SUMMARYBackground: Visceral hypersensitivity plays a major role in the pathogenesis of non-erosive oesophageal reflux disease (NERD). Prevalence of NERD differs according to the population and geographical region. Oesophageal hypersensitivity in NERD has not been well studied, especially in Japanese patients. Aim: To investigate oesophageal hypersensitivity in Japanese NERD patients. Patients and methods: We performed upper GI endoscopy and the modified acid perfusion test on 14 control subjects and 68 GERD patients, including 26 with NERD, 34 with erosive GERD, and six with Barrett's oesophagus. The stimulus-response function to acid was quantified by three parameters (lag time, intensity rating and the acid perfusion sensory score) and compared among four groups.
The localization and the expression patterns of tight-junction proteins were different in the controls and the rat esophagitis model. The expression of claudin-3 in the esophageal mucosa was decreased, while that of claudin-1 was increased. It is postulated that these alterations in tight-junction proteins most likely increase the permeability of the esophageal the epithelium, thereby impairing the defense mechanism of this epithelium.
SUMMARYBackground: It is still disputed whether gastric atrophy or intestinal metaplasia improves after the cure of Helicobacter pylori infection. Aim: To clarify the histological changes after the cure of H. pylori infection through a literature survey. Methods: Fifty-one selected reports from 1066 relevant articles were reviewed. The extracted data were pooled according to histological parameters of gastritis based on the (updated) Sydney system. Results: Activity improved more rapidly than inflammation. Eleven of 25 reports described significant improvement of atrophy. Atrophy was not improved in one of four studies with a large sample size (> 100 samples) and in two of five studies with a long follow-
Summary
Background: An antimicrobial susceptibility test for Helicobacter pylori before second‐line treatment is often performed, although whether the test is truly necessary remains unknown.
Patients and methods: Eighty‐two patients with H. pylori infection for whom first‐line treatment with a 1‐week proton pump inhibitor/amoxicillin–clarithromycin (AC) regimen had failed were randomly assigned to two groups: those having or not having the susceptibility test before re‐treatment. The cure rates for these two groups were compared.
Results: Five of the 82 patients were excluded from the analysis. For 38 patients in the susceptibility‐test group, we used what we considered the best regimen based on susceptibility testing: 10 patients [no resistance to clarithromycin (CAM)] received the lansoprazole–amoxicillin–clarithromycin regimen, 22 patients [19 CAM resistant, metronidazole (MNZ) susceptible; three failure of culture] were given the lansoprazole‐amoxicillin‐metronidazole (LAM) regimen, and six patients (both MNZ and CAM resistant) received dual therapy with omeprazole (OPZ) and amoxicillin (AMOX) in which the OPZ dose was determined by the CYP2C19 gene polymorphism. For 39 patients in the group with no susceptibility testing, LAM regimens were prescribed. The intention‐to‐treat (ITT)‐based cure rates in the groups with and without susceptibility testing were 81.6% (95% confidence interval; 66–92%) and 92.4% (79–98%), respectively, and there was no significant difference between these two groups.
Conclusion: Susceptibility testing is not necessarily required before second‐line therapy if the first‐line treatment has been performed using proton pump inhibitor/AC regimens.
Both eGERD and NERD, but especially NERD, exhibited esophageal hypersensitivity not only to acid but also saline perfusion, suggesting that hyperalgesia to acid and other factors (eg, psychologic and/or autonomic nerve disturbance) may play some roles in symptom generation in NERD.
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