The study shows that in our area anti-reflux surgery is more effective in relieving reflux symptoms than medical care according to clinical practice.

BackgroundOptimal treatment gives complete relief of symptoms of many disorders. But even if such treatment is available, some patients have persisting complaints. One disorder, from which the patients should achieve complete relief of symptoms with medical or surgical treatment, is gastroesophageal reflux disease (GERD). Despite the fact that such treatment is cheap, safe and easily available; some patients have persistent complaints after contact with the health services. This study evaluates the causes of treatment failure.MethodsTwelve patients with GERD and persistent complaints had a semi-structured interview which focused on the patients' evaluation of treatment failure. The interviews were taped, transcribed and evaluated by 18 physicians, (six general practitioners, six gastroenterologists and six gastrointestinal surgeons) who completed a questionnaire for each patient. The questionnaires were scored, and the relative responsibility for the failure was attributed to the patient, primary care, secondary care and interaction in the health services.ResultsFailing interaction in the health services was the most important cause of treatment failure, followed by failure in primary care, secondary care and the patient himself; the relative responsibilities were 35%, 28%, 27% and 10% respectively. There was satisfactory agreement about the causes between doctors with different specialities, but significant inter-individual differences between the doctors. The causes of the failures differed between the patients.ConclusionsTreatment failure is a complex problem. Inadequate interaction in the health services seems to be important. Improved communication between parts of the health services and with the patients are areas of improvement.

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Patients operated for GERD have less heartburn/acid regurgitation symptoms and less airway symptoms than non-operated patients. The findings lend support to the hypothesis of a causal relationship between gastroesophageal reflux, airway symptoms, and sleeping difficulties.

In the management of Helicobacter pyloriinduced gastroduodenal disease, a pilot study at our hospital (St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway) revealed that culture often seemed to fail compared to the polymerase chain reaction (PCR). A more thorough evaluation was therefore undertaken. We included 201 patients referred to upper gastrointestinal endoscopy in the period [2002][2003][2004]. Serology, biopsy rapid urease test, culture and PCR were performed. Conventional PCR was performed using the ureC, vacA and cagA genes, and real-time PCR for ureC. A diagnostic standard was defined on the basis of all four tests, and all four tests were then compared to this standard. One hundred eleven patients were deemed H. pylori-positive by the defined diagnostic standard, and 90 were labeled negative. Compared to this standard, culture showed a sensitivity of 87.4%, which was significantly lower than PCR at 99.1% (P<0.001). Culture showed a perfect specificity of 100%, which was significantly better than PCR at 97.8%. ureC was the gene with the best sensitivity (94.6% in conventional PCR, 97.3% in real-time PCR). vacA sensitivity was 87.4%, which is significantly lower than ureC (P<0.001). cagA was present in 37.8% of our H. pylori-positive patients. By real-time PCR a significantly lower cycle threshold was observed in antral biopsies than in corpal biopsies, indicating a higher H. pylori DNA template concentration in antral biopsies. PCR-testing for H. pylori is faster and significantly more sensitive than culture. Culture on the other hand was significantly more specific than PCR in our hand.