Invasive tests

H pylori can be detected at endoscopy by histology, culture, or urease tests, each with inherent advantages and disadvantages. All these biopsy based methods for detecting Hpylori are liable to sampling error because infection is patchy. Up to 14 of infected patients do not have antral infection but have Hpylori elsewhere in the stomach, especially if they have gastric atrophy, intestinal metaplasia, or bile reflux. In addition, after partially effective eradication treatment, low levels of...

Indigestion When is it functional

Nicholas J Talley, Nghi Phung, Jamshid S Kalantar Patients often complain of indigestion, but what do they mean Indigestion is an old English word that means lack of adequate digestion, but patients and doctors interpret this in different ways. Many patients mean heartburn or acid regurgitation, the classic symptoms of gastro-oesophageal reflux disease. Some describe belching, abdominal rumblings, or even bad breath as indigestion. Others mean pain localised to the epigastrium or a non-painful...

Hypersecretion in duodenal ulcer disease

Before the discovery of Hpylori it was known that patients with duodenal ulcers secrete about twice as much acid as controls because they have twice as many parietal cells. Patients with gastric ulcer and those with functional dyspepsia have normal acid output and parietal cell count. Thus there was good evidence that acid played a major role in ulcer formation. Duodenal ulcers did not occur in achlorhydric people or in those secreting < 15 mmol h of acid. Duodenal ulcers can be healed, but...