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BACKGROUND & AIMS: Expert consensus mandates retesting for eradication of Helicobacter pylori infection after treatment, but it is not clear how many patients are actually retested. We evaluated factors associated with retesting for H pylori in a large, nationwide cohort. METHODS: We performed a retrospective cohort study of patients with H pylori infection (detected by urea breath test, stool antigen, or pathology) who were prescribed an eradication regimen from January 1, 1994 through December 31, 2018 within the Veterans Health Administration (VHA). We collected data on demographic features, smoking history, socioeconomic status, facility poverty level and academic status, and provider specialties and professions. The primary outcome was retesting for eradication. Statistical analyses included mixed-effects logistic regression. RESULTS: Of 27,185 patients prescribed an H pylori eradication regimen, 6486 patients (23.9%) were retested. Among 7623 patients for whom we could identify the provider who ordered the test, 2663 patients (34.9%) received the order from a gastroenterological provider. Female sex (odds ratio, 1.22; 95% CI, 1.08–1.38; P=.002) and history of smoking (odds ratio, 1.24; 95% CI, 1.15–1.33; P

Conventional teaching is that Helicobacter pylori infection is required for the development of non-cardia gastric adenocarcinoma (NCGC) through a sequence of atrophic gastritis, intestinal metaplasia, dysplasia, and finally, cancer.1-3 However, studies have not demonstrated a 100% rate of H pylori infection in gastric malignancy, hypothesized to be due to false negatives, gastric atrophy leading to apparent loss of infection, and inclusion of cardia, nonintestinal cancers.1-3.

Background & Aims Zollinger–Ellison syndrome (ZES) is a rare disorder characterized by gastrin-secreting tumors of the gastrointestinal tract and gastric acid hypersecretion. There is controversy over the best way to manage these patients; we investigated outcomes of patients with different forms of the disease, who did and did not undergo surgery. Methods We performed a retrospective chart review of patients with ZES associated with multiple endocrine neoplasia type 1 (MEN-1) (n = 16) and those with sporadic ZES (n = 33) seen at a tertiary care center from August 1994 to January 2012. Cox proportional hazards modeling was used to compare survival times among groups, based on treatment with surgery (n = 34) and the presence of MEN-1 (n = 9 with surgery; n=7 without surgery). Differences were compared using the unpaired Student t test and the Fisher exact test. Results Patients with MEN-1 syndrome-associated ZES presented at a younger age than patients with sporadic ZES (34.9 vs 45.7 y, respectively; P P P = .91). None of the patients with MEN-1–associated ZES died of progressive disease, compared with 86% of deaths among patients with sporadic ZES ( P P = .13) and lack of cure by surgery ( P = .01). Surgery reduced all-cause mortality (hazard ratio, 0.11; 95% confidence interval, 0.2–0.6; P = .011) and disease-related mortality (hazard ratio, 0.14; 95% confidence interval, 0.2–0.84; P = .032) of patients with sporadic, but not MEN-1 syndrome-associated, ZES. Conclusions The presence of MEN-1 is associated with earlier onset and diagnosis of ZES, but a benign clinical course that rarely results in disease-related death; surgery therefore can be deferred for these patients. However, 86% of deaths among patients with sporadic ZES are attributed to disease-related causes, and mortality is reduced by early surgical intervention. Patients with sporadic ZES should undergo surgery soon after diagnosis.

*Division of Gastroenterology, and Division of Clinical Epidemiology, McGill University and the McGill University Health Centre, Montreal, Quebec, Canada; INSERM IC-P 803, CHU du Bocage, Dijon, France; Universite de Bourgogne, Dijon, France; **Department of Medicine, Division of Gastroenterology, Farncombe Family igestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Guelph General Hospital, Guelph and McMaster University, Guelph, Ontario, Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Gastroenterology, Medical University Canada; f South Carlolina, Charleston, South Carolina; and the Department of Medicine, Chinese University of Hong Kong, Hong Kong, China

The medical management of patients with gastrointestinal diseases is advancing rapidly. At a recent symposium held during Digestive Disease Week in Chicago in May of 2005, specific attention was given to the future prospects for medical management of 3 common gastrointestinal disease areas: antisecretory therapy, chronic hepatitis C, and inflammatory bowel disease. Antisecretory approaches include drug combinations including a proton pump inhibitor, potassium competitive acid blockers, and antigastrin agents. The latter two classes are still experimental, but the former combinations have potential to enhance the highly effective agents currently available. The focus of treatment advances in chronic hepatitis C in the immediate future is the discovery of more effective treatment regimens for nonresponders to prior therapy, who are becoming the largest group of patients seeking treatment of hepatitis C. The combination of peginterferon with ribavirin results in 6%-15% sustained virologic response rates in patients who were prior nonresponders to standard interferon plus ribavirin. Newer strategies to eradicate hepatitis C virus infection using different interferons, such as interferon alfacon-1 or higher doses of peginterferon, or long-term maintenance peginterferon, are undergoing study and show promise based on data from preliminary studies. Several immunomodulators have promise in inflammatory bowel disease, although the risk-benefit ratio and costs of therapy require evaluation. Nevertheless, the success of new biologics such as anti-TNFalpha agents augurs well for effective future therapies.