Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomized Clinical Trial to Examine the Efficacy of a Clarithromycin-, Amoxicillin-, and Metronidazole-Based Regimen to Eradicate Helicobacter Pylori Infections in Pasto, Colombia
Brief Summary: More than half of the world's population is infected with Helicobacter pylori, a bacterium that colonizes the human stomach. Although most infected subjects live free of symptoms and disease outcomes (except superficial gastritis), only a few develop peptic ulcers or gastric cancer, while some others may develop non-ulcer dyspepsia. Current clinical practice for the management of peptic ulcer disease includes testing for and treating H. pylori, if present. Although there are triple therapies that contain 2 antibiotics plus a bismuth compound, a proton-pump inhibitor, or a H2-receptor antagonist which are effective at eliminating H. pylori in Europe and North America, these treatments are dramatically less effective in developing countries. Our recent meta-analysis showed quadruple therapies containing clarithromycin, amoxicillin, metronidazole and a proton pump inhibitor to be effective in the presence of clarithromycin or metronidazole resistance. However, this regimen has yet to be tested in a developing country. Therefore, in the current randomized clinical trial in Pasto, Colombia, we aim to examine the effectiveness of clarithromycin, amoxicillin, metronidazole with and without a proton pump inhibitor compared to the Food and Drug Administration approved 10-day regimen containing clarithromycin, amoxicillin and omeprazole. Since antibiotic therapy is most effective within a specific gastric pH range, and since mutifocal atrophy results in damage and loss of the acid producing parietal cells, we will test the efficacy of our modified therapy stratified by diagnosis of multifocal atrophic gastritis.


Options:
A: Inclusion Criteria:

* Sibling or offspring of patients with gastric adenocarcinoma confirmed by EGD and biopsy
* Informed consent should be signed

Exclusion Criteria:

* Gastric cancer history
* Other malignancy within the past 5 years
* Hereditary cancer family member (HNPCC, FAP)
* Peptic ulcer history
* Peptic ulcer, esophageal cancer, gastric cancer case found at EGD
* H. pylori eradication treatment history
* Previous serious side effect to antibiotics
* Serious concurrent infection or nonmalignant disease such as liver cirrhosis, renal failure, cardiovascular diseases
* Pregnant or nursing women
* Psychiatric disorder that would preclude compliance, alcoholics
* Refuse informed consent
B: Inclusion Criteria:

* H pylori infected patients with gastric low-grade dysplasia, high-grade dysplasia, and early gastric cancer
* Gastric tumor is completely removed through endoscopic resection.

Exclusion Criteria:

* Patients underwent gastrectomy before enrollment
* patients underwent endoscopic resection before enrollment
* Previous history of eradication for H. pylori
* Pregnancy
* Aged \<20 yr old or aged \>75 yr old
* Patients underwent additional gastrectomy due to incomplete endoscopic resection
C: Inclusion Criteria:

* Helicobacter pylori infection subjects

Exclusion Criteria:

* Prior gastrectomy; pregnant women
D: Inclusion Criteria:

* Aged 29-77 years; have lived in Pasto, Colombia for at least 5 years and plan to remain in Pasto for ≥5 more years;
* Currently have Helicobacter pylori infection;
* Willing to refrain from alcohol consumption for 2 weeks;
* Have never taken a therapy to eradicate Helicobacter pylori;
* Have not taken antibiotics, bismuth compounds, proton-pump inhibitors, H2-receptor antagonists, or antacids within 30 days of the trial;
* Are not pregnant, and have little or no risk of pregnancy.

Exclusion Criteria:

* History of kidney, liver, heart, or mental disease;
* Frequent alcohol consumption;
* Allergic to clarithromycin, amoxicillin, penicillin, omeprazole or metronidazole;
* Currently taking drugs which may interact with any of the trial medications.

Answer: D