Since the discovery of Helicobacter pylori in the early 1980s, its role as a major pathogenic factor in peptic ulcer disease has been well established. Therapeutic regimens aiming to eradicate the bacterium have been shown to be highly effective and are strongly recommended in the treatment of patients with peptic ulcer disease.1 With classic bismuth salt based triple therapy, combining bismuth with two antibiotics, poor compliance is often observed resulting from a high incidence of side-effects. 2 In search for therapeutic approaches leading to fewer side-effects and compliance problems, regimens combining antibiotics with proton pump inhibitors have been under investigation. The latter are not only used to relieve symptoms but also to provide an optimal environment for the action of the antibiotics.
3As reported by several authors, a short-term therapy with omeprazole in combination with clarithromycin and either amoxycillin or metronidazole can achieve eradication rates of above 90%. 4±6 These regimens were
Oesophageal transmural potential difference measurements have been used to localize the oesophagogastric mucosal junction and to detect reflux-induced mucosal damage. The current study confirms that such measurements lead to reproducible results when they are used to identify the oesophagogastric mucosal junction. In normal persons this anatomical structure is always localized within or below the lower oesophageal sphincter. In contrast potential difference measurements of the distal oesophagus show marked intraindividual variations and no correlation was found between these measurements on 2 different days. These results indicate that potential difference measurements are a valuable tool to determine the relation of the oesophagogastric mucosal junction to the lower oesophageal sphincter, but are less useful for detecting oesophageal mucosal alterations.
The change in pressure of competent and incompetent lower esophageal sphincter (LES) due to abdominal compression is still a controversial subject. Therefore, we studied the effect of sustained (SAC) and intermittent (IAC) abdominal compression on lower esophageal sphincter pressure (LESP) in normals (N), patients with hiatus hernia (HH), and patients with scleroderma (S). When resting lower esophageal sphincter pressure exceeded 15 mm Hg, response to SAC and IAC was similar in patients with HH and in normals. On the other hand when basal LESP was below 15 mm Hg, stimulated sphincter pressure during IAC was significantly lower than during SAC. Values recorded during SAC were also falsely high in patients with scleroderma. Values obtained during either SAC or IAC did not depend on presence or absence of reflux symptoms in any group. LES stimulation with IAC gives valid results which correlate closely with LESP. Stress tests with IAC therefore seem to be a useful stimulation test for the analysis of LES function.
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