Conclusion-Nearly three quarters of patients previously diagnosed as having oesophagitis still had significant morbidity related to gastro-oesophageal reflux disease more than 10 years after diagnosis. Some quality of life scores were significantly lower than those of the general population.

Although a high prevalence of antibodies to Helicobacter pylori has been documented within families, culture and DNA typing of strains from infected children and their parents has not been evaluated. This study aimed to analyse H pylori infection within family groups. Endoscopy, gastric biopsy, and H pylori culture were performed on all eight parents of four children who presented with dyspepsia and who had a positive H pylori culture. All biopsy specimens were cultured on Columbia based blood agar under microaerophilic conditions for four days. The DNA from each strain was extracted and electrophoretic patterns were compared after digestion with restriction endonucleases Hae III or Hind III. Ribotyping using a biotinylated cDNA probe prepared from 16S and 23S rRNA of H pylon NCTC 11638 was also used. Seven of the parents were positive for H pylorn on urease testing, histology, and on culture. DNA typing showed the same or a similar strain to be present in at least two family members in three of the four family groups. In family 1, the mother, father, and child all had an identical strain; in family 2, father and son had a similar related strain; father and mother had the same strain in family 3; and all strains were unique in family 4. These data provide evidence for either intrafamilial cross infection or a common source of infection within family groups. (Gut 1993; 34: 1348-1350 Helicobacter pylon is recognised as a significant cause of chronic antral gastritis and important in the aetiology of peptic ulceration.' There is also evidence to support a role as a risk factor for gastric carcinoma.2 5 It is known that the prevalence increases with age6 and that while the incidence in children is lower than that in adults, intrafamilial clustering has been shown. DNA TYPING H pyloni isolates from four children and their parents, plus two isolates chosen randomly from unrelated individuals were incubated on brain heart infusion agar supplemented with 5% v/v horse blood and 1% v/v isovitalex (Oxoid) for 48 hours at 37%, under microaerophilic conditions (5% 02, 5% C02, 2% H2, 88% N2). Chromosomal DNA was isolated and purified from each isolate using the guanidium thiocyanate reagent method.'0 The purified DNA was incubated with the restriction endonuclease (Hae III) for four hours at 37°C and the digests were electrophoresed at 30 v for 16 hours in a horizontal agarose gel. After electrophoresis the gels were stained with ethidium bromide and photographed. Strain DNAs which did not cut with Hae III were subjected to Hind III digestion. For ribotyping, the gels were then transferred to nylon membranes by means of vacublotting. A biotinylated cDNA probe was prepared from 16S and 23S rRNA of H pylori NCTC 11638 using reverse transcriptase. Biotinylation was achieved by the incorporation of biotin-16-dUPT. The membranes were then hybridized by standard procedures for 16 hours at 42°C, using the biotinylated cDNA probe. Restriction digest patterns and ribopatterns were compared. Details of DNA typing methods have b...

Background-Management of dyspepsia remains a controversial area. Although the European Helicobacter pylori study group has advised empirical eradication therapy without oesophagogastroduodenoscopy (OGD) in young H pylori positive dyspeptic patients who do not exhibit alarm symptoms, this strategy has not been subjected to clinical trial. Aims-To compare a "test and treat" eradication policy against management by OGD. Patients-Consecutive subjects were prospectively recruited from open access OGD and outpatient referrals. Methods-H pylori status was assessed using the carbon-13 urea breath test. H pylori positive patients were randomised to either empirical eradication or OGD. Symptoms and quality of life scores were assessed at baseline and subsequent reviews over a 12 month period. Results-A total of 104 H pylori positive patients aged under 45 years were recruited. Fifty two were randomised to receive empirical eradication therapy and 52 to OGD. Results were analysed using an intention to treat policy. Dyspepsia scores significantly improved in both groups over 12 months compared with baseline; however, dyspepsia scores were significantly better in the empirical eradication group. Quality of life showed significant improvements in both groups at 12 months; however, physical role functioning was significantly improved in the empirical eradication group. Fourteen (27%) in the empirical eradication group subsequently proceeded to OGD because of no improvement in dyspepsia. Conclusions-This randomised study strongly supports the use of empirical H pylori eradication in patients referred to secondary practice; it is estimated that 73% of OGDs in this group would have been avoided with no detriment to clinical outcome. (Gut 1999;45:186-190)