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Objective: Existing endoscopy-based data on gastro-oesophageal reflux disease (GOAD) in the general population are scarce. This study aimed to evaluate typical symptoms and complications of GOAD, and their associated risk factors, in a representative sample of the Italian population. Methods: 1533 adults from two Italian villages were approached to undergo symptom assessment using a validated questionnaire and upper gastrointestinal endoscopy. Data were obtained from 1033 individuals (67.4% response rate). Results: The prevalence of reflux symptoms was 44.3%; 23.7% of the population experienced such symptoms on at least 2 days per week (frequent symptoms). The prevalence rates of oesophagitis and Barrett's oesophagus in the population were 11.8% and 1.3%, respectively. Both frequent (relative risk (AR) 2.6; 95% confidence interval (Cl) 1.7 to 3.9) and infrequent (AR 1.9; 95% Cl 1.2 to 3.0) reflux symptoms were associated with the presence of oesophagitis. No reflux symptoms were reported by 32.8% of individuals with oesophagitis and 46.2% of those with Barrett's oesophagus. Hiatus hernia was associated with frequent reflux symptoms and oesophagitis, and was present in 76.9% of those with Barrett's oesophagus. We found no association between body mass index and ref lux symptoms or oesophagitis. Conclusions: GOAD is common in Italy, but the prevalence of Barrett's oesophagus in the community is lower than has been reported in selected populations. Both frequent and infrequent reflux symptoms are associated with an increased risk of oesophagitis. Individuals with oesophagitis and Barrett's oesophagus often have no reflux symptoms. [ABSTRACT FROM AUTHOR]

The article discusses treatment strategies for the Helicobacter pylori infection. The prevalence and description of the infection and its association to gastric cancer are explained. Dual and triple treatment regimens which use a proton pump inhibitor and antibiotics are discussed. Alternative therapies including those that involve a seven day regimen and sequential therapy for eradication of the infection are also discussed. Descriptions of other treatment regimens including those which use levofloxacin and rifabutin and furazolidone are included. A discussion of the recurrence rates for the infection is also presented. The authors conclude that the prevalence of drug resistance will determine the treatment strategy. They recommend validated treatments. INSETS: Standard and third line treatments for eradicationg H pylori;TIPS FOR NON-SPECIALISTS.

Background: H. pylori infection is associated with peptic ulcer disease and gastric cancer and has also been implicated as a possible cause of extraintestinal disorders such as skin diseases. There are a few case reports on patients with skin diseases, such as prurigo nodularis that are associated with gastric cancer. Aims: The aim of this study was to examine the prevalence of H. pylori infection and the gastric cancer in patients with pruritic skin diseases. Methods: All patients were examined for circulating specific IgG antibodies against H. pylori in sera using ELISA. H. pylori-positive selected patients who were more than 50 years old underwent upper gastrointestinal endoscopy for confirmation of infection and screening of gastric cancer. Results: Seventy five patients with pruritic skin diseases were examined including 43 cases of pruritus cutaneous, 15 cases of nummular dermatitis, 17 cases of prurigo chronica multiforme. The prevalence of H. pylori infection was 70% in pruritus cutaneous, 73% in nummular dermatitis and 76% in pmrigo chronica multiforme. Early gastric cancer was detected in 3 of 30 patients with pruritus cutaneous, 1 of 11 with nummular dermatitis, 1 of 11 with pmrigo chronica multiforme. The prevalence of early gastric cancer was 9.6% which was much higher than the prevalence among patients having general endoscopic screening for gastric cancer. Two patients underwent endoscopic mucosal resection; the others had partial gastrectomy. Conclusions: These results suggest H. pylori -positive patients with pruritic skin diseases are a high risk group of gastric cancer and endoscopic screening is recommended. [ABSTRACT FROM AUTHOR]

Background: HP infection and family history (FH) of gastric cancer (GC) seem to be risk factors for GC. Aim and methods: to study if Hp infection is associated with an increased risk of intestinal metaplasia (IM)in relatives of GC patients. In the frame of the ongoing Loiano-Monghidoro Project (APT 2001; 15:10017), inhabitants are re-invited to undergo upper gastrointestinal endoscopy with biopsies, [sup 13]C-UBT, medical interview and questionnaire. Odds ratio (OR), as an estimate of the relative risk for IM, was calculated by logistic regression analysis. Results: of 892 subjects enrolled histological evaluation is available for 672 subjects. 104 subjects had FH+ and 568 subjects had a FH-. The prevalence of IM was 32% (140/437) vs 17.4% (41/235), (p<0.0001), in HP+ and HP- subjects, respectively (OR= 2.2, 95% CI 1.5-3.3); the risk however appeared to be greater in HP+ FH+ (OR= 2.6, 95% CI 1.0-7.3) than HP+ FH- subjects (OR= 2.0, 95% CI 1.3-3.2). The prevalence of IM was 36.5% (38/104) vs. 25.2% (143/568) (p< 0.02)in FH+ and FHsubjects respectively(OR=1.7, 95% CI 1.1-2.6). The prevalence of IM was 42.1%(32/76) vs 29.9%(108/361), (p< 0.04), in HP+ FH+ and HP+FHsubjects respectively (OR= 1.7, 95% CI 1.0-2.8). Differently the prevalence of IM was similar in HP- FH+ 21.4% (6/28) and HP- FH- 16.9% (35/207) (p= ns) (OR= 1.3, 95% CI 0.5-3.5). Conclusions: The risk of developing IM associated with HP infection is increased in first-degree relatives of GC patients and a FH+ for GC is a risk factor of IM only in HP+ subjects. [ABSTRACT FROM AUTHOR]

Background: Data on the prevalence of endoscopic lesions of the UGI tract in asymptomatic subjects are lacking. Aim: To evaluate the prevalence of endoscopic lesions of the UGI tract and their association with dyspeptic symptoms in the general population. Methods: In the frame of the ongoing Loiano-Monghidoro project (APT 2001;15:1001-7), inhabitants of the Loiano and Monghidoro commons are being re-invited to undergo UGI endoscopy and [sup 13]C-urea breath test. During UGI endoscopy gastric biopsies are obtained for histology and rapid urease test. Dyspeptic symptoms are evaluated by a previously validated questionnaire. Results: 892 subjects (442 males, 450 females, age range 18-86 years, mean age 54.4 years) were enrolled. The prevalence of endoscopic lesions of UGI tract was 16.7%: erosive esophagitis 8.2%, gastric ulcer 1.3%, duodenal ulcer 2%, concomitant esophagitis + gastric or duodenal ulcer 0.7%, erosive duodenitis 3.6%, gastric neoplasia 0.9%. Overall, 24.8% (37/149) of subjects with endoscopic lesions was asymptomatic. In particular, no symptoms were reported by 23.2% of subjects with esophagitis (20% with esophagitis of grade I and 31.4% of grade II), 33.3% of subjects with gastric ulcer, 33.3% with duodenal ulcer, 25% with erosive duodenitis and 25% with gastric neoplasia. H. pylori infection was present in 54.8%, 83.3%, 100%, 100%, 87.5%, and 100% of the subjects with esophagitis, gastric ulcer, duodenal ulcer, concomitant esophagitis + peptic ulcer, erosive duodenitis end gastric neoplasia, respectively. Conclusions: Endoscopic lesions of UGI tract are observed in 16% of this population and their association with H. pylori infection is as one would expect. Although not supporting the need of endoscopic screening of the general population, these results do support the need of defining high risk groups of asymptomatic subjects in whom endoscopic screening might prevent the development of advanced disease or severe complications. [ABSTRACT FROM AUTHOR]