Background-There is increasing evidence that reflux of bile plays a part in the pathogenesis of Barrett's oesophagus. Bile injury to the gastric mucosa results in a "chemical" gastritis in which oedema and intestinal metaplasia are prominent. Aim-To determine if patients with Barrett's oesophagus have more bile related changes in antral mucosa than patients with uncomplicated gastro-oesophageal reflux disease (GORD) or non-ulcer dyspepsia (NUD). Patients and methods-Patients were identified by a retrospective search of pathology records and those with a clinically confirmed diagnosis of either Barrett's oesophagus or reflux oesophagitis who had oesophageal and gastric biopsies taken at the same endoscopy and had no evidence of Helicobacter pylori infection entered the study. Control biopsies were taken from H pylori negative NUD patients. Antral biopsies were examined "blind" to clinical group and graded for a series of histological features from which the "reflux gastritis score" (RGS) and "bile reflux index" (BRI) could be calculated. The reproducibility of these histological scores was tested by a second pathologist. Results-There were 100 patients with Barrett's, 61 with GORD, and 50 with NUD. The RGSs did not diVer between groups. BRI values in the Barrett's group were significantly higher than those in GORD subjects (p=0.014) which in turn were higher than those in NUD patients (p=0.037). Similarly, the frequency of high BRI values (>14) was significantly greater in the Barrett's group (29/100; 29%) than in the GORD (9/61; 14.8%) or NUD (4/50; 8%) group. However, agreement on BRI values was "poor", indicating limited applicability of this approach. Conclusion-Patientswith Barrett's oesophagus have more evidence of bile related gastritis than subjects with uncomplicated GORD or NUD. The presence of bile in the refluxate could be a factor in both the development of "specialised" intestinal metaplasia and malignancy in the oesophagus. (Gut 2001;49:359-363) Keywords: Barrett's oesophagus; reflux gastritis; bile; duodenogastro-oesophageal reflux; intestinal metaplasia Barrett's oesophagus is widely considered to be a consequence of longstanding acid induced injury commencing as an erosive oesophagitis and progressing over years to columnar and intestinal metaplasia of the squamous epithelium. The process of metaplasia represents a non-neoplastic change in cellular phenotype which is thought to be a response to a sustained adverse environment.1 The change may be a consequence of somatic mutation in the epithelial stem cells or an epigenetic event whereby divergent diVerentiation in progeny cells produces the altered phenotype.2 Whatever the precise mechanism, the resulting cell lineage has a survival advantage over "native" epithelium so that selection pressures promote the emergence and dominance of the metaplastic population. Examples in the gastrointestinal tract include gastric metaplasia in the duodenum in response to acid injury, 3 intestinal metaplasia in the stomach in longstanding Helicobacte...

Background : Current guidelines for Helicobacter pylori eradication recommend 7 days of a proton‐pump inhibitor, clarithromycin (C), and either metronidazole (M) or amoxycillin (A). A shorter course would be cheaper and could be as effective. Aim : This study was designed to investigate the efficacy of three 5‐day regimens based on lansoprazole (L). Methods : 168 dyspepsia patients with H. pylori infection were randomized to receive a 5‐day course of either LCM, LAC or CALM, and a 13C‐urea breath test was performed after 4 weeks to assess eradication. Results : 160 patients completed the study. Intention‐to‐treat eradication rates were as follows: LCM 81%, LAC 59%, CALM 88%. LCM and CALM gave significantly better eradication rates than LAC. There was no significant difference in adverse events across the three groups. Logistical regression analysis showed that the specific regimen used and the age of the patient were the only factors influencing eradication outcome. Conclusions : Five days of CALM yields acceptable eradication rates, and is cheaper than conventional 7‐day proton pump inhibitor‐triple therapy. It appears to offer good results in metronidazole‐resistant strains of H. pylori. A randomized trial comparing 5‐day CALM with conventional 7‐day therapy is needed before this regimen can be recommended for routine use.

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Aims-To investigate interleukin (IL)-12(p40) and IL-10 mRNA expression levels in the gastric mucosa in relation to H pylori cag status, peptic ulceration, and histopathology. Methods-In 81 dyspeptic patients, antral and corpus biopsies were taken for reverse transcriptase polymerase chain reaction (RT-PCR) and histology. G3PDH (control) and IL-10 and IL-12 were coamplified in a duplex PCR and the ratios of cytokines to G3PDH were determined. Bacterial ureA and cagA status was determined by RT-PCR. (J Clin Pathol 1999;52:658-664) Results-IL-10