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  1. John Atherton, Deputy Editor

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EFFECTS OF H PYLORI ERADICATION IN ASYMPTOMATIC PEOPLE

Little is known about long term risks or benefits of H pylori eradication in asymptomatic people. Ten years ago, the study authors treated a group of completely asymptomatic Italians with H pylori eradication. As the treatment regimens were relatively ineffective, this was only successful in about a half. In this study they have reported what happened to the successfully and unsuccessfully treated groups over eight and a half years. Most remained well, but a few developed symptoms with or without ulcers, and this was more common in the group which remained infected, especially if they were infected with a more pathogenic cag + strain. H pylori eradication has previously been shown to provoke symptoms or endoscopic signs of oesophagitis in some patient groups; that did not occur significantly here although there was a trend towards this and lack of significance may have been due to lack of study power. This study has other inherent weaknesses and in particular its non-randomised nature may have introduced important biases. However its unusual study population and careful documentation by symptom questionnaire and endoscopy make it a valuable contribution to the observational literature.

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STIMULATION OF PROBIOTIC BACTERIA MAKES RATS MORE SUSCEPTIBLE TO SALMONELLA

Non-digestible carbohydrates increase levels of supposedly “good” bacteria, and this is widely believed to protect against bacterial pathogens. This paper again demonstrates, this time in rats, that these compounds stimulate intestinal lactobacilli and bifidobacteria and also that this inhibits later colonisation by experimentally administered pathogens, in this case salmonella. However, surprisingly, Salmonella were more likely to translocate across the mucosa in non-digestible carbohydrate-treated rats, so the overall effect was detrimental. This should stimulate further experimental research on the benefits and risks of ingesting exogenous or stimulating endogenous lactobacilli and bifidobacteria. Also, use of prebiotics and probiotics is probably sufficiently widespread in humans for observational studies to give informative results.

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ULCERATIVE COLITIS IS NOT RARE IN THE PUNJAB

It is almost axiomatic that inflammatory bowel disease is rare in developing countries. In this study from the Punjab in India, the authors went to great lengths to ensure accurate case-finding and accurate diagnostic classification in a community-based survey. The prevalence and incidence rates of ulcerative colitis they found were similar to figures reported in Europe and the USA and their methodology would have underestimated rather than overestimated their results. It remains unclear whether ulcerative colitis is getting more common in the Punjab, or whether it has previously been under-diagnosed. If this is a real increase, it could be because the survey was performed in a relatively affluent Indian state: direct comparison with poorer regions using identical methodology would be interesting.

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HEPATITIS C PATIENTS WITH NORMAL TRANSAMINASES SHOULD BE CONSIDERED FOR COMBINATION THERAPY

Little is known about the efficacy of interferon plus ribavirin combination therapy in patients with chronic hepatitis C whose transminases are normal. This study from San Francisco compared patients with normal ALT levels to those with elevated ALT levels and found that combination therapy with interferon plus ribavirin was equally effective in both groups. The authors conclude that all patients with HCV infection, regardless of their ALT levels, should be evaluated for combination treatment. This paper provides evidence to support the recommendations made to this effect in many national guidelines, including those published by the U.S. National Institute of Health in their 2002 consensus statement and those published by the British Society of Gastroenterology.

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