For maintenance treatment of reflux esophagitis, omeprazole alone or in combination with cisapride is more effective than ranitidine alone or cisapride alone, and the combination of omeprazole and cisapride is more effective than ranitidine plus cisapride.

INTRODUCTIONPeptic ulcer can be cured by eradicating Helicobacter pylori infection. 1 Many anti-Helicobacter regimens have been proposed over the past decade, but none of these reliably cures 100% of infections. The therapeutic potential, however, has greatly improved over the last few years, and the 1996 gold standard for successful treatment is considered to be an eradication rate higher than 85%±90% and a number of serious adverse events lower than 5%. 2 This goal can be achieved with multi- H. pylori infection was assessed by CLO-test and histology on both antral and corpus biopsies before and at least 4 weeks after the end of therapy. The bacterium was considered eradicated when both tests were negative. Eradication rates and the number of side-effects were evaluated in each group. The Chi-squared test was used for statistical analysis.

Endoscopic studies were performed to determine whether changes occurred in the duodenum related to portal hypertension in patients with liver cirrhosis. The total of 271 patients studied were subdivided into three groups: 83 patients with liver cirrhosis and portal hypertension, 53 with liver cirrhosis but no portal hypertension, and 135 controls. In the duodenum of cirrhotic patients with portal hypertension several changes were observed on endoscopy that were also present in the other two groups. Atrophy and vascular malformations, however, were present only in the duodenum of cirrhotic patients with portal hypertension, although in only a few patients and with statistical significance only for vascular malformations (p less than 0.01, phi = 0.21). Eleven percent of the patients had more than one endoscopic finding, but the associations of findings were without statistical significance. No statistically significant correlation was observed between the clinical severity of cirrhosis or the severity of esophageal varices and the endoscopic findings. Finally, there was no statistically significant difference between the histological findings of duodenitis in the three groups of patients.

INTRODUCTIONAt present, 1-week proton pump inhibitor-based triple therapy is the most recommended regimen for the treatment of H. pylori infection.1 From the ®rst successful experience of Bazzoli and his group, 2 other clinical trials, both small and large 3,4 have con®rmed the ef®cacy of this short-term multiple treatment. In recent years, however, the novel compound ranitidine bismuth citrate (RBC) has been shown to be an effective antiHelicobacter drug when combined with clarithromycin for 14 days.5 In relation to the good results of 1-week proton pump inhibitor-based triple therapy, we have recently shown that shortening the treatment with RBC plus low-dose clarithromycin and metronidazole to SUMMARY Background: Ranitidine bismuth citrate (RBC) co-prescribed with clarithromycin and metronidazole for 1 week has been shown to be an effective eradicating regimen for Helicobacter pylori. Aim: To determine the optimal duration of this regimen. Methods: A series of 165 dyspeptic patients were recruited for this randomized, open, parallel-group study. They were subdivided into three groups receiving RBC 400 mg b.d. plus clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. for three different periods (4, 7 and 10 days). H. pylori infection was assessed by the concomitant positivity of CLO-test and histology performed at the pre-entry endoscopy. The bacterium was considered eradicated on the basis of a negative 13 Curea breath test performed at least 28 days after the completion of treatment. Results: The three subgroups were well matched and 16 patients dropped out of the study for many reasons (six

INTRODUCTIONMany clinical studies support the relationship between acid suppression and healing of duodenal ulcer and re¯ux oesophagitis.1, 2 Moreover, proton pump inhibitors represent a central component of numerous triple therapies against Helicobacter pylori infection.3 A recent Consensus Meeting held in Maastricht 4 has recommended twice daily doses of proton pump inhibitors combined with two antibiotics for 1 week as the best treatment to cure the infection. In relation to the above wide range of indications for therapeutic schemes involving antisecretory drugs, it is becoming increasingly clear that the extent to which gastric acidity must be suppressed varies with the clinical condition being treated. For instance, it is common belief that moderate or severe re¯ux oesophagitis requires a greater and more prolonged acid inhibition than gastric and