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There is now a persuasive body of evidence linking Helicobacter pylori infection and peptic ulcer disease. Over 90% of duodenal ulcer and 70% of gastric ulcer patients are infected with H. pylori. Only a minority of infected patients develop ulcers, however, and host cofactors, rather than H. pylori strain, are probably critical to the development of peptic ulcer in infected individuals. Conversely, not all ulcers are associated with H. pylori, and in these cases enterogastric reflux and non-steroidal anti-inflammatory drug ingestion may be important. Eradication of H. pylori dramatically reduces ulcer relapse, effectively curing the disease. Eradication may also accelerate duodenal ulcer healing. Triple therapy with bismuth and antibiotics is effective against H. pylori, but there are problems with side effects, compliance and antibiotic resistance. Encouraging results are emerging on the efficacy and safety of omeprazole/antibiotic combination therapy, and this novel approach to H. pylori eradication is an exciting development. H. pylori has established itself as a pivotal factor in peptic ulcer disease and an effective helicobactericidal regimen is now the most rational and cost-effective treatment.

A portable optical-fiber sensor for ambulatory assessment of the enterogastric reflux, based on the optical properties of the bile, was developed. It makes use of two light-emitting diodes and of an appropriate electronic circuit that processes the signals and provides the readout on a display. A suitable probe for in vivo measurements was designed. Plastic fiber bundles are used in order to obtain probe flexibility and low price. In vivo measurements performed on different patients show the superiority of this technique over existing methods.

To study the effects of chronic bile reflux on the mammalian gastric mucosa, the ferret model was chosen for its practical aptitude and for its similarity to human gastric anatomy and physiology. A technique was first perfected for endoscopically directed gastric mucosal biopsy in the ferret. Subsequently, a surgical model of maximal enterogastric reflux (MR) and a control model of minimal reflux or "nonreflux" (NR) were developed. A stable population of 9 MR and 9 NR ferrets surviving 1-3 years has been established. All 18 animals, plus 6 nonoperative control animals, have undergone multiple repeat endoscopy and gastric biopsy without complication. The surgical and endoscopic techniques, with preliminary findings, are described.

A modified, quantitative cholescintigraphic method for the assessment of enterogastric reflux has been developed. The distribution of the hepatobiliary tracer 99mTc-Hida is continuously recorded by a computer for 1 h after intravenous injection of the substance. With the patient still in a supine position under the gamma camera two administrations were made orally: 1) a gelatin capsule containing a known amount of 99mTc-pertechnetate, which was studied, making possible a determination of the relation between registered counts and known activity; and 2) 99mTc-labelled Albu-Res in water, which identified the gastric region. An intravenous injection of synthetic cholecystokinin (Kinevac) 25 min after Hida administration emptied the biliary system into the duodenum in a controllable manner. The lower limit of reflux detected by this method was about 0.5% of the Hida dose given.