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Background: Infection by Helicobacter pylori is common and affects both genders at any age. The 13C-urea breath test is a widely used test for the diagnosis of this infection. However, multiple drugs used for the treatment of Helicobacter pylori infection symptoms have interactions with this breath test that generate false negative results. This observational study was to assess the potential interaction between almagate and the breath test. Methods: Thirty subjects on almagate therapy who underwent a breath test were included. If the result was negative, almagate was withdrawn for a month and the breath test was then repeated. Results: In general, 51.9 % of assessed subjects had a negative result after the first test, and 100 % of these also had a negative result after the second test. Conclusions: It was concluded that the use of almagate does not interfere in breath test results. These results provide a drug therapy option for the treatment of symptoms associated with Helicobacter pylori infection during the diagnostic process.

Introduction and objectives: antireflux surgery performed by an experienced surgeon is a maintenance option for patients with well-documented gastroesophageal reflux disease (GERD). Well-documented GERD is difficult to find, as GERD is a multifactorial disease in which the gastroesophageal junction, with its special anatomical and functional components, is important. In order to examine patient preoperative workups, and their indication for surgical treatment in GERD, we retrospectively studied patients who underwent a laparoscopic antireflux procedure. Methods: preoperative workups in patients from our health care area who underwent a laparoscopic antireflux procedure from December 1997 to February 2007 were retrospectively analyzed. Data related to epidemiological findings, symptoms, morphologic and functional evaluation, medical therapy, and indication for surgical treatment were recorded and statistically analyzed by means of a bivariate test. Differences were significant when the p value was equal to or less than 0.05. Results: 100 patients (50 % female, 51.31 ± 13.53 years of age) underwent a laparoscopic antireflux surgery after 56.47 ± 61.33 months with symptoms. Ninety-five percent of patients had an anatomical abnormality. The pH monitoring test diagnosed three quarters of cases. The most frequent indication for GERD treatment was persistent or recurrent esophagitis despite adequate medical treatment (52 cases). Conclusions: based on our preoperative workup, as described, 100 percent of subjects were well documented and diagnosed with GERD (both non-erosive reflux disease and erosive reflux disease), and their indication for laparoscopic treatment was retrospectively assessed in 94% of cases.Introducción y objetivos: la cirugía antirreflujo realizada por un cirujano experto es una opción para el tratamiento de mantenimiento para el paciente con enfermedad por reflujo gastroesofágico (ERGE) bien documentada. La "buena documentación" de la ERGE es difícil de llevar a cabo, dado que se trata de una entidad multifactorial, en la que la unión gastroesofágica, con sus condiciones tan especiales tanto anatómicas como funcionales, es determinante. Para evaluar preoperatoriamente tanto el diagnóstico como la indicación quirúrgica de los pacientes que han sido intervenidos mediante un procedimiento laparoscópico antirreflujo en nuestro centro, hemos estudiado retrospectivamente sus historiales clínicos. Métodos: se analizaron retrospectivamente los historiales clínicos de los pacientes de nuestra Área Sanitaria sometidos a un procedimiento laparoscópico antirreflujo desde diciembre de 1997 hasta febrero de 2007. Para evaluar el aseguramiento preoperatorio en el diagnóstico y la indicación quirúrgica, se tomaron los datos epidemiológicos, la sintomatología, las pruebas diagnósticas realizadas, tanto morfológicas como funcionales, la terapéutica médica pautada y la indicación quirúrgica recogida en la historia clínica de cada uno de los pacientes. La información obtenida fue analizada estadísticamente mediante los test bivariantes. Las diferencias obtenidas fueron significativas cuando el valor de p resultó igual o menor a 0,05. Resultados: se estudiaron 100 pacientes (50% mujeres, con una edad media de 51,31 ± 13,53 años) intervenidos mediante cirugía antirreflujo por vía laparoscópica. Su sintomatología previa duró 56,47 ± 61,33 meses. El 95% de los pacientes presentó una anormalidad anatómica. La monitorización del pH diagnosticó a 3 cuartas partes de ellos. Y la indicación quirúrgica más frecuente resultó la recurrencia o persistencia de la esofagitis a pesar de un adecuado tratamiento médico (52 casos). Conclusiones: según los datos recogidos retrospectivamente en sus historiales clínicos, nuestros pacientes tuvieron un diagnóstico preoperatorio bien documentado (incluyendo tanto el reflujo no erosivo como el erosivo) en el 100% de los casos y una indicación quirúrgica sólidamente fundamentada en el 94% de ellos.

