in general questionnaires, including SF-36.[44] Nonetheless, as has been reported in patients with MHE, there is a greater risk of causing or suffering car accidents as well as falls.

fundyense filtrate. These results demonstrate that competitor cell size, independent from taxonomy, may influence the outcome of allelopathic interactions. The findings presented here suggest a potential ecological impact of diatom cell size reduction and sexual reproduction that has not yet been described and that may be important in determining diatom survival and success. “
“In wetland habitats, periphyton is a common component of open-water areas with species assemblage determined by local water quality. Extracellular polymeric substances (EPS) secreted by algae and bacteria give structure to periphyton, and differences in EPS chemistry

affect the functional roles of these polymers. The Florida Everglades provide a unique opportunity to study compositional differences of Metabolism inhibitor EPS from Selleck ABT 199 distinctive algal assemblages that characterize areas of differing water chemistry. Water conservation area (WCA)-1 is a soft-water impoundment; periphyton was loosely associated with Utricularia stems and amorphous in structure, with a diverse desmid and diatom assemblage, and varying cyanobacterial abundance. Extracellular polymers were abundant and were loosely cell-associated sheaths and slime layers in addition to tightly cell-associated capsules. The EPS were

complex heteropolysaccharides with significant saccharide residues of glucose, xylose, arabinose, and fucose. Carboxylic acids were also prominent, while ester sulfates and proteins were small components. Structured, cohesive cyanobacteria-dominated periphyton was observed in WCA-2A, a minerotrophic impoundment, and filaments were heavily encrusted with calcium carbonate and detrital matter. 上海皓元 EPS were primarily cell-associated sheaths, and polymer residues were dominated by glucose, xylose, fucose, and galactose, with uronic acids also a significant component of the polymers. Principal components analysis revealed that periphyton community assemblage determined the monosaccharide composition of EPS, which ultimately

determines a range of biogeochemical processes within the periphyton. “
“The genera Esoptrodinium Javornický and Bernardinium Chodat comprise freshwater, athecate dinoflagellates with an incomplete cingulum but differing reports regarding cingulum orientation and the presence of chloroplasts and an eyespot. To examine this reported diversity, six isolates were collected from different freshwater ponds and brought into clonal culture. The isolates were examined using LM to determine major cytological differences, and rDNA sequences were compared to determine relatedness and overall phylogenetic position within the dinoflagellates. All isolates were athecate with a left-oriented cingulum that did not fully encircle the cell, corresponding to the current taxonomic concept of Esoptrodinium. However, consistent cytological differences were observed among clonal isolates.

fundyense filtrate. These results demonstrate that competitor cell size, independent from taxonomy, may influence the outcome of allelopathic interactions. The findings presented here suggest a potential ecological impact of diatom cell size reduction and sexual reproduction that has not yet been described and that may be important in determining diatom survival and success. “
“In wetland habitats, periphyton is a common component of open-water areas with species assemblage determined by local water quality. Extracellular polymeric substances (EPS) secreted by algae and bacteria give structure to periphyton, and differences in EPS chemistry

affect the functional roles of these polymers. The Florida Everglades provide a unique opportunity to study compositional differences of selleck chemicals llc EPS from find more distinctive algal assemblages that characterize areas of differing water chemistry. Water conservation area (WCA)-1 is a soft-water impoundment; periphyton was loosely associated with Utricularia stems and amorphous in structure, with a diverse desmid and diatom assemblage, and varying cyanobacterial abundance. Extracellular polymers were abundant and were loosely cell-associated sheaths and slime layers in addition to tightly cell-associated capsules. The EPS were

complex heteropolysaccharides with significant saccharide residues of glucose, xylose, arabinose, and fucose. Carboxylic acids were also prominent, while ester sulfates and proteins were small components. Structured, cohesive cyanobacteria-dominated periphyton was observed in WCA-2A, a minerotrophic impoundment, and filaments were heavily encrusted with calcium carbonate and detrital matter. medchemexpress EPS were primarily cell-associated sheaths, and polymer residues were dominated by glucose, xylose, fucose, and galactose, with uronic acids also a significant component of the polymers. Principal components analysis revealed that periphyton community assemblage determined the monosaccharide composition of EPS, which ultimately

determines a range of biogeochemical processes within the periphyton. “
“The genera Esoptrodinium Javornický and Bernardinium Chodat comprise freshwater, athecate dinoflagellates with an incomplete cingulum but differing reports regarding cingulum orientation and the presence of chloroplasts and an eyespot. To examine this reported diversity, six isolates were collected from different freshwater ponds and brought into clonal culture. The isolates were examined using LM to determine major cytological differences, and rDNA sequences were compared to determine relatedness and overall phylogenetic position within the dinoflagellates. All isolates were athecate with a left-oriented cingulum that did not fully encircle the cell, corresponding to the current taxonomic concept of Esoptrodinium. However, consistent cytological differences were observed among clonal isolates.

