Background/Aims: Ardabil Province, in northwestern Iran, has the highest rate of gastric (predominantly cardia) adenocarcinoma in Iran. This study aimed to investigate the feasibility of endoscopic screening and to look for associated Helicobacter pylori infection and gastric precancerous lesions. Methods: One thousand one hundred and five adult volunteers, residents of Ardabil and Meshkinshahr, districts, 40 years old and above were selected and invited by a simple random household canvass in rural and urban locations. Informed consents were obtained and upper gastrointestinal video endoscopy was performed to biopsy all visible lesions and standard sites in the antrum, corpus, and cardia Results: One thousand and eleven of the invited individuals agreed to participate, including 494 men and 517 women, with a mean (SD) age of 53.32 (10.39) years. Endoscopy was well tolerated by all subjects; 96.7% of antral and 80.7% of cardia mucosal biopsies were satisfactory. The urease test or histology for H pylori was positive in at least 89.2% of subjects. Histological evidence of mucosal atrophy was seen in 39.3% of antral and 21.9% of cardia samples. Chronic gastritis with or without activity, reactive atypia of glandular epithelium, intestinal metaplasia, dysplasia, and cancer were found in 95.1%, 38.0%, 8.7%, 0.2%, and 0.3% of antral and 85.3%, 22.9%, 3.8%, 0.3%, and 0.1% of cardiac biopsies, respectively. Conclusion: Endoscopic screening for upper gastrointestinal diseases was feasible and well tolerated in Ardabil, Iran. Most subjects showed H pylori infection. Atrophic gastritis, reactive atypia, and intestinal metaplasia were common in antrum, corpus, and cardia subsites.

INTRODUCTIONAchalasia is a primary oesophageal motor disorder characterized by incomplete relaxation of the lower oesophageal sphincter on swallowing and aperistalsis of the oesophageal body.1 Histopathological examination of the achalasic oesophagus demonstrates a loss of inhibitory myenteric plexus ganglionic cells. The loss of inhibitory ganglion cells secreting nitrous oxide and vasoactive intestinal peptide and the persistence of cholinergic stimulatory cells appear to be the primary pathophysiological defects.2 The mainstay of therapy is directed towards the reduction of lower oesophageal sphincter pressure resulting in improved oesophageal emptying by gravity. Pharmacological therapy, endoscopic dilatation, botulinum toxin injection and surgical myotomy are the primary therapeutic modalities. Pneumatic balloon dilatation is a commonly used treatment modality. Studies have found that balloon dilatation provides good to excellent symptomatic relief in 86±100% of cases. 3±6 In a large prospective study, Barkin et al. reported that dilatation with a 3.5-cm balloon provided symptomatic response in 90% of patients. 6 The advantages of this technique include the opportunity for a 1-day out-patient procedure, SUMMARY Background: Therapeutic options for achalasia include pharmacological therapy, surgical myotomy, pneumatic dilatation and intrasphincteric botulinum toxin injection. Aim: To compare botulinum toxin injection with pneumatic dilatation in a randomized trial. Patients/methods: Forty adults with newly diagnosed achalasia were randomized to receive botulinum toxin (n 20) or pneumatic dilatation (n 20). Symptom scores were evaluated at 1, 6 and 12 months. Clinical relapse was de®ned as a symptom score greater than 50% of baseline. Relapsers received a second botulinum toxin injection or pneumatic dilatation. Results: The cumulative 12-month remission rate was signi®cantly higher after a single pneumatic dilatation

Treatment regimens of 4 or 7 days are unacceptable for H. pylori infection in Iran, even in the presence of a favorable sensitivity profile.

Background: Pneumatic dilatation is considered to be the first line therapy for achalasia, but long-term outcome studies are scarce and limited by their retrospective design. There is also no consensus on the optimal method for performing pneumatic dilation as regard to balloon diameter, amount and the rate inflation pressure. Aim: To address these questions in a large long-term prospective study.