The results of the 2nd Spanish Consensus Conference for appropriate practice regarding indications for eradication, diagnostic tests, and therapy regimens for Helicobacter pylori infection are summarized. The Conference was based on literature searches in Medline, abstracts from three international meetings, and abstracts from national meetings. Results were agreed upon and approved by the whole group. Results are supplemented by evidence grades and recommendation levels according to the classification used in the Clinical Practice Guidelines issued by Cochrane Collaboration. Convincing indications (peptic ulcer, duodenal erosions with no history of ASA or NSAIDs, MALT lymphoma), and not so convincing indications (functional dyspepsia, patients receiving low-dose ASA for platelet aggregation, gastrectomy stump in patients operated on for gastric cancer, first-degree relatives of patients with gastric cancer, lymphocytic gastritis, and Ménétrier's disease) for H. pylori eradication are discussed. Diagnostic recommendations for various clinical conditions (peptic ulcer, digestive hemorrhage secondary to ulcer, eradication control, patients currently or recently receiving antibiotic or antisecretory therapy), as well as diagnostic tests requiring biopsy collection (histology, urease fast test, and culture) when endoscopy is needed for clinical diagnosis, and non-invasive tests requiring no biopsy collection (13C-urea breath test, serologic tests, and fecal antigen tests) when endoscopy is not needed are also discussed. As regards treatment, first-choice therapies (triple therapy using a PPI and two antibiotics), therapy length, quadruple therapy, and a number of novel antibiotic options as "rescue" therapy are prioritized, the fact that prolonging PPI therapy following effective eradication is unnecessary for patients with duodenal ulcer but not for all gastric ulcers is documented, the fact that cultures and antibiograms are not needed for all eradicating therapies is indicated, and finally the test and treat strategy is considered adequate, however only under certain circumstances.Se resumen los resultados de la II Conferencia Española de Consenso para la práctica más idonea en cuanto a las indicaciones de erradicación, métodos diagnósticos y pautas de tratamiento de la infección por Helicobacter pylori. La conferencia se basó en la búsqueda bibliográfica con la base de datos de "Medline", los resumenes de tres congresos internacionales y de los congresos nacionales. Los resultados fueron consensuados y aprobados por todo el grupo. Los resultados se complementan indicando los grados de evidencia y el nivel de recomendación, de acuerdo con la clasificación utilizada en las Guías de Práctica Clínica editadas con la Colaboración Cochrane. Se analizan las indicaciones convincentes de la erradicación del H. pylori (úlcera péptica, erosiones duodenales sin antecedentes de AAS o AINE, linfoma MALT) y las indicaciones menos convincentes (dispepsia funcional, pacientes en tratamiento con AAS a dosis bajas como antiagregante plaquetario, muñón de gastrectomía en operados de cáncer gástrico, familiares de primer grado de pacientes con cáncer gástrico, gastritis linfocítica y enfermedad de Menètriér). Se exponen recomendaciones diagnósticas de la infección ante diversas situaciones clínicas (úlcera péptica, hemorragia digestiva secundaria a úlcera, control de erradicación, pacientes en tratamiento antibiótico o antisecretor actual o reciente), así como los métodos diagnósticos que requieren toma de biopsia (histología, test rápido de la ureasa y cultivo) cuando se necesita endoscopia para el diagnóstico clínico y los métodos no invasivos que no requieren biopsia (test de aliento con 13C-urea, tests serológicos y test de antígenos en heces) cuando la endoscopia es innecesaria. En cuanto al tratamiento se priorizan aquellos de primera elección (triple terapia con un IBP y dos antibióticos), la duración del tratamiento, la cuádruple terapia y algunas nuevas alternativas antibióticas como tratamiento de "rescate", se documenta que es innecesario prolongar el tratamiento con IBP después de erradicación eficaz en pacientes con úlcera duodenal pero no en todas las úlceras gástricas, así mismo se indica que en la práctica clínica habitual es innecesario el cultivo con antibiograma en cualquier tratamiento erradicador y finalmente se considera adecuada, pero sólo en ciertas circunstancias, la estrategia "test and treat".

Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a new-generation PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.