The clinical characteristics and laboratory data at admission were documented, based on which MELD-Na, MELD and CTP scores were calculated. Results: Among 429 patients who had complete control of bleeding by endoscopic variceal ligation or sclerotherapy injections at admission, 97 patients (22.6%) suffered learn more esophageal variceal rebleeding within 3 months and 206 patients (48.0%) within 1 year. Fifty-three patients (12.4%) died within 3 months

and 98 patients (22.8%) within 1 year. The area under receiver operator characteristics curve (AUC) of the MELD-Na score for predicting rebleeding was significantly higher than that of the MELD and the CTP score (0.83 v.s. 0.77 v.s. 0.69 for 3-month and 0.85 v.s. 0.80 v.s. 0.65 for 1-year, P < 0.05) in predicting rebleeding. The AUC of the MELD-Na score for predicting rebleeding associated mortality was also significantly higher than the other two modols (0.81 v.s. 0.75 v.s. 0.66 for 3-month and 0.82 v.s. 0.78 v.s. 0.68 for 1-year, P < 0.05). Conclusion: The MELD-Na score is superior to MELD and

CTP scoring in predicting 3-month and 1-year rebleeding and associated mortality in cirrhotic patients after cessation of initial esophageal variceal hemorrhage. Key Word(s): 1. Cirrhosis; 2. Rebleeding; 3. Mortality; 4. MELD-Na; Presenting Author: EE-THIAM OOI Additional Copanlisib Authors: SARAVANAN ARJUNAN, SHASHIKUMAR MENON Corresponding Author: EE-THIAM OOI Affiliations: Kuala Lumpur Hospital Objective: Early endoscopy is the standard of care in upper gastrointestinal bleeding. However most patients with lower gastrointestinal bleeding (LGIB) have favorable outcomes and majority will stop

bleeding spontaneously. 上海皓元 Therefore the role of urgent colonoscopy in LGIB remains controversial. To study the completeness, diagnostic yield and clinical impact of urgent colonoscopy in patients with LGIB. Methods: Procedure reports for urgent colonoscopy performed in Kuala Lumpur Hospital from 1 May 2011 till 30 April 2012 were retrieved from Malaysian GI Registry. The reports were reviewed and analyzed. Results: 146 urgent colonoscopies were performed for LGIB during study period. 78 (53.4%) were male. Mean age was 56.5 years and median age was 56.6 years (range 18.8 to 90.0 years). Caecal intubation rate was 64.4% (n = 94). 14.4% (n = 21) of patients needed repeat colonoscopy due to inadequate visualization of bowel for definite clinical decisions; this included 7.4% (n = 4) of colonoscopies with successful caecal intubation. 24.0% (n = 35) had an endoscopic therapy done. 26.7% (n = 39) of them altered the immediate clinical management. Causes were found in 60.3% (n = 88) of patients. However only 39.8% (n = 35) of them had endoscopic therapy, and 55.7% (n = 49) had no clinical impact on immediate management of patients though the cause was identified. The causes were colorectal ulcers (n = 36, 40.9%), diverticular disease (n = 16, 18.2%), hemorrhoid (n = 16, 18.

Z-scores for height, weight, and BMI were calculated buy GSK2118436 using the CDC growth tables, implemented using the gc-calculate-BIV. SAS program from the Centers for Disease Control and Prevention (CDC). All analyses were performed using SAS v. 9.3. We identified 44 treatment-naïve children with chronic HCV infection and no concurrent liver diseases with at least two liver biopsies more than 1 year apart from the eight participating centers. Their demographics are given in Table 1. The mode of transmission was

vertical in 25 (57%) children, by way of transfusions in 17 (39%), and unknown in two (4%) adopted children. Viral genotype was known in 35 children and was 1 (a/b) in 30 (84%) selleck kinase inhibitor children. Mean age at the first and last liver biopsy was 8.6 and 14.5 years, respectively. The mean interval between biopsies was 5.8 ± 3.5 years, range 1-17 years. The duration of infection to the two biopsies was 7.7 and 13.5 years, respectively.

