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PubMed1999

Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers.

BACKGROUND AND METHODS: After endoscopic treatment to control bleeding of peptic ulcers, bleeding recurs in 15 to 20 percent of patients. In a prospective, randomized study, we compared endoscopic retreatment with surgery after initial endoscopy. Over a 40-month period, 1169 of 3473 adults who were admitted to our hospital with bleeding peptic ulcers underwent endoscopy to reestablish hemostasis. Of 100 patients with recurrent bleeding, 7 patients with cancer and 1 patient with cardiac arrest were excluded from the study; 48 patients were randomly assigned to undergo immediate endoscopic retreatment and 44 were assigned to undergo surgery. The type of operation used was left to the surgeon. Bleeding was considered to have recurred in the event of any one of the following: vomiting of fresh blood, hypotension and melena, or a requirement for more than four units of blood in the 72-hour period after endoscopic treatment. RESULTS: Of the 48 patients who were assigned to endoscopic retreatment, 35 had long-term control of bleeding. Thirteen underwent salvage surgery, 11 because retreatment failed and 2 because of perforations resulting from thermocoagulation. Five patients in the endoscopy group died within 30 days, as compared with eight patients in the surgery group (P=0.37). Seven patients in the endoscopy group (including 6 who underwent salvage surgery) had complications, as compared with 16 in the surgery group (P=0.03). The duration of hospitalization, the need for hospitalization in the intensive care unit and the resultant duration of that stay, and the number of blood transfusions were similar in the two groups. In multivariate analysis, hypotension at randomization (P=0.01) and an ulcer size of at least 2 cm (P=0.03) were independent factors predictive of the failure of endoscopic retreatment. CONCLUSIONS: In patients with peptic ulcers and recurrent bleeding after initial endoscopic control of bleeding, endoscopic retreatment reduces the need for surgery without increasing the risk of death and is associated with fewer complications than is surgery.

Aged↗
PubMed2002

Retreat space and human visitor density moderate undesirable behavior in petting zoo animals.

This study focused on the relationship between nonhuman animal behavior and envi-ronment- specifically, between the undesirable behavior exhibited by domestic pet-ting zoo animals in the presence of humans and the spatial design of the petting zoo environment. A spatial feature of a petting zoo referred to as a retreat space was ma-nipulated so that it affected the animals' opportunity for individual control over inter-action with humans. Three conditions were tested: no retreat space, semi-retreat space, and a full-retreat space. The subjects of this study were 5 African pygmy goats (Capra hircus) and 2 Romanov sheep (Ovis aries). Investigators used a focal sam-pling technique to analyze approximately 27 hr of behavioral data collected. The data were analyzed using multiple linear regression methods. The findings suggest that the full-retreat design beneficially moderated both sheep and goat behavior: Undesirable behaviors were lowest in the full-retreat condition. This study provides information that may improve human-animal interactions in a petting zoo setting and may in-crease animal well-being through exhibit design and management techniques.

Aggression↗
PubMed1996

Retreatment of patients surviving cancer-free 2 or more years after initial treatment of small cell lung cancer.

STUDY OBJECTIVE: To assess the outcome after retreatment of patients with small cell lung cancer (SCLC) who redevelop small cell cancer (SCC) 2 or more years after initial therapy. DESIGN: Retrospective analysis. SETTING: Single government institution: the National Cancer Institute. PATIENTS: Twenty patients who redeveloped SCC among 65 patients who survived 2 or more years after starting treatment for their initial cancer. MEASUREMENTS: The response rate of patients after retreatment, the survival duration from the time of redevelopment of SCC, and the toxicities of retreatment. RESULTS: Twenty patients redeveloped SCC: 18 with a relapse and 2 with a second primary cancer. Sixteen received treatment after they redeveloped SCLC while four did not. Eleven patients were retreated with chemotherapy alone, two patients received chemotherapy plus chest radiotherapy, one patient received radiotherapy alone, one patient underwent lobectomy, and one patient was treated with a monoclonal antibody followed by chemotherapy. Nine of 16 patients (56%) treated after they redeveloped SCLC had an objective response (3 complete and 6 partial). The median survival of all 20 patients after they redeveloped SCC was 3.9 months (range, 0 to 46 months). The median survival of the patients who were retreated was 6.5 months (range, 1 to 46 months). CONCLUSIONS: Patients who suffer relapses with SCLC 2 or more years from diagnosis are candidates for retreatment.

