***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective : There have been a number of reports that natural foods such as garlic , honey , and capsaicin can inhibit Helicobacter pylori in vitro and each report has suggested the natural ingredient be used for treatment of the infection . We investigated whether garlic or capsaicin-containing peppers would actually inhibit H. pylori in vivo . Methods : We performed a prospect i ve crossover study in healthy H. pylori-infected adults . We used the urea breath test to assess the status of the H. pylori infection . On separate days subjects received three test meals consisting of beef , tortillas , and salad with one of the following : fresh garlic ( 10 sliced cloves ) , capsaicin ( six sliced fresh jalapeños ) , two tablets of bismuth subsalicylate ( Pepto-Bismol , positive control ) , or nothing added ( negative control ) . Breath testing was done before the first meal , the evening meal , and the following morning . At least 2 days elapsed between the test substances . Results : Twelve subjects participated ( seven men , five women ) , with an average age of 41.4 yr , range 27–51 yr . Ten subjects received garlic , six received jalapeños , and 11 received bismuth . Neither garlic nor capsaicin had any in vivo effect on H. pylori ( median urease activity 28.5 vs 39.8 and 43.7 vs 46.6 before and after garlic and jalapeños , respectively ) p > 0.8 . Bismuth had a marked inhibitory effect ( median 55.8 vs 14.3 before and after bismuth ) p < 0.001 , respectively . Conclusions : This study did not support a role for either garlic or jalapeños in the treatment of H. pylori infection . Caution must be used when attempting to extrapolate data from in vitro studies to the in vivo condition In this study , in vivo effectiveness of ascorbic acid ( AA ) , beta carotene ( BC ) and allicin in HP eradication were evaluated . 210 patients who are HP positive in biopsy were involved in this study . The patients r and omised to seven treatment groups ( each group consisting of 30 patients ) . The first group was given st and ard eradication treatment ( lansaprasol 30 mg bid , clarithromycin 500 mg bid , amoxicillin 1 g bid for 14 days ) . Second group received AA 1000 mg/day in addition to the st and ard treatment . Third group received only AA 1000 mg/day for 14 days . Fourth group was treated with st and ard regiment plus 120 mg/day BC . Fifth group was given only BC 120 mg/day for 14 days . Sixth group was given st and ard regiment and allicin 4200 micrograms/day . Seventh group received only Allicin 1200 micrograms/day for 14 days . The eradication was achieved in 20 ( 66.6 % ) in group I , 15 ( 50 % ) in group II , 3 ( 10 % ) in group III , 15 ( 50 % ) in group IV , 0 ( 0 % ) in group V , 27 ( 90 % ) in group VI and 7 ( 23.3 % ) in group VII . Allicin seemed to be potentially effective agent for HP eradication but ascorbic acid , beta caroten was found to be ineffective Resistance of Helicobacter pylori to clarithromycin and metronidazole is now found worldwide . Steam‐distilled garlic oil has in vitro activity against H. pylori and may be a useful alternative treatment strategy OBJECTIVE To characterize Helicobacter pylori isolates from western Argentina using virulence markers and antimicrobial susceptibility patterns in order to assess the association between virulent genotypes , antimicrobial resistance , and disease . DNA fingerprinting was also evaluated for the segregation of virulent or resistant strain clusters . METHODS Genotyping of 299 H. pylori isolates was performed by PCR using specific primers for the cagA , vacA and iceA genes . R and om amplification of polymorphic DNA (RAPD)-PCR and rep-PCR genetic clustering were assessed using five r and om primers and BOXA1R and ERIC primers , respectively .  