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.

Background: Whilst the role of Helicobacter pylori eradication in managing duodenal ulcers has been established, consensus regarding the ideal regimen has not been achieved. Methods: Patients with H. pylori‐positive active duodenal ulcer were randomly assigned to receive triple therapy with amoxycillin 1000 mg b.d. + clarithromycin 500 mg b.d. + omeprazole 20 mg daily for 10 days (ACT‐10) or dual therapy with clarithromycin 500 mg t.d.s. + omeprazole 40 mg daily for 14 days (Dual). No additional acid suppression was provided following eradication therapy. Endoscopy, with biopsy for culture and histology, as well as 13C‐urea breath testing (13C‐UBT) were performed pre‐treatment to assess H. pylori infection. H. pylori eradication was established at 4–6 weeks follow‐up with culture (2 antral, 1 corpus biopsies), histology (2 antral biopsies), and 13C‐UBT. Ulcer healing by endoscopy and change in clinical symptoms were also assessed at 4–6 weeks. Results: Two hundred and sixty‐seven (267) patients were randomized to ACT‐10 (n=137) or Dual therapy (n=130). By per‐protocol and intention‐to‐treat analyses, H. pylori eradication at 4–6 weeks follow‐up was 91% (115/127) and 88% (120/136), respectively, for ACT‐10 patients and 59% (68/115) and 55% (72/130), respectively, for Dual therapy patients (P<0.001 for both analyses). Ulcer healing was high in both treatment groups: ACT‐10, 93% (118/127) and 90% (122/136), respectively; and Dual therapy, 91% (104/114) and 85% (111/130), respectively. Pre‐treatment resistance to clarithromycin was low (4%, 8/214) as compared to metronidazole resistance which was over 40%. Emergence of resistance to clarithromycin was observed in 2% of patients receiving ACT‐10 and in 25% of those receiving Dual therapy. ACT‐10 and Dual therapy patients experienced similar rates of drug‐related adverse events (33% vs. 32%, respectively) and discontinuation from therapy due to an adverse event (1.5% vs. 5%, respectively). More than 90% of patients were compliant with each prescribed medication. Conclusion: In patients with active duodenal ulcer, a 10‐day course of amoxycillin–clarithromycin‐based triple therapy without additional acid suppression is highly effective in eradicating H. pylori and healing duodenal ulcer.

We isolated a novel hepatitis E virus (HEV-Au1) variant from a patient in Austria suffering from acute viral hepatitis, who had no known risk factors for acquiring hepatitis E. The clinical presentation and initial serological findings have been reported previously. In this paper we report the results of sequence and phylogenetic analysis of HEV products from viral RNA isolated from acute phase serum. The results show that HEV-Au1 is significantly divergent from other HEV isolates. The nucleotide identity of analysed fragments from the novel isolate ranges from 76n6 to 78n4 % when compared to isolates from endemic regions and 84n6 to 87n9 % when compared to isolates from non-endemic regions. Divergent results were obtained when serum samples taken from the convalescent phase of disease were tested with three different immunoassays (EIAs). An EIA based on United States isolate-specific peptides showed enhanced reactivity whereas EIAs based on recombinant proteins derived from prototype HEV strains from Burma and Mexico were unable to detect antibodies to HEV (anti-HEV) in late phase serum. The findings verify the presence of an additional HEV variant in an industrialized country and provide information about possible problems in detecting anti-HEV.

No abstract

A 1-week course of clarithromycin and metronidazole in combination with a proton pump inhibitor is SUMMARY Background: One-week low-dose triple therapy is currently considered the gold standard regimen for treatment of Helicobacter pylori infection. However, the mechanisms involved in the synergy between antibiotics and proton pump inhibitors are controversial. Aims: To test the hypothesis that acid suppression represents the crucial mechanism by which the antibacterial activity of antibiotics can be enhanced, and to assess the impact of primary resistance on treatment outcome. Methods: One hundred and twenty patients with H. pylori infection and duodenal ulcer, gastric ulcer or non-ulcer dyspepsia were randomly assigned to a 1 week course of either famotidine 80 mg b.