Adult↗
PubMed2000

High-versus low-threshold surfactant retreatment for neonatal respiratory distress syndrome.

UNLABELLED: Surfactant therapy has become an effective standard therapy for infants with respiratory distress syndrome (RDS). The first dose may be given either as prophylaxis immediately after delivery, or as rescue after an infant has developed RDS. Second and subsequent doses are currently recommended by the manufacturers to be administered at minimal levels of respiratory support. PURPOSE: This study compared the relative efficacy of administering second and subsequent doses of Infasurf surfactant at a low threshold (FIO(2) >30%, still requiring endotracheal intubation) versus a high threshold (FIO(2) >40%, mean airway pressure >7 cm H(2)O) of respiratory support. METHODS: A total of 2484 neonates received a first dose of surfactant; 1267 reached conventional retreatment criteria and were randomized to be retreated according to low- or high-threshold criteria. They were then retreated at a minimum of 6-hour intervals each time they reached their assigned threshold until receiving a maximum of 4 total doses. Subjects were stratified by whether they received their first dose by prophylaxis or rescue and by whether their lung disease was considered complicated (evidence of perinatal compromise or sepsis) or uncomplicated. RESULTS: Among the patients randomized, 33% of prophylaxis and 23% of rescue subjects met criteria for the complicated stratum. Although infants allocated to the high-threshold strategy were receiving slightly more oxygen at 72 hours, there was no difference in the number receiving mechanical ventilation at 72 hours or in the secondary respiratory outcomes (requirement for supplemental oxygen or mechanical ventilation at 28 days, supplemental oxygen at 36 weeks' postconceptional age, inspired oxygen concentration >60% at any time). However, there was a significantly higher mortality for infants with complicated RDS who had received retreatment according to the high-threshold strategy. CONCLUSIONS: We conclude that equal efficacy can be realized by delaying surfactant retreatment of infants with uncomplicated RDS until they have reached a higher level of respiratory support than is the current standard. We speculate that this would result in a substantial cost-saving from less utilization of drug. Conversely, we believe that infants with complicated RDS should continue to be treated by the low-threshold retreatment strategy, which is currently recommended by the manufacturers of the commercially available surfactants.

Biological Products↗
PubMedDate not supplied

Alcon LADARWave customcornea retreatments.

PURPOSE: To present our experience performing wavefront-guided ablations for the treatment of residual refractive error following previous refractive surgery. METHODS: Four different cases are presented-1) primary wavefront-guided LASIK; 2) wavefront-guided lift-flap LASIK retreatment; 3) wavefront-guided photorefractive keratectomy (PRK) retreatment; and 4) wavefront-guided PRK over radial keratotomy retreatment. All procedures were performed with the Alcon CustomCornea laser platform. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and wavefront analysis (6.5-mm pupil) were performed preoperatively and 3 months after CustomCornea retreatment. The Alcon LADARWave device was used for wavefront measurements. RESULTS: Total lower order and higher order aberrations were decreased following wavefront-guided retreatment, resulting in improved quality of vision. The maximum target offset (+ 0.75 diopters) can be used to prevent an overcorrection of defocus (myopia) when treating a significant amount of spherical aberration. CONCLUSIONS: Wavefront-guided ablation was an effective treatment for residual lower and higher order aberrations following previous refractive surgery. Custom ablation treatment algorithms need to be developed specifically for retreatment procedures.

Adult↗
PubMedDate not supplied

Threshold and retreatment parameters of NPe6 photodynamic therapy in retinal and choroidal vessels.

BACKGROUND AND OBJECTIVE: To determine the threshold fluence for producing choroidal and retinal vascular occlusion with mono-L-aspartyl chlorin e6 (NPe6) photodynamic therapy (PDT) during primary treatment and the effect of retreatment. METHODS: Primary treatment: Rats, rabbits, and monkeys underwent NPe6 PDT to determine the threshold fluences for choroidal and retinal vessel occlusion. The threshold was determined by analyzing fluorescein angiograms for areas of nonperfusion. Retreatment: Dutch-belted rabbits underwent NPe6 PDT followed by fluorescein angiography. Rabbits were retreated one week later at the same parameters. RESULTS: Fluence levels and vascular damage thresholds were always higher for retinal than for choroidal vascular occlusion. Retreatment caused choroidal vessel closure at all tested fluences but retinal capillaries closed only at a fluence > 17.7 J/cm2. CONCLUSION: NPe6 PDT has a lower threshold to occlude choroidal vessels than retinal vessels. The cumulative effect of retreatment does not damage retinal vessels unless the threshold is exceeded during a single retreatment session.

