{"product_id":"a-patients-guide-to-helicobacter-pylori-infection-treatment-options","title":"دليل المريض لخيارات علاج عدوى الملوية البوابية","description":"\u003cp\u003eعلاج عدوى الملوية البوابية (H. pylori) شديد التخصيص، مع توفر العديد من البرامج العلاجية الفعالة. يعتمد اختيار العلاج بشكل كبير على أنماط المقاومة المحلية للمضادات الحيوية، والتاريخ الدوائي للمريض، وأي حساسيات دوائية. يوضح هذا الدليل الشامل جميع خيارات العلاج الرئيسية - من العلاجات الخط الأول إلى علاجات الإنقاذ - بما في ذلك جرعات الأدوية المحددة، ومدة العلاج، ومعدلات النجاح الموثقة، مما يمكن المرضى من إجراء مناقشات مستنيرة مع مقدمي الرعاية الصحية.\u003c\/p\u003e\n\u003ch1\u003eدليل المريض لخيارات علاج عدوى الملوية البوابية\u003c\/h1\u003e\n\u003ch2\u003eجدول المحتويات\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#introduction\"\u003eالمقدمة: لماذا العلاج مُخصَّص\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#first-line\"\u003eخيارات العلاج في الخط الأول\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#second-line\"\u003eالعلاجات في الخط الثاني وعلاجات الإنقاذ\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#adjuvant\"\u003eالعلاجات المساعدة والتجريبية\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#conclusion\"\u003eالنقاط الرئيسية والخطوات التالية\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eمعلومات المصدر\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2 id=\"introduction\"\u003eالمقدمة: لماذا العلاج مُخصَّص\u003c\/h2\u003e\n\u003cp\u003eعلاج عدوى الملوية البوابية (H. pylori) ليس نهجًا واحدًا يناسب الجميع. هذه البكتيريا، التي يمكن أن تسبب قرح المعدة ومشاكل هضمية أخرى، طورت مستويات متفاوتة من المقاومة للمضادات الحيوية المختلفة حول العالم. بسبب هذا، سيختار طبيبك نظام العلاج الأولي تجريبيًا. هذا يعني أن الاختيار يعتمد على العلاجات الأكثر فعالية في منطقتك الجغرافية المحددة، والمبادئ التوجيهية الطبية المحلية، والأدوية المتاحة بسهولة.\u003c\/p\u003e\n\u003cp\u003eلقد تطور مجال علاج الملوية البوابية بشكل كبير. يطبق الأطباء الآن بقوة مبادئ الإشراف على المضادات الميكروبية، مما يعني اختيار المضادات الحيوية بعناية للحفاظ على فعاليتها ومنع مزيد من المقاومة. كما زادت توفر اختبارات الحساسية، حيث يمكن اختبار عينة من معدتك لمعرفة أي المضادات الحيوية ستعمل بشكل أفضل ضد العدوى المحددة لديك.\u003c\/p\u003e\n\u003cp\u003eتاريخك الطبي حاسم. سيسألك طبيبك أسئلة مفصلة حول أي استخدام سابق للمضادات الحيوية، حيث يجب مراعاة هذا التاريخ لتجنب اختيار علاج قد تكون البكتيريا مقامة له بالفعل. تشمل الخيارات الأولية الشائعة العلاج الرباعي القائم على البزموت لمدة 14 يومًا أو العلاج الثلاثي القائم على الريفابوتين، ولكن الخيار الأفضل دائمًا هو النظام الذي ثبتت فعاليته العالية في منطقتك المحلية.\u003c\/p\u003e\n\u003ch2 id=\"first-line\"\u003eخيارات العلاج في الخط الأول\u003c\/h2\u003e\n\u003cp\u003eهناك عدة فئات من علاجات الخط الأول، لكل منها تركيبات دوائية محددة، ومدة علاج، ومعدلات نجاح.