Background:  Sequential therapy (ST) seems to offer higher success rates than triple therapy (TT) in the eradication of Helicobacter pylori (H. pylori) infection. However, from the standpoint of therapeutic compliance, there is no difference between the two treatments. Adjuvant treatment (especially with probiotics (PB) and lactoferrin (LF)) has often improved compliance and eradication rates in patients subjected to TT, while ST had never been used in association with adjuvants. Methods:  Over a period of 2 years, we randomized and divided 227 consecutive adult patients with H. pylori infection into three groups. The patients were given ST with the addition of adjuvants, as follows: group A (ST + placebo), group B (ST + LF + PB), and group C (ST + PB). Our goal was to assess therapeutic compliance, so we prepared a questionnaire to help determine the severity of the side effects. We also determined the eradication rates for the groups. Results:  Patients with ST + placebo had the worst compliance as compared with the other two groups in terms of the absence of symptoms (p < .001 between B and A; p = .001 between C and A) and the presence of intolerable symptoms (p = .016 between B and A; p = .046 between C and A). The differences between the values for the treated groups and those for the placebo group were statistically significant. On the other hand, there was no statistically significant difference in compliance between groups B and C. The eradication rate was similar for the three groups. Conclusions:  Probiotics associated with ST provide optimum therapeutic compliance compared with the placebo and, despite the need to take a larger number of tablets, they should be taken into consideration as an adjuvant to therapy for H. pylori infection. The addition of LF to the PB did not bring about any further improvements in compliance. As compared with the placebo, the eradication rate of ST did not improve by adding LF + PB or by using PB alone.

Esophageal bizarre stromal cells (BSCs) represent an important diagnostic pitfall, since they can closely resemble a malignancy, thus leading to a significant overtreatment. We recently encountered a case in a healthy 38-year-old man, with a normal blood count, who underwent an upper gastrointestinal endoscopy during the follow-up of a grade I esophagitis and hiatus hernia. The endoscopy revealed an ulcerated sessile polyp that, on histology, consisted of a proliferation of round atypical discohesive cells, with a variable amount of cytoplasm, large nuclei, and prominent eosinophilic nucleoli. They were intermingled with many granulocytes and plump vessels, in a background of granulation tissue. Immunohistochemical stains with pan-cytokeratin, S100, and CD31 were negative and Ki67 stained only very few nuclei. At variance with other anatomical sites and despite the putative fibroblastic or myofibroblastic origin, BSCs in esophagus can have a striking epithelioid appearance, mimicking a carcinoma or a melanoma. Awareness of BSCs can prevent serious misdiagnoses.