Animals↗
PubMed1999

[Retreatment after excimer laser photorefractive keratectomy].

OBJECTIVE: To evaluate the efficacy and safety of reoperation of residual myopia because of regression, undercorrection with or without coexisting severe corneal haze after excimer laser photorefractive keratectomy (PRK). METHODS: A VISK 20/20 excimer laser was used to treat myopia of -1.00 to -16.50 diopters (spherical equivalent) at corneal plane. 35 patients (51 eyes) who had residual myopia because of regression, undercorrection with or without coexisting severe corneal haze after initial PRK were retreated by using PRK and phototherapeutic keratectomy. RESULTS: At 12 months after retreatment, the rates of uncorrected visual acuity more than or equal to 10/20 or 20/20 were 82.6% and 39.1% respectively, 100.0% and 50.0% in myopia up to -6.00 D, 73.3% and 33.3% in myopia of -6.25 to -16.50 D respectively. 86.3% of eyes were within +/- 1.00 diopters of desired emmetropia. Corneal haze after retreatment was not greater than that observed after initial procedures. CONCLUSIONS: The residual myopia because of regression, undercorrection with or without severe corneal haze after initial PRK can be successfully retreated. Although the therapeutic result of retreatment of PRK is less successful than that of the initial procedure, retreatment appears to enhance it.

Adult↗
PubMed2004

Antituberculosis drug resistance among retreatment tuberculosis patients in a referral center in Taipei.

BACKGROUND AND PURPOSE: To determine the prevalence of antituberculosis drug resistance among retreatment tuberculosis patients in a referral center in Taipei. METHODS: We reviewed the register of susceptibility testing of the mycobacteriology laboratory of the Chronic Disease Control Bureau to identify patients with positive culture for Mycobacterium tuberculosis in the year 2000-2001. Medical charts were reviewed to determine patients' tuberculosis treatment histories. Patients who had multidrug-resistant (MDR) tuberculosis, defined as documentation of isolates resistant to at least isoniazid and rifampin, were identified. Retreatment tuberculosis patients without prior evidence of MDR tuberculosis were classified into 3 categories, i.e., relapse, treatment after default and treatment after failure, and the frequency and patterns of antituberculosis drug resistance were determined. RESULTS: A total of 317 patients who had received antituberculosis treatment for more than 1 month were identified. Among them, 183 were retreatment cases without prior evidence of MDR tuberculosis, including 93 with relapse, 57 with treatment after default, and 33 with treatment after failure. Among the 183 patients, the prevalence of resistance to any drug was 42.6%; 14.2% were resistant to 1 drug, 13.7% to 2 drugs, 7.1% to 3 drugs, 7.7% to 4 drugs or more, and 24.6% had MDR tuberculosis. The prevalence of any drug resistance among patients with relapse, treatment after default and treatment after failure was 33.3%, 42.1%, and 69.7%, respectively, while the prevalence of MDR tuberculosis in these groups was 12.9%, 19.3% and 66.7%, respectively. CONCLUSIONS: If susceptibility results are unavailable, the World Health Organization-recommended retreatment regimen may be used in retreatment tuberculosis patients. However, the high proportion of MDR tuberculosis among patients with treatment after failure poses a challenge to the efficacy of the retreatment regimen.

Adult↗
PubMed2006

[Management and retreatment of laser in situ keratomileusis flap buttonhole].

