pylori for uninvestigated dyspepsia Level of evidence C, Grade o

pylori for uninvestigated dyspepsia. Level of evidence C, Grade of recommendation 1 Experts’ opinions: completely

agree (51.7%), mostly agree (34.5%), partially agree (6.9%), mostly disagree (3.5%), completely disagree (3.5%), Selleck Romidepsin not sure (0%) In Western countries, a test-and-treat strategy for H. pylori infection has been recommended as a safe, cost-effective initial approach for young patients with uninvestigated dyspepsia and without alarm symptoms.[13, 48] In a meta-analysis, the test-and-treat strategy for H. pylori infection as an initial approach to uninvestigated dyspepsia was more cost-effective, and not significantly different in symptom improvement when compared with an early endoscopy.[49] However, early endoscopy is recommended as an initial approach to uninvestigated dyspepsia instead of a test-and-treat strategy of H. pylori infection in Asia (including Korea, China,

and Japan), where the prevalence rate of gastric cancer is very high (0.9–3.4%) and the average age of incidence is low.[50, 51] The optimal cut-off age for early endoscopy as an initial approach for patients with uninvestigated dyspepsia varies according to region and ethnicity.[50, 52] In Korea, further studies are needed to determine the appropriate cut-off age for early endoscopy as an initial approach in patients with uninvestigated dyspepsia. Statement 7. H. pylori eradication helps long-term symptom improvement in some patients with functional dyspepsia. Level of evidence A, Grade of recommendation 2 Experts’ opinions: completely Opaganib research buy agree (18.5%), mostly agree (55.6%), partially agree (22.2%), mostly disagree (3.7%), completely disagree (0%), not sure (0%) Studies have shown that an H. pylori eradication group exhibited long-term symptom improvement in functional dyspepsia compared with the placebo group.[53, 54] In a meta-analysis of 17 randomized studies, the risk of symptom persistence was reduced by 9% in the H. pylori eradication group compared with the placebo group,

which was a statistically significant difference.[55] In addition, a prospective study conducted by a primary Racecadotril medical facility showed that H. pylori eradication had a significant impact on symptom improvement in patients with functional dyspepsia.[56] It is not clear whether H. pylori eradication improves functional dyspepsia in Asian populations. Previous studies are insufficient as they have included a small sample size or no randomization protocol.[57] Although a meta-analysis showed 3.6 times greater symptom improvement in the H. pylori eradication group, H. pylori eradication is not cost-effective in all regions.[58] Another analysis of 12 randomized studies showed that H. pylori eradication was a cost-effective treatment for functional dyspepsia.[59] No randomized controlled studies have assessed the effect of H. pylori eradication on functional dyspepsia in Korea. In one prospective study, there was no difference in symptom improvement between the successful H.

If switching between abstract rules, and the reconfiguration it e

If switching between abstract rules, and the reconfiguration it engenders in both

stimulus and response sets, is cortically mediated, PD should only be associated with switching deficits in the presence of cortical dysfunction (HY stage II), but not when it might be assumed to be generally limited to the striatum (HY stage I). Second, we aimed to validate our hypothesis concerning the sensitivity of the rule reconfiguration manipulation to cortical involvement in task switching by including a group of patients buy Buparlisib with frontal lesions which spare the basal ganglia. Although neuropsychological and imaging studies have dissociated to some extent frontal contributions to components of cognitive control (e.g., Brass et al., 2005; Braver et al., 2003; Wylie, Javitt, & Foxe, 2004; Yeung et al., 2006), the current neuropsychological investigation is the first,

to our knowledge, to address this issue as a function of whether reconfiguration in the rule that maps stimuli to responses determines cortical involvement. Cytoskeletal Signaling inhibitor Based on previous findings of impaired abstract rule switching in cortically compromised stage II but not hypothetically cortically intact stage I PD patients (Kehagia et al., 2009), frontal patients were predicted to show SC deficits only when response rule reconfiguration is required on a switch of task, that is, only with abstract rules, but not when switching between concrete rules governing attentional selection where ZD1839 datasheet the superordinate rule that maps a task-relevant stimulus to a response remains unchanged. Such a finding in

patients with frontal cortical damage and intact basal ganglia would strengthen the claim that switching between abstract rules is a paradigm sensitive to frontal cortical deficits in PD. Third, we addressed whether disease severity also differentiates task switching impairments with concrete naming rules known to be l-dopa responsive. Previous dopaminergic withdrawal studies using naming rules have been inconsistent in that they have shown that dopaminergic medication can either ameliorate PD switching deficits to control levels (Cools et al., 2003) or simply temper them (Cools et al., 2001a), and deficits have also been reported in a large group of medicated patients, that is, despite medication (Cools et al., 2001b). In this case, the efficacy of pharmacotherapy may depend not only on the degree of the neurochemical deficit, but also on the functional integrity of the neural substrate targeted by the pharmacotherapeutic regime, that is, the basal ganglia and their connections to cortex. Thus, we investigated how disease severity at these early HY stages, that represent differential degrees of nigrostriatal and cortical neuronal loss, impacts on the cognitive remediation effects conferred by dopa-therapy.