\u003c\/p\u003e\n\u003ch3\u003eالعلاج الثلاثي\u003c\/h3\u003e\n\u003cp\u003eيظل العلاج الثلاثي القائم على مثبط مضخة البروتون (PPI) خيارًا في الخط الأول في المناطق التي تكون فيها مقاومة الكلاريثروميسين منخفضة (أقل من 15٪). يتكون هذا النظام من ثلاثة مكونات تؤخذ لمدة 14 يومًا:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eمثبط مضخة البروتون (PPI)\u003c\/strong\u003e لتقليل حمض المعدة. أمثلة تشمل:\n  \u003cul\u003e\n\u003cli\u003eأوميبرازول 20 مجم مرتين يوميًا (BID)\u003c\/li\u003e\n\u003cli\u003eلانسوبرازول 30 مجم مرتين يوميًا (BID)\u003c\/li\u003e\n\u003cli\u003eإيسوميبرازول 40 مجم مرة يوميًا (QD)\u003c\/li\u003e\n\u003cli\u003eبانتوبرازول 40 مجم مرة يوميًا (QD)\u003c\/li\u003e\n\u003cli\u003eرابيبرازول 20 مجم مرتين يوميًا (BID)\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eكلاريثروميسين 500 مجم مرتين يوميًا (BID)\u003c\/strong\u003e (إذا لم يكن هناك تعرض سابق للماكروليد ومقاومة محلية منخفضة) \u003cstrong\u003eأو ميترونيدازول 500 مجم مرتين يوميًا (BID)\u003c\/strong\u003e (إذا كانت مقاومة الكلاريثروميسين مصدر قلق)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eأموكسيسيلين 1000 مجم مرتين يوميًا (BID)\u003c\/strong\u003e أو، إذا لم يتم اختياره بالفعل، ميترونيدازول 500 مجم مرتين يوميًا (BID)\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eبعض هذه الأدوية متاحة في تركيبات معبأة مسبقًا مريحة مثل Omeclamox-Pak و Prevpac. خلص تحليل رئيسي لـ 55 دراسة إلى أن مدة 14 يومًا هي الأمثل، حيث تحقق معدل استئصال يبلغ 81.9٪، مقارنة بـ 72.9٪ فقط لدورة مدتها 7 أيام.\u003c\/p\u003e\n\u003ch3\u003eالعلاج القائم على الريفابوتين (Talicia)\u003c\/h3\u003e\n\u003cp\u003eهذا نظام علاج ثلاثي لمدة 14 يومًا حيث تؤخذ ثلاثة أدوية معًا كل 8 ساعات:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eأموكسيسيلين 1 جم\u003c\/li\u003e\n\u003cli\u003eأوميبرازول 40 مجم\u003c\/li\u003e\n\u003cli\u003eريفابوتين 50 مجم\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eهذا معبأ مسبقًا كـ Talicia، والذي تمت الموافقة عليه من قبل إدارة الغذاء والدواء الأمريكية (FDA) في عام 2019 بناءً على دراستين أظهرتا معدلات استئصال بلغت 84.1٪ و 90.3٪. غالبًا ما يوصى به كعلاج إنقاذ إذا فشلت أدوية الخط الأول.\u003c\/p\u003e\n\u003ch3\u003eالعلاج القائم على الفونوبرازان (Voquezna)\u003c\/h3\u003e\n\u003cp\u003eفي مايو 2022، وافقت إدارة الغذاء والدواء الأمريكية (FDA) على أول علاج قائم على حاصض مضخة البوتاسيوم (PCAB)، وهو علاج ثلاثي لمدة 14 يومًا مع:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eفونوبرازان 20 مجم مرتين يوميًا (BID)\u003c\/li\u003e\n\u003cli\u003eأموكسيسيلين 1000 مجم مرتين يوميًا (BID)\u003c\/li\u003e\n\u003cli\u003eكلاريثروميسين 500 مجم مرتين يوميًا (BID)\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eتم تعبئته كـ Voquezna Triple Pak. كما تمت الموافقة على العلاج المزدوج (فونوبرازان بالإضافة إلى أموكسيسيلين). ومع ذلك، لم يتم إطلاق أي من المنتجين إلى السوق بسبب اكتشاف مستويات ضئيلة من شوائب النيتروسامين أثناء التصنيع.\u003c\/p\u003e\n\u003ch3\u003eالعلاجات الرباعية غير المحتوية على البزموت\u003c\/h3\u003e\n\u003cp\u003eتتضمن هذه الأنظمة أربعة أدوية ويمكن إعطاؤها بتسلسلات مختلفة.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eالعلاج المتسلسل:\u003c\/strong\u003e هذا النظام لمدة 10-14 يومًا هو خيار مقترح في الخط الأول وهو superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to superior to\u003c\/p\u003e","brand":"Diagnostic Detectives Network","offers":[{"title":"Default Title","offer_id":45206076915868,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/ar\/products\/a-patients-guide-to-helicobacter-pylori-infection-treatment-options","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}