after completing treatment of h.pylori still symtoms are

[ajeet kumar]

hi every one.
i'm from pakistan and a doctor. before a month ago a patient coome to me with the symptoms of h.pylori .
firstly got her blood test of h.pylori , which was positive. then i started h. pylori's regmin (clarithromycin + amoxicilline +omeprazole) for 15 days . after ten days patient felt some relief in symptoms and after 15 days she reported no any sign .
but after a month , she came back with same symptoms again . now she is taking just omeprazole 20 mg bd since last 5 days . patient still have the same compaints.
now kindly guide me what should i take next step or forward for endoscopy .

thanks & regards
your's sincere
dr.ajeet kumar oad
d/6 zeeshan housing scheme
hyderabad sindh
pakistan
cell# +923313507088
skype id . ajeet.kumar48
email address : oadajeetkumar AT yahoo.com

[Helico_expert]

This is the guideline to follow.
http://gut.bmj.com/content/61/5/646.full.pdf+html

in brief,
any therapy longer than 10 days is shown no benefit to just 10 days treatment.
a breath test should be done to confirm the eradication before the next treatment.
in most cases, when CLR + AMX failed, MTZ + AMX would fail too.
other salvage therapy that you can try include Bismuth-based or Rifabutin-based
quinolones-based can be effective, however care should be taken in case of other bacteria resistance.

quinolones should not be used if the resistance in the area is known to be high
Rifabutin should not be used if TB is common.

you may also have a look at the following link to Prof. Marshall's treatment plan.
http://www.helico.com/?q=Marshall%27sTreatments