PURPOSE: To examine the etiology and management of buttonholes created during laser in situ keratomileusis (LASIK). PATIENTS AND METHODS: Retrospective review of case records of 1010 eyes of 514 patients who underwent LASIK. Four eyes of 4 patients developed a flap buttonhole, and subsequent laser ablation was not performed. Retreatment was done after a mean interval of 6 months. RESULTS: The etiology of a buttonhole was considered to be misuse of microkeratome in 1 patient and desiccation of the cornea in 2 patients, and could not be determined in 1 patient. Uncorrected visual acuity in those 4 patients was 1.2, 1.2, 0.9, and 1.5 respectively, after retreatment. The mean preoperative spherical equivalent was -5.47 diopters(D), and the mean spherical equivalent before retreatment was -5.19 D. The mean preoperative corneal refractive power of 43.53 D flattened to 42.88 D before retreatment. The mean preoperative corneal astigmatism of 1.63 D increased to 2.06 D before retreatment. CONCLUSION: Misuse of microkeratome and desiccation of the cornea may cause a buttonhole. If a buttonhole is created, retreatment by LASIK scheduled several months later may achieve good uncorrected visual acuity.

Adult↗
PubMed1994

Retreatment of chronic hepatitis C with interferon.

OBJECTIVE: We analyzed the retreatment of chronic hepatitis C with interferon to get the standpoint for the selection of patients to receive it. METHODS: A complete response was defined as continuous normalization of the serum alanine aminotransferase (ALT) level and continuous disappearance of serum hepatitis C virus RNA (HCV-RNA) during interferon administration and more than 6 months after. Patients without complete response were classified as noncomplete responders. From August 1990 to May 1993, we retreated 23 noncomplete responders on initial treatment with interferon and studied the factors that alter the effectiveness. RESULTS: Complete response was achieved in eight (34.8%) patients; the other 15 patients did not achieve this degree of response. Three patients were of genotype II and five were of genotype III in these eight complete responders. All complete responders were patients with relapse who had had normalized serum ALT levels during the initial administration and undetectable HCV-RNA at the end of the period. No patient who failed to achieve normalization of the serum ALT level on initial treatment achieved a complete response on retreatment. HCV-RNA concentrations before retreatment were significantly less than before initial treatment in the eight complete responders. CONCLUSION: Interferon retreatment of patients who do not achieve a complete response may be effective in relapsed cases with undetectable HCV-RNA at the end of initial treatment. Selection of patients to receive interferon retreatment requires careful review and consideration of genotype, HCV-RNA concentration, and the clinical response on initial treatment.

Alanine Transaminase↗
PubMed2006

Efalizumab retreatment in patients with moderate to severe chronic plaque psoriasis.

BACKGROUND: Efalizumab targets T cell-mediated steps important in psoriasis immunopathogenesis. OBJECTIVE: We sought to evaluate the efficacy and safety of efalizumab retreatment in patients with moderate to severe plaque psoriasis. METHODS: In this open-label, phase III study, 365 patients who received efalizumab therapy during an earlier clinical trial were retreated with 12 weeks of subcutaneous efalizumab (1 mg/kg/wk) 35 days or more after their last dose of efalizumab. RESULTS: After 12 weeks of efalizumab retreatment, 56.9% of patients achieved 50% or more improvement from baseline Psoriasis Area and Severity Index (PASI) and 25.3% achieved at least 75% reduction in PASI score. The mean percentage PASI improvement from baseline was 51.2%. Overall, 76.1% of patients surveyed were "very satisfied" or "satisfied" with the efficacy of efalizumab. The safety profile of efalizumab retreatment was similar to that observed in patients receiving efalizumab for the first time. LIMITATIONS: Not all patients received sufficient exposure to efalizumab during their previous efalizumab clinical trial to allow for determination of their initial response to efalizumab. Of 365 patients enrolled in the study, 282 received at least 12 weeks of prior efalizumab therapy; of these patients, 208 (73.8%) achieved a PASI-50 response from their previous therapy. CONCLUSION: These results suggest that retreatment with efalizumab therapy is an efficacious option for patients who have previously discontinued treatment.

Adult↗
PubMed1999

Results of endodontic retreatment: a randomized clinical study comparing surgical and nonsurgical procedures.

Information of "success" rates after surgical or nonsurgical endodontic retreatment is abundant but inconclusive. Reported healing frequencies vary between 45% and 90%. The present study was designed to find any systematic difference between the methods. Nonsurgical and surgical retreatment was randomly assigned to 95 endodontically "failed" cases. The outcome of the procedures was clinically and radiographically recorded, and followed for 4 years. At the 12-month recall, a statistically significant (p < 0.05) higher healing rate was observed for cases surgically retreated. At the final 48-month examination, no such difference was found. These findings may be explained by (a) slower healing dynamics in the nonsurgical group and (b) the event of late "failures" in the surgical group. Within the latter category, four cases classified as healed after 1 yr failed at the final follow-up. Conclusively, this study failed to show any systematic difference in the outcome of surgical and nonsurgical endodontic retreatment. Surgical retreatment seems to result in more rapid periapical bone fill, but also may imply a higher risk of "late failures." From a scientific point of view, the length of the follow-up period is very important and may strongly influence the conclusions made.

