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Dr Wjst addresses a number of important issues. First, he raises the point that “the stomach is not the first immunological line of defence”. We are not certain what the definition of the “first line” might be, but the literature contains ample evidence that the stomach has immunological function,1 2 and that the presence of Helicobacter pylori affects the nature of the response.3–5 For example, Mattson and colleagues provided evidence that H pylori-positive subjects had stronger gastric, intestinal and systemic responses to an orally administered cholera vaccine than did H pylori-negative subjects;3 in addition to providing evidence of measurable immunological …