Resistance to clarithromycin ( Cla ) and metronidazole ( Mtz )  was assessed by the agar dilution method . RESULTS It was observed that 40.8 % of the genotypes were cagA-positive ; 66.9 % were vacA s1m1 genotype and the iceA1 allele was found in 40.8 % . A significant correlation ( p=0.0000 ) was observed between cagA positivity and vacA s1m1/iceA1 genotypes . Triple virulent genotypes were statistically associated with peptic ulcer ( PU ) ( p=0.0001 ) and Cla resistance ( p=0.0000 ) . RAPD fingerprints obtained with AO2 primers identified clusters that were strongly associated with PU , virulence markers , and resistance to Cla and Mtz . CONCLUSIONS The H. pylori isolates that harbored two or three virulence markers were more resistant to Cla and Mtz . Combined analysis of virulent genotypes and resistance patterns may permit identification of high-risk patients to prevent PU later in life or to avoid antimicrobial treatment failure Background : Due to increasing antimicrobial resistance , a bismuth-based quadruple regimen has been recommended as an alternative first-line therapy for  Helicobacter pylori ( H pylori )  eradication . However , different results are varied greatly and the availability of bismuth was limited in some countries . We assessed the efficacy and safety of 14-day berberine-containing quadruple therapy as an alternative regimen for H pylori eradication . Methods : In a r and omized , open-label , non-inferiority , phase IV trial between November 25 , 2014 , and October 15 , 2015 , 612 treatment-naive patients were r and omly assigned to 14-day berberine-containing ( n = 308 ) or 14-day bismuth-containing ( n = 304 ) quadruple therapy . The primary outcomes were eradication rates determined by the 13C urea breath test ( 13C-UBT ) 28 days after the end of treatment . The secondary outcomes were adverse events and compliance . Results : The baseline demographic data including age , gender , body mass index ( BMI ) , general condition and severity score were not statistically different in both groups . The eradication rates in bismuth and berberine groups were 86.4 % ( 266/308 ) and 90.1 % ( 274/304 ) in intention-to-treat ( ITT ) analysis ( P = .149 ) , and 89.6 % ( 266/297 ) and 91.3 % ( 273/299 ) in per- protocol ( PP ) analysis ( P = .470 ) , respectively . No statistically significant difference was found in the overall incidence of adverse events between both groups ( 35.7 % vs 28.6 % , P = .060 ) . Conclusions : Both regimens achieved the recommended efficacy for H pylori eradication . The berberine-containing quadruple regimen was not inferior to bismuth-containing quadruple regimen and can be recommended as an alternative regimen for H pylori eradication in the local region Purpose The present study was done to assess the prevalence rate , antibiotic resistance pattern and genotyping status of the Helicobacter pylori strains isolated from human and animal gastric biopsy sample s. Patients and methods A total of 1,150 gastric biopsy sample s were r and omly collected from humans ( children and adults ) and animals ( cows , sheep and goats ) . All sample s were subjected to culture , urease test and histopathologic examination . H. pylori isolates were also confirmed using the 16S rRNA gene PCR-amplification . Antibiotic resistance pattern was assessed by the disk diffusion method . Distribution of different genotypes was studied by PCR . Results The prevalence of H. pylori in gastric biopsy sample s which were studied using urease test , culture and histological examination were 57.04 % , 55.40 % and 60.80 % , respectively . Sample s that were collected from adult humans ( 78 % ) and sheep ( 70 % ) had the highest prevalence of H. pylori strains , while those of goats ( 0.6 % ) and cows ( 4 % ) had the lowest . Findings of the culture method were confirmed using PCR-based amplification of 16S rRNA . Distribution of H. pylori among the gastric ulcers , duodenal ulcers , chronic gastritis gastric cancer and chronic cancer sample s were 10.40 % , 15.70 % , 96.50 % , 0.60 % and 3.14 % , respectively . H. pylori strains harbored the highest prevalence of resistance against ampicillin ( 74.4 % ) , clarithromycin ( 63.4 % ) , trimethoprim ( 61.5 % ) and metronidazole ( 61.5 % ) . The most commonly detected genotypes among the H. pylori strains isolated from different types of biopsy sample s were cagA ( 84.79 % ) , vacA m2 ( 55.95 % ) , vacA s1a ( 49.84 % ) , cagE ( 48.58 % ) , iceA1 ( 47.02 % ) and iceA2 ( 47.02 % ) . Conclusion High prevalence of antibiotic resistance and virulent genotypes indicates an important public health issue . Similarities in antibiotic resistance and genotyping pattern of H. pylori strains isolated from humans and animals may show their similar routes of infection 
    Output:
    
CONCLUSION Allicin as an add-on therapy improves H. pylori eradication , healing of ulcers , and remission of symptoms .