A significant proportion of patients with gastro‐oesophageal reflux disease (GERD) have Helicobacter pylori infection, but it is unclear whether or not H. pylori should be treated in this clinical setting. The aim of this review was to critically assess the relationship between H. pylori and GERD and its potential implications for the management of GERD. Data for this review were gathered from the following sources up to April 1998—the biomedical database M EDLINE, a detailed review of medical journals, and a review of abstracts submitted to relevant international meetings. On average, 40% of GERD patients carry H. pylori infection, with a reported infection prevalence ranging from 16% to 88%. To date, there has been no reported controlled trial of effective H. pylori therapy in GERD. GERD has been reported to develop de novo following the cure of H. pylori in peptic ulcer disease. In the presence of H. pylori, proton pump inhibitor therapy appears to accelerate the development of atrophic corpus gastritis, a potentially precancerous condition. Conversely, proton pump inhibitor therapy seems to become less effective after cure of H. pylori. The mechanisms underlying these important contrasting phenomena are poorly understood. The relationship between H. pylori and GERD is complex, and it is difficult to give definitive guidelines on the management of H. pylori infection in GERD. Controlled trials of H. pylori therapy in GERD are urgently needed, as well as further long‐term data on both the natural history of gastric histopathological changes in the H. pylori‐positive GERD patient treated with proton pump inhibitors, and the impact of H. pylori status on the clinical efficacy of antisecretory therapy. Pending these data, it is perhaps advisable to advocate cure of H. pylori in young patients with proton pump inhibitor‐dependent GERD who, in the absence of anti‐reflux surgery, are faced with the likelihood of long‐term medical therapy.

The aim of our retrospective study is to report on our experience using the Prevena™ wound system in obese patients undergoing caesarean section delivery. A total of 26 cases were identified from July 2012 to October 2013. The median BMI of these women was 45.3 kg/m(2). Elective caesarean sections were performed in 20 women (77%). There were four cases (15%) of superficial dehiscence. Factors associated with wound breakdown were wound infection (p = 0.03), increasing BMI (p < 0.001) and emergency LSCS (p = 0.04). In a logistic regression model the presence of infection was the only factor which remained associated with wound breakdown. Wound disruption is a major cause of morbidity following caesarean section in morbidly obese patients. The wound complication rate in our experience was low with the Prevena™ dressing with no cases of sheath dehiscence, and no patient required a second operation. The presence of infection is the most important factor in wound breakdown and should be the focus for management protocols.

INTRODUCTIONSeven-day proton pump inhibitor triple therapy is currently the treatment of choice for H. pylori, capable of curing infection in over 90% of patients. 1, 2 Less acknowledged is the fact that 7-day proton pump inhibitor triple therapy carries an appreciable adverse event rate, up to 37% in one study, 3 which discourages good compliance, and the regimen is relatively expensive. At present, it is unclear whether proton pump inhibitor triple therapy for less than 7 days might preserve ef®cacy while at the same time improving patient acceptability and compliance, and reducing expense. The aim of this open prospective study was to assess the Helicobactericidal ef®cacy, ulcer healing capacity and patient acceptability of a 5-day lansoprazole triple therapy regimen. MATERIALS AND METHODS PatientsPatients were eligible for inclusion in the study if they were in good general health, were found to have a gastric or duodenal ulcer at endoscopy, and had a gastric biopsy which gave a positive rapid urease test indicating the presence of H. pylori infection. An active ulcer was de®ned as a circumscribed break in the mucosa measuring at least 5 mm in the longest diameter with apparent depth and covered with an SUMMARY Background: Seven-day proton pump inhibitor triple therapy is currently the treatment of choice for Helicobacter pylori infection. It is unclear whether triple therapy for less than 7 days might preserve ef®cacy while at the same time improving patient acceptability and compliance. Aim: To evaluate the Helicobactericidal ef®cacy, ulcer healing capacity and patient acceptability of a 5-day lansoprazole-based triple therapy regimen. Methods: Sixty-nine consecutive patients with H. pyloripositive peptic ulcer received lansoprazole 30 mg twice daily in combination with metronidazole 400 mg twice daily and clarithromycin 250 mg twice daily for 5 days. Ulcer healing medication was not continued after the 5-day regimen. H. pylori status was assessed

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