Adolescent↗
PubMed2002

Retreatment of the spinal cord with palliative radiotherapy.

PURPOSE: We conducted this retrospective review of patients whose spinal cord was irradiated twice to evaluate the outcome in terms of palliation and long-term side effects. METHODS AND MATERIALS: Eight patients (4 females, 4 males; median age: 67 years) were identified whose spinal cord had been irradiated twice between July 1990 and July 1997, usually for the management of bone metastases. All patients were followed up until their death from progressive disease. The Karnofsky performance score at the time of retreatment ranged from 20% to 90%. Total dose for the first treatment ranged from 29 to 50 Gy (median: 38 Gy) with single doses 1.25-3 Gy; the total dose for the retreatment ranged from 29 to 38 Gy (median: 30 Gy) with a single dose 1.8-4 Gy. The cumulative dose ranged from 59 to 88 Gy (median: 67.5 Gy). The overlap in the site of retreatment consisted of 1-3 segments, whereas in one patient, 2 single segments were treated twice. The outcome in terms of progressive disease, the palliative effects, and the development of myelopathy was assessed retrospectively. RESULTS: The median interval to reirradiation was 30 months (range: 6-63 months), and the median follow-up after the last treatment was 16 months (range: 5-44 months). After reirradiation, 4/7 patients experienced complete pain relief, 2/7 patients experienced minor pain relief, and only 1 patient showed no change. Two patients with paraparesis experienced complete recovery. All patients tolerated retreatment very well. No serious acute side effects requiring any therapy were seen. During follow-up, no patient showed treatment-induced neurologic abnormalities affecting motor and sensory function, and all patients were able to walk and were continent for stool and urine. CONCLUSION: On the basis of the findings in this limited number of patients, it is not possible to give clear and general recommendations concerning the optimal total dose and fraction size that will have maximal palliative effects and minimal side effects. However, for the purpose of palliation, retreatment within the dose range used at our institution should be considered, taking the patient's expected life span and clinical symptoms into account.

Aged↗
PubMed2002

The perceived benefit of endodontic retreatment.

AIM: There is substantial variation amongst dentists in the management of symptom-free periapical lesions in root-filled teeth. It has been suggested that this variation can be understood as clinicians' choice of different cut-off points on a continuous periapical health scale (the 'Praxis Concept (PC) theory'). Based on this suggestion, an individual's inclination to propose retreatment can be expressed in the Retreatment Preference Score (RPS). In the present study it was hypothesized that: (i) the PC theory is valid amongst experienced endodontists; and that (ii) interindividual variation in RPS can be explained by a corresponding variation in the perceived benefit of endodontic retreatment. METHODOLOGY: The RPS was determined for 16 experienced Swedish endodontists. The retreatment benefit (RTB) was defined as the gain in utility when a root-filled tooth with a persistent periapical lesion ('health state B') moved to a state where the lesion had healed ('health state A'). For each individual the utility values of the two health states were measured by means of the standard gamble technique. RESULTS: The RPS and RTB were found to be subjected to substantial inter- and intrarater variation. The decision makers acted in accordance with the PC theory. No significant correlation between RPS and RTB was detected. CONCLUSIONS: Findings suggest that the PC theory is valid amongst endodontic experts. The study did not support the notion that the more potential utility that could be produced, the more the individual dentist should tend to perform retreatment. However, alternative consequentialist strategies focusing low risk taking may be involved.

Attitude of Health Personnel↗
PubMed2002

Clinical investigation of second mesiobuccal canals in endodontically treated and retreated maxillary molars.