Laboratory values including complete blood count, prothrombin time, bilirubin, and albumin did not differ significantly between the two sets of biopsies. The histologic features in the 44 children at the time of initial and final biopsies are shown in Table 2. Biopsy sizes were excellent (containing over 11 portal tracts) in 40 biopsies, adequate (between 6-11 portal tracts) in 43, and modest (between 3-5 tracts) in 14. There were two wedge and two surgical resection specimens. Thirty-seven patients had two biopsies each and seven patients had more than two biopsies (five patients had three biopsies, two patients had four each). The total biopsies reviewed were 97. Necroinflammatory activity was minimal in 55% and 50% of the patients on the first and the final biopsy, respectively. Fibrosis was absent in 16% at both biopsies and limited to portal/periportal in

73% of children at the first biopsy and 64% at the final biopsy. Bridging fibrosis/cirrhosis was present in five medchemexpress patients (11%) at the first biopsy and nine patients (20%) at the final biopsy (P = 0.0046). Thirteen patients showed progression in fibrosis at varying stages between the two sets of biopsies. The changes of progression and regression of fibrosis between biopsies in 24 patients are discussed below. Steatosis was minimal or moderate in 23% and 27% of the biopsies and showed no progression or regression. “Chicken wire” fibrosis was found in three, giant cell transformation in two, and iron overload in two biopsies. The demographic features such as age at biopsy, duration of infection, BMI, laboratory values such as ALT and viral load, and histologic changes of inflammation and steatosis on the initial liver biopsy were analyzed for correlation with the stage of fibrosis to identify any characteristics that had a predictive value for the severity of fibrosis (Table 3). Necroinflammatory changes (P = <0.

Cytokeratin 18 (CK18) is an intermediate filament, the cleavage of which is considered an early event during apoptosis following activation of effector caspases. Methods:  Helicobacter pylori

strains were isolated from 76 dyspeptic patients. cagA 3’ variable region and CagA protein status were analyzed by PCR and western blotting, respectively. Eight hours post-co-culture of AGS cells with different H. pylori strains, flow cytometric analysis was performed using M30 monoclonal antibody specific to CK18 cleavage-induced neo-epitope. Results:  Higher rates of CK18 cleavage were detected during co-culture of AGS cells with H. pylori ABT-263 chemical structure strains bearing greater numbers of cagA EPIYA-C and multimerization (CM) motifs. On the other hand, H. pylori strains with greater numbers of EPIYA-B relative to EPIYA-C demonstrated a decrease in CK18 cleavage rate. Thus, H. pylori-mediated cleavage of CK18 appeared proportional to the number of CagA EPIYA-C and CM motifs, which seemed to be downplayed in the presence of EPIYA-B LEE011 supplier motifs. Conclusions:  Our observation associating the heterogeneity of cagA variants with the potential of H. pylori strains in the induction of CK18 cleavage as an early indication of apoptosis in gastric epithelial cells supports the fact that apoptosis may be a type-specific trait. However, additional cagA-targeted experiments are required to clearly identify the role of EPIYA and CM motifs in

apoptosis and/or the responsible effector molecules. “
“Objectives:  The prospective study was designed to clarify the impact of CYP2C19 on quadruple therapies and survey the efficacies of rabeprazole-based quadruple therapy for Helicobacter pylori infection after failure of standard triple therapies. Patients and Methods:  From January 2007 to March 2009, 1055 H. pylori-infected patients received standard triple regimens (proton-pump inhibitor (PPI), clarithromycin, and amoxicillin). Helicobacter pylori eradication was achieved in 865 (81.9%) subjects. One hundred ninety eradication-failure patients were enrolled and randomly assigned to receive a 7-day eradication

therapy. Ninety-six patients were treated with esomeprazole-based quadruple rescue therapies (EB), while 94 patients were treated with rabeprazole-based quadruple rescue therapies (RB). Follow-up endoscopy was done 16 weeks MCE公司 later to assess the treatment response. Patients’ responses, CYP2C19 genotypes, and antibiotics resistances were also examined. Results:  Intention-to-treat analysis revealed that RB had better eradication rates than EB (EB: 72.9%; 95% CI: 64.9–80.9% and RB: 78.7%; 95% CI 72.5–84.9%) (p value = .543). Per-protocol results were EB = 75.3%; 95% CI: 70.3–80.3% and RB = 85.1%; 95% CI: 80.6–89.6% (p value = .0401). Both regimens had similar compliance (p value = 0.155) and adverse events (p value = 0.219). We also surveyed those patients without resistance of any antibiotics. RB still showed better outcome than EB.