INTRODUCTIONHelicobacter pylori is now thought to be the most important exogenous factor in the development of duodenal ulcer disease, and is present in over 95% of duodenal ulcer patients. 1, 2 Several studies have provided strong evidence that eradication of the infection reduces ulcer relapse rate, 3±5 so it has been suggested that an attempt to eradicate the infection should be made in all patients with duodenal ulcer disease. 6 Eradication therapy therefore offers a potential cure for the disease and provides the general practitioner with an alternative to long-term treatment with acid-lowering SUMMARY Background: Helicobacter pylori is the main acquired factor in the pathogenesis of duodenal ulcer disease. Methods: This multicentre study conducted in 32 general practice centres in the UK and Ireland was a double-blind, placebo-controlled, randomized, parallelgroup comparison of triple therapy (n 98: omeprazole 40 mg once daily and amoxycillin 1 g b.d. for 2 weeks, and metronidazole 400 mg t.d.s. for the ®rst week) and dual therapy (n 85: omeprazole 40 mg once daily and amoxycillin 1 g b.d. for 2 weeks, with placebo during the ®rst week) for the eradication of H. pylori in patients with symptomatic duodenal ulcer disease. Patients who were successfully treated entered a followup phase for 12 months to assess symptomatic relapse and use of health-care resources. Results: Eradication of H. pylori based on a second 13 C-urea breath test was successful in 95% (95% con®dence interval (CI) 90±100%) of patients receiving omeprazole triple therapy and 53% (95% CI 41±65%) of those receiving omeprazole dual

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There is still uncertainty about when to refer patients for endoscopic investigations.

The majority of patients with chronic diarrhoea can be successfully managed in primary care

Heartburn and reflux may be symptoms of a more serious oesophageal disorder, says Dr Mark Cottrill