Presence of HRS (p<00001, HR 113,

95%CI 86-1505) was

Presence of HRS (p<0.0001, HR 11.3,

95%CI 8.6-15.05) was associated with MAPK Inhibitor Library chemical structure highest risk of mortality on multivariate analysis. Conclusion: The prevalence, spectrum, natural history and mortality of AKI in ACLF is distinctly different from patients with CLD. Patients with ACLF and HRS have the highest risk of mortality. Disclosures: The following people have nothing to disclose: Rakhi Maiwall, Suman Kumar, Chitranshu Vashishtha, Manoj Kumar, Hitendra K. Garg, Sumanlata Nayak, Sunil Taneja, Bhaskar Thakur, Shiv K. Sarin Background: Hepatopulmonary syndrome (HPS) occurs in 20-30% of patients with liver cirrhosis and is associated with a > 2fold increased mortality. Pulmonary angiogenesis and endothelial dysfunction seem to play a central role in its

pathogenesis. von Willebrand factor antigen (vWF-Ag), a marker of endothelial dysfunction, is significantly elevated in patients with liver cirrhosis and portal hypertension. vWF levels Panobinostat are associated with increased pulmonary angiogenesis in a rat model of HPS. Single nucleotide polymorphisms (SNPs) in the vWF-gene are associated with HPS. Aim of the present study was to evaluate the relevance of vWF-Ag as a diagnostic marker for HPS in patients with cirrhosis. For this purpose we considered assessment of vWF-Ag as index test and HPS screening as reference standard. Methods: 145 patients (107 male, 38 female; mean age: 56 years) with liver cirrhosis were included in this prospective study. vWF-Ag was assessed by

ELISA. All patients were screened for presence Amino acid of clinically significant HPS according to the established criteria (presence of cirrhosis, AaDO2 > 15mmHg & PaO2 < 80mmHg, intrapulmonary vasodilatation in contrast enhanced echocardiography). (1)Results: Criteria of HPS were fulfilled in 31 patients. Liver cirrhosis was caused mainly by alcoholic liver disease (58%), chronic hepatitis C (26%) and others (16%). vWF-Ag level was significantly higher in patients with HPS compared to patients without HPS (423% (IQR, 387% 519%) vs. 315% (IQR, 248%-417); P < 0, 001). In HPS positive subjects vWF-Ag correlated significantly with gas exchange abnormalities (PaO2 (r = 0, 404, P < 0, 05), AaDO2 (r = 0, 426, P < 0, 05). Univariate analysis showed a significant association between vWF-Ag and presence of HPS (OR per 1% increase of vWF-Ag: 1, 016, 95% Cl: 1, 009-1, 023, P < 0, 001). vWF-Ag remained significantly associated with HPS after correction for sex, age, MELD score and hepatic venous pressure gradient in multivariate analysis (OR per 1% increase of vWF-Ag: 1, 019, 95% Cl: 1, 004-1, 035, P < 0, 05). The area under the ROC curve of vWF-Ag for detection of HPS was 0, 838.The best cut off with maximal sensitivity was 328% (sensitivity of 100% and specificity of 53.5%; positive predictive value: 36.9%; negative predictive value: 100%). Positive likelihood ratio was 2, 15 and negative likelihood ratio was 0, 00.

47,48 Gabapentin is typically a well-tolerated medication but mor

47,48 Gabapentin is typically a well-tolerated medication but more common AEs include somnolence and fatigue, dizziness, weight gain, peripheral edema, and ataxia. In a small open-label study of baclofen 10 mg 3 times daily, 6 of 9 subjects went into remission within 1 week and an additional 1 subject had improvement followed by remission at week 2.49 Although adverse events were not reported by subjects in this study, more PI3K inhibitor common AEs to baclofen include drowsiness, dizziness, ataxia, and muscle weakness. Clonidine, given as a 5 mg to