An examination of 1873 conventionally treated and retreated maxillary first and second molars was made in an attempt to determine the percentage of second mesiobuccal (MB2) canals that could be located routinely and evaluate if there were any significant differences between initial treatments and retreatments. The teeth examined were 1193 first molars and 680 second molars treated consecutively over a 2-yr period by five endodontists. Overall the MB2 canal was found in 724 (61%) first molars and 245 (36%) second molars. The incidence of a MB2 canal in first molar retreatments was 67% compared to a 59% incidence in initial treatments. Whereas in second molars, the retreatment incidence was 44% compared with 35% in initial treatments. The significant difference in the incidence of a MB2 canal between initial treatments and retreatments suggests that failure to find and treat existing MB2 canals will decrease the long-term prognosis.

Chi-Square Distribution↗
PubMed2005

A 5 yr clinical investigation of second mesiobuccal canals in endodontically treated and retreated maxillary molars.

An examination of 5616 endodontically treated and retreated maxillary first and second molars was made in an attempt to determine the percentage of MB2 canals that could be located routinely, and evaluate if there were any significant differences between initial treatments and retreatments. The teeth examined were 3578 first molars and 2038 second molars treated consecutively over a 5-yr period by six endodontists. Overall the MB2 canal was found in 2133 (60%) first molars, and 712 (35%) second molars. The incidence of a MB2 canal in first molar retreatments was 66% compared to a 58% incidence in initial treatments. Whereas in second molars the retreatment incidence was 40% compared to 34% in initial treatments. The significant difference in the incidence of a MB2 canal between initial treatments and retreatments suggests that failure to find and treat existing MB2 canals will decrease the long-term prognosis.

Chi-Square Distribution↗
PubMed2004

Retreatment and maintenance therapy with infliximab in fistulizing Crohn's disease.

OBJECTIVES: Infliximab has clearly demonstrated its efficacy in the short-term treatment of fistulizing Crohn's disease. We present here the results of retreatment and long-term maintenance therapy. PATIENTS AND METHODS: Eighty one consecutive patients with active fistulizing Crohn's disease, in whom previous treatments had failed, were treated with infliximab. All patients received as the initial treatment of 5 mg/kg i.v. infusions (weeks 0, 2, and 6). Those patients who failed to respond after the initial cycle (group 1, n = 25), or those who relapsed after having responded (group 2, n = 13), received retreatment with three similar doses (weeks 0,2, and 6). Those who responded to retreatment were included in a long-term maintenance programme (n = 44), with repeated doses (5 mg/kg i.v. infusions) every eight weeks for 1-2 years. RESULTS: In the initial treatment 56% of the patients responded partially; this response being complete in 44%. In the retreatment, 28% of group 1 (non-responders) presented a complete response, compared to 77% in group 2 (relapsers) (p < 0.0001). In the maintenance treatment, the global response was 88% (39/44). The mean number of doses per patient was 4.4 +/- 2 (range 1-9) with a duration of 36 +/- 12 weeks (range 8-72). Adverse effects were not significantly increased in either treatment. CONCLUSIONS: Both retreatment and long-term maintenance therapy with infliximab, are highly effective and well tolerated in fistulizing Crohn's disease patients.

Adolescent↗
PubMed2003

[Retreatment of Helicobacter pylori infection with triple therapy after initial treatment failure].

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) treatments fail at least in 10-20% of patients. However, retreatment strategies after failure of initial treatment have not been established. This study was conducted to evaluate the eradication rate of retreatment choices. METHODS: Twenty-seven peptic ulcer patients who were retreated with OAC (omeprazole + amoxicillin + clarithromycin) or BMT (bismuth + metronidazole + tetracycline) after failure of BMT or OAC were included. Quadruple therapy (omeprazole + BMT) was also tried after failure of two successive triple therapies. Furthermore, the effect of resistance of metronidazole or clarithromycin on the eradication of H. pylori was evaluated. RESULTS: Among 13 patients who were retreated with OAC after failure of BMT regimen, H. pylori was eradicated in 10 patients (76.9%). Among 14 patients retreated with BMT after failure of OAC regimen, H. pylori was eradicated in 11 patients (78.6%). Resistance of H. pylori to metronidazole or clarithromycin decreased the efficacy of BMT or OAC, respectively. CONCLUSIONS: Eradication regimen should be decided considering the resistance to H. pylori. However, in case of unknown state of resistance, OAC can be chosen if BMT fails. Similarly, BMT can be tried in cases that OAC therapy failed. After failures of both triple therapies, quadruple therapy can be tried as the next step.

Adult↗