SUMMARYIntroduction: Motilin-receptor agonists are prokinetics; whether they relieve the symptoms of functional dyspepsia is unknown. We aimed to test the ef®cacy of the motilin agonist ABT-229 in functional dyspepsia patients with and without delayed gastric emptying. Methods: Patients were randomized with postprandial symptoms and documented functional dyspepsia by endoscopy (n 589 in intention-to-treat analysis). Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated 13 C octanoic acid breath test. Patients were then further randomized within each strata, to receive one of four doses of ABT-229 (1.25, 2.5, 5 or 10 mg b.d. before breakfast and dinner) or placebo for 4 weeks, following a 2-week baseline. The primary outcome was the assessment of change in symptom severity over the 2 weeks from baseline to ®nal visit, based on a self-report questionnaire measuring severity on visual analogue scales.

Background: Rabeprazole sodium is the most recent member of a class of substituted benzimidazole molecules known as proton pump inhibitors. Other proton pump inhibitors have been shown to be effective in healing oesophagitis. Methods: In this randomised, double‐blind, multicentre study, conducted at 27 European sites, the efficacy and safety of rabeprazole and omeprazole were compared in patients with erosive or ulcerative gastro‐oesophageal reflux disease (GERD).100 patients received rabeprazole 20 mg, and 102 patients omeprazole 20 mg once daily for 4 or 8 weeks, with healing monitored by endoscopy. Results: Overall GERD healing rates observed and evaluated at weeks 4 and 8 were equivalent. Four‐week healing rates for rabeprazole and omeprazole were 81%–81% and 92%–94% for 8‐week healing. Rabeprazole‐treated patients had similar relief of the frequency and intensity of heartburn to those treated with omeprazole. Both drugs were well tolerated over the 8‐week treatment period. Mean changes in fasting serum gastrin were comparable. No significant differences in laboratory parameters were seen. Biopsies for argyrophil ECL cell histology at the end‐point revealed a similar distributions of hyperplasia grades to those at baseline in both groups. Biopsies of body and antral mucosa for other parameters were similar between treatments for Helicobacter pylori colonization, presence or degree of inflammation, atrophy or intestinal metaplasia at the end‐point. Conclusion: In this study, GERD healing rates following rabeprazole 20 mg once daily were equivalent to those obtained with omeprazole 20 mg once daily. Both treatments resulted in a comparable relief of the frequency and intensity of heartburn associated with this disease, and both were well tolerated.

Background: Rabeprazole sodium is the newest member of a class of substituted benzimidazole molecules known as proton pump inhibitors. Other proton pump inhibitors have been shown to be effective in healing active duodenal ulcer. Method: This randomized, double‐blind, multicentre study, conducted at 25 European sites, compared the efficacy and tolerability of rabeprazole and omeprazole in patients with active duodenal ulcers. One hundred and two patients with active duodenal ulcer received rabeprazole 20 mg and 103 patients omeprazole 20 mg once daily for 2 or 4 weeks, with ulcer healing monitored by endoscopy. Results: After 2 weeks, complete ulcer healing was documented in 69% of patients given rabeprazole 20 mg and in 62% of patients given omeprazole 20 mg (N.S.). After 4 weeks, healing rates were 98% in the rabeprazole group and 93% in the omeprazole group (P = 0.083). Rabeprazole‐treated patients had significantly greater improvement in daytime pain symptom relief than those treated with omeprazole at the conclusion of the study (P = 0.038). Both drugs were well tolerated over the 4‐week treatment period. Mean changes from baseline to end‐point in fasting serum gastrin were significantly greater in the rabeprazole group, but at end‐point mean values were well within normal limits for both groups. No clinically meaningful changes or other between‐group differences were observed in laboratory parameters. Conclusion: In this study, rabeprazole produced healing rates equivalent to omeprazole at weeks 2 and 4, and provided significantly greater improvement in daytime pain. Both treatments were well tolerated.

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SUMMARY Twenty patients took part in a controlled double blind study comparing the efficacy of colloidal bismuth and cimetidine (800 mg at night) with cimetidine alone in the treatment of ulcerative reflux oesophagitis. Colloidal bismuth 120 mg was administered through an intraoesophageal tube four times a day. Cimetidine with colloidal bismuth gives significantly (p<0001) better results than cimetidine alone. Of 10 patients treated with cimetidine and bismuth, seven had no endoscopic signs of oesophagitis after three weeks and three had grade I oesophagitis. Of 10 patients treated with cimetidine alone, one had grade I oesophagitis and three grade II oesophagitis after three weeks. The remaining six still had grade III oesophagitis. This study also shows that in nine of 10 patients reflux oesophagitis was accompanied by infection with campylobacter like organisms (CLO). After treatment the bacteria disappeared promptly in five patients receiving combination therapy and in two of four treated with cimetidine alone. The possible role of CLO in reflux oesophagitis is uncertain.Gastro-oesophageal reflux is a quite common condition, usually accompanied by incompetence of the lower oesophageal sphincter.' Oesophagitis develops in only about one half of patients with gastrooesophageal reflux.4Reflux oesophagitis is usually treated with H2-receptor antagonists, antacids in gel or drugs that promote gastric emptying together with postural and dietary recommendations.' In some cases, however, the reflux oesophagitis does not respond to conventional therapy and admission to hospital is necessary. Persistent reflux oesophagitis remains a therapeutical challenge.Colloidal bismuth subcitrate has been proved to be effective in peptic ulcer disease. It is known as a cytoprotective agent that stimulates the generation of mucosal prostaglandin E2 and retards the movement of hydrogen ions.f Because of these properties colloidal bismuth was thought to be a useful therapeutic agent for ulcerative reflux oesophagitis. During the past three years 36 patients have been successfully treated with colloidal bismuth adminis- The aim of the present study was to compare colloidal bismuth in combination with cimetidine and cimetidine alone for the treatment of reflux oesophagitis. Furthermore the proportion of patients with reflux oesophagitis and CLO was determined. Methods PATI ENTSTwenty patients (eight men, 12 women; mean age 69-1 years, (56-79)) with endoscopically and histologically proven grade I1-1Va reflux oesophagitis'4 (Table) were admitted to the trial. All patients had 385 on 11 May 2018 by guest. Protected by copyright.