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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Clarithromycin, a new and well tolerated, acid stable macrolide antibiotic, has a similar antimicrobial spectrum to erythromycin but a better in vitro MIC90 (0.03 itg/l-1) against Helicobacter pylon (H pylori). This study aimed at determining the eradication rate using clarithromycin 500 mg thrice daily and omeprazole 40

Background-Factors that determine gastric metaplasia in the duodenal bulb are ill defined. It is more common and extensive in the presence of high acid output and possibly in the presence of Helicobacter pyloni. However, no quantitative relation between acid output and the extent of gastric metaplasia has been demonstrated and its relation to H pylori is uncertain. Aim-To determine the relation between H pylori infection and acid output and the presence and extent of gastric metaplasia in the duodenal bulb. Subjects-H pylori positive and negative patients with duodenal ulcer and healthy controls were studied.Methods-Quadrantic duodenal bulb biopsy specimens were taken and the presence and extent of gastric metaplasia determined using a computer enhanced image intensifier. Basal and stimulated acid outputs were measured. Results-Gastric metaplasia was significantly (p<0.05) more common and significantly (p<0.05) greater in extent in patients with duodenal ulcer than in controls. Neither the prevalence or extent of gastric metaplasia was affected by H pylori status. There were significant (p

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