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SUMMARY The possibility that malabsorbed fat passing through the human ileum exerts an inhibitory feedback control on jejunal motility has been investigated in 24 normal subjects by perfusing the ileum with a fat containing solution designed to produce ileal luminal fat concentrations similar to those in steatorrhoea (30-40 mg/ml). Mean transit times through a 30 cm saline perfused jejunal segment were measured by a dye dilution technique. Thirty minutes after ileal fat perfusion, mean transit times rose markedly to 18 9±2 5 minutes from a control value of 7*5±0-9 minutes (n=5; p<005). This was associated with an increase in volume of the perfused segment which rose to 17541±229 ml (control 976±103 ml, n=5; p<005). Transit times and segmental volumes had returned towards basal values 90 minutes after completing the fat perfusion. Further studies showed that ileal fat perfusion produced a pronounced inhibition of jejunal pressure wave activity, percentage duration of activity falling from a control level of 40 3±5 0% to 14 9±2 8% in the hour after ileal perfusion (p<001). Ileal fat perfusion was associated with marked rises in plasma enteroglucagon and neurotensin, the peak values (218±37 and 68±13 1 pmol/l) being comparable with those observed postprandially in coeliac disease. These observations show the existence in man of an inhibitory intestinal control mechanism, whereby ileal fat perfusion inhibits jejunal motility and delays caudal transit of jejunal contents.

MethodsPatients attending for routine diagnostic gastroscopy and likely to need omeprazole were invited to take part in, and give written consent to this study, which was approved by the Parkside Ethical Committee. Patients with previous gastric surgery, known bleeding diathesis, taking oral anticoagulants, or who had been treated with bismuth compounds, omeprazole, or antibiotics known to be active against H pylori within the previous two months, were excluded. To determine H pylori status biopsy specimens were taken from the antrum (within 2 cm of the pylorus, two for histology and two for microbiology), corpus (half way along greater curvature, two for histology), and fundus (two for histology).After each examination the endoscopes were disinfected by an automatic washing machine (Olympus EW20)13 and the biopsy forceps were sterilised by autoclaving.

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Background-Eradication ofThere was a significant diVerence (p < 0.001) in the proportion of patients in whom eradication was successful between LAC and LCM when compared with LAM, but no significant diVerence (p = 0.15) between LAM and OAM. Metronidazole resistance before treatment was identified as a significant prognostic factor with regard to eradication of H pylori. The regimens which contained metronidazole were significantly less eVective than those without metronidazole in the presence of pretreatment resistant H pylori. There was no diVerence among the treatment groups with regard to the incidence and severity of adverse events reported. Conclusions-All four treatment regimens were safe and eVective in eradicating H pylori in the patient population studied. LAC was the most eYcacious treatment in patients with pretreatment metronidazole resistant H pylori, and was significantly better than LAM and OAM in this group of patients. (Gut 1997; 41: 735-739)