الفهرس 
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Abstract
H. pylori is a common Gram - negative spiral bacteria with a microaerophilic nature that usually colonizes human gastro intestinal tract specially stomach. Almost half of the world’s population is infected by this bacteria. It is mainly responsible for development of gastric clinical outcomes as gastritis, peptic ulcer diseases and gastric cancer. Moreover, it also participates in the development of many other extra-gastrointestinal diseases as cardiovascular, neurological, hematological and respiratory diseases.
Varies regimens were developed for H. pylori eradication including first line, second line and third line therapy based on CLR-R. Nowadays CLR-R is the cause of treatment failure.
The most prevalent mutations that are responsible for about 90% of the CLR-R are A2143G, A2142G and A2142C mutations.
The aim of this study was to determine the rate of CLR-R among children attending El-Shatby University Hospital, Alexandria, Egypt.
Fifty H. pylori positive children whom were previously diagnosed by means of H. pylori stool antigen test after cessation of clarithromycin based treatment were included in this study; over a period of 15 months.
The majority of the samples included in this study were obtained mostly from children aged between 7 - 12 years old (70 %) and mostly obtained from females (56%).
The most common symptom reported among the 50 children was abdominal pain (50 %) followed by Hematemesis (28%) while, the most common endoscopic finding detected in all of the 50 patients was erythema (100%) followed by nodularity in 78% of the patients.
The majority of gastric biopsy specimens (74%) were positive upon performing the RUT and only 4 specimens (8%) H. pylori could not be seen attached to gastric epithelium using PAS.
Regarding to CLR-R wild type H. pylori strain was the predominant genotype in H. pylori positive cases (62.5%). Followed by 2143A-G single mutation (25%). Only (12.5%) showed Double mutation. However, in (36%) of the cases H. pylori could not be detected (true negativity as internal control of the test was amplified).
Majority of PCR positive cases; (93.75%) showed positive RUT results. In addition, most of urease negative cases (61.1%) were negative for H. pylori by PCR and which was statistically significant (p ˂0.001).
H. pylori was seen attached to the gastric epithelium in (92%) of gastric biopsies of which (76%) were also positive when RUT was performed and (24%) were rapid urease negative and this was not statistically significant (P= 0.275)
Moreover, H. pylori that was seen attached to the gastric epithelium in most of gastric biopsy specimens (69.6%) were also PCR positive, in addition, in all the PCR negative cases H. pylori was absent and this was statistically significant (P =0.013).