The association between Helicobacter pylori and ischemic heart disease seems to be due to a higher prevalence of more virulent Helicobacter strains in patients. These results support the hypothesis that Helicobacter pylori may influence atherogenesis through low-grade, persistent inflammatory stimulation.

SUMMARY BackgroundBreath tests represent a valid and non-invasive diagnostic tool in many gastroenterological conditions. The rationale of hydrogen-breath tests is based on the concept that part of the gas produced by colonic bacterial fermentation diffuses into the blood and is excreted by breath, where it can be quantified easily. There are many differences in the methodology, and the tests are increasingly popular.

Background-Both celiac disease (CD) and myocarditis can be associated with systemic autoimmune disorders; however, the coexistence of the 2 entities has never been investigated, although its identification may have a clinical impact. Methods and Results-We screened the serum of 187 consecutive patients with myocarditis (118 males and 69 females, mean age 41.7Ϯ14.3 years) for the presence of cardiac autoantibodies, anti-tissue transglutaminase (IgA-tTG), and anti-endomysial antibodies (AEAs). IgA-tTG-positive and AEA-positive patients underwent duodenal endoscopy and biopsy and HLA analysis. Thirteen of the 187 patients were positive for IgA-tTG, and 9 (4.4%) of them were positive for AEA. These 9 patients had iron-deficient anemia and exhibited duodenal endoscopic and histological evidence of CD. CD was observed in 1 (0.3%) of 306 normal controls (PϽ0.003). In CD patients, myocarditis was associated with heart failure in 5 patients and with ventricular arrhythmias (Lown class III-IVa) in 4 patients. From histological examination, a lymphocytic infiltrate was determined to be present in 8 patients, and giant cell myocarditis was found in 1 patient; circulating cardiac autoantibodies were positive and myocardial viral genomes were negative in all patients. HLA of the patients with CD and myocarditis was DQ2-DR3 in 8 patients and DQ2-DR5(11)/DR7 in 1 patient. The 5 patients with myocarditis and heart failure received immunosuppression and a gluten-free diet, which elicited recovery of cardiac volumes and function. The 4 patients with arrhythmia, after being put on a gluten-free diet alone, showed improvement in the arrhythmia (Lown class I). Conclusions-A common autoimmune process toward antigenic components of the myocardium and small bowel can be found in Ͼ4% of the patients with myocarditis. In these patients, immunosuppression and a gluten-free diet can be effective therapeutic options.

INTRODUCTIONEradication of Helicobacter pylori is now the treatment of choice to cure peptic ulcers and prevent ulcer complications.1, 2 The ef®cacy of proton pump inhibitors in combination therapies to eradicate H. pylori infection has been clinically well documented in previous studies.3, 4 It mainly depends on the ability of proton pump inhibitors to suppress acid secretion and partially on a direct bactericidal activity against H. pylori.Since the adequate suppression of acid secretion is required for proton pump inhibitor-based triple therapies, the ef®cacy of various proton pump inhibitors also has attracted signi®cant interest. Rabeprazole has a very potent antisecretory effect, 5,6 and it has a greater antibacterial effect than omeprazole or lansoprazole. 7±9In addition, rabeprazole 20 mg was shown to have a faster onset of antisecretory activity than omeprazole, 10 suggesting that it has an advantage when it is used in short-term eradication regimens. Although these ®nd-ings suggest that a rabeprazole-based regimen could achieve a high cure rate, there are as yet only a few

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