In patients with recurrent duodenal ulcer, eradication of H. pylori by a regimen that does not have any direct action on the mucosa is followed by a marked reduction in the rate of recurrence, suggesting a causal role for H. pylori in recurrent duodenal ulcer.

SUMMARYAim: To assess the efficacy of the 8-week therapy with esomeprazole 40 mg vs. pantoprazole 40 mg for healing erosive oesophagitis (EE) as part of a management study. Methods: Patients had a history of gastro-oesophageal reflux disease symptoms ( ‡6 months) and had suffered heartburn on at least 4 of the 7 days preceding enrolment. Endoscopies were performed to grade EE severity using the Los Angeles (LA) classification system at baseline, 4 and 8 weeks (if unhealed at 4 weeks). Heartburn severity was recorded by patients on diary cards. The primary end point was healing of EE by week 8 of treatment.Results: Of 3170 patients randomized, the intentto-treat population consisted of 3151 patients (63% male, mean age: 50.6 years, 27% Helicobacter pyloripositive). Esomeprazole 40 mg healed a significantly greater proportion of EE patients than pantoprazole 40 mg at both 4 weeks (life table estimates: esomeprazole 81%, pantoprazole 75%, P < 0.001) and 8 weeks (life table estimates: esomeprazole 96%, pantoprazole 92%, P < 0.001). The median time to reach sustained heartburn resolution was 6 days in patients receiving esomeprazole and 8 days with pantoprazole (P < 0.001). Conclusion: Esomeprazole 40 mg is more effective than pantoprazole 40 mg for healing EE and providing resolution of associated heartburn.

Patients and methods Hpylori eradication in subjects with a history of at least two symptomatic recurrences and an endoscopically confirmed, active duodenal ulcer was achieved with a 12 day regimen of amoxicillin (750 mg three times daily) plus metronidazole (500 mg three times daily), already described elsewhere.5 Additional ranitidine was given for six (or 10) weeks. After ulcer healing and H pylori eradication, control endoscopies were performed on months 4, 8, 14±1, 27±2, and 43±4 after starting treatment or whenever symptoms occurred. If reinfection was detected, the spouse of the reinfected patient was also asked to undergo endoscopy. H PYLORI STATUSAt each endoscopy five biopsy specimens were collected from the antral mucosa. H pylori was identified by the rapid urease test, histological examination, and culture, as already described previously. All sera from each individual patient were tested in duplicate at the same time.H PYLORI TYPING Hpylori strains were stored at -70°C in 0 5 ml horse serum +17% glycerol. If a reinfection occurred, the newly detected strains were compared to the corresponding pretreatment isolates. In addition, the isolates of the reinfected patient's spouse were obtained at the end of the follow up period. Typing was 831 on 9 May 2018 by guest. Protected by copyright.

A highly sensitive seminested PCR assay to detectHelicobacter pylori DNA in feces was developed. PCR with stool specimens and a novel antigen enzyme immunoassay (EIA) forH. pylori detection in feces were evaluated as diagnostic tools and in follow-up with samples from 63 infected and 37 noninfected persons. Infected individuals received eradication therapy followed by endoscopic follow-up 35 days after the start of treatment. At that time, a second stool specimen was obtained from 55 of these patients. Before eradication, the sensitivity of PCR was 93.7% and that of EIA 88.9%. Specificities were 100 and 94.6%, respectively. Of the 55 follow-up specimens, 41 originated from patients from whom H. pylori had been eradicated. Of these, 21 were still positive by PCR and 13 were positive by EIA, indicating that 1 month may be too short a period for follow-up evaluation of stool specimens by these tests.

SUMMARYBackground: Following initial healing of erosive oesophagitis, most patients require maintenance therapy to prevent relapse. Aim: To compare endoscopic and symptomatic remission rates over 6 months' maintenance therapy with esomeprazole or pantoprazole (both 20 mg once daily) in patients with healed erosive oesophagitis. Methods: Patients with symptoms of gastro-oesophageal reflux disease and endoscopically confirmed erosive oesophagitis at baseline were randomized to receive esomeprazole 40 mg or pantoprazole 40 mg for up to 8 weeks. Patients with healed erosive oesophagitis and free of moderate/severe heartburn and acid regurgitation at 4 weeks or, if necessary, 8 weeks entered the 6-month maintenance therapy phase of the study.