7.5 mg transdermal patch (that delivers the drug at a rate of 0.2-0.3 mg daily for 1 week), has been studied in 2 small open-label studies.50,51 In the first, which included 8 ECH and 5 CCH patients, there were significant reductions in mean attack frequency, pain intensity, and attack duration.50 However, a second study including 16 ECH patients failed to confirm these positive results.51 Tiredness and reduction in blood pressure were AEs noted in these studies. An open-label study of

botulinum toxin type A as add-on therapy in 3 ECH and 9 CCH patients had mixed results.52 Fifty units injected ipsilateral to the headache resulted in headache remission in 1 CCH patient, improvement in attack frequency and severity in an additional 2 CCH patients, improvement in a continuous baseline headache with no change LY294002 ic50 in superimposed cluster attacks in an additional 1 CCH patient, and no

benefit in the remaining 8 patients. More common AEs to botulinum toxin therapy include weakness of injected muscles and pain at injection sites. Corticosteroids are often prescribed concurrent with initiation of maintenance prophylaxis in order to quickly obtain cluster control. Oral and intravenous corticosteroids may both provide benefit. Varying doses of oral prednisone, ranging from 10 mg/day to 80 mg/day, were evaluated in a study of 9 episodic and 10 chronic cluster patients.53 Peak prednisone dose was given for 3 to 10 days and tapered over 10 to 30 days. Complete relief from CH was seen in 11 patients, 3 had 50-99% relief, 3 had 25-50% relief, and 2 patients had no benefit. The ECH and CCH patients had similar responses. Investigators Chloroambucil observed that prednisone doses of 40 mg or higher were needed for benefit. Headache recurrence was common during the prednisone taper. Other studies of oral prednisone have had similar results.54,55 Intravenous corticosteroids, sometimes followed by oral steroids, may also provide benefit for transitional cluster therapy.56,57 A single high dose of intravenous methylprednisolone (30 mg/kg body weight over 3 hours) delivered on the eighth day of an active cluster period provided 10 of 13 treated patients with 2 or more days of attack cessation.56 The mean interval between steroid treatment and attack recurrence was 3.8 days. Three patients had complete cluster remission.

At the Mayo Clinic, country

At the Mayo Clinic, country Napabucasin clinical trial of birth and primary language information was available to allow Somali patients to be identified. A control group of age and gender-matched patients was identified from the remaining non-Somali patients. Clinical data such as HCV treatment, reasons for lack of treatment, sustained virologic response (SVR) rates, and laboratory values were collected and the two groups were compared. Results: We identified 145 Somali patients

and 145 non-Somali controls that were age and gender-matched. Although Somali patients were offered treatment at similar rates as non-Somali patients, a larger percentage of them declined treatment (n=24; 17% vs 7; 5%). The most significant barrier to treatment was refusal of liver biopsy (11; 8% vs 1; 1%). Fear of side effects was also treatment limiting for 6% of the Somali patients who were treatment candidates. Overall, 58% of Somali patients who were treatment candidates underwent treatment vs. 75% of non-Somalis. Of the patients that underwent treatment, rates of SVR were similar (26% of Somalis vs 23% of non-Somalis). Although treatment limiting comorbidities were similar in both groups, the non-Somali population had more ongoing alcohol and intravenous drug use. Conclusions: We did not find significant differences in access to treatment, but fewer Somali patients accepted treatment.

The most significant barriers to accepting treatment for Somalis Carfilzomib molecular weight were refusal of a liver biopsy and fear of treatment side effects. When the Somali patients were treated, their rates of SVR were similar to the non-Somali population. It is

essential for healthcare providers to find interventions aimed at reducing the barriers to treatment and increasing acceptance of HCV treatment. In the era of interferon-free regimens and increasing use of noninvasive methods to assess liver fibrosis, we anticipate that Somali patient outcomes will continue to improve. Disclosures: Lewis R. Roberts – Grant/Research Support: Bristol Myers Squibb, ARIAD Pharmaceuticals, BTG, Wako Diagnostics, Inova Diagnostics, Gilead Sciences Mohamed A. Hassan – Speaking and Teaching: GILEAD The following people Tideglusib have nothing to disclose: Esther Connor, Albert Ndzengue, Nasra H. Giama, Jeremiah Menk, Essa A. Mohamed, Saleh Elwir BACKGROUND: Sub-saharan Africa (SSA) is reported to have one of the highest global rates of HCV infection, accounting for nearly 20% of all global cases. However, reports suggesting a high rate of serologic false positive cases have led to uncertainty regarding the true burden of HCV infection in this region. METHODS: We conducted a case-control study of prior blood donors at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana to identify appropriate screening strategies and determine rates of active infection.

The Need for a Headache Classification (1988)— Although

The Need for a Headache Classification (1988).— Although Navitoclax the need for a unified headache classification

had been mentioned previously in the 20th century, it lasted until 1962 when an Ad Hoc Committee classified headaches, but the use of words like “usually” and “commonly” made the definition widely open for personal interpretation.118 Thus, migraine was defined as: Recurrent attacks of headache, widely varied in intensity, frequency, and duration. The attacks are commonly unilateral in onset; are usually associated with anorexia, and sometimes with nausea and vomiting; and some are preceded by, or associated with, conspicuous sensory, motor, and mood disturbances; and are often familial.119 A major breakthrough in headache research was the work of the Headache Classification Committee (headed by the Danish researcher Jes Olesen) of the International Headache Society (founded in 1981), resulting in the first extensive headache classification with operational diagnostic criteria in 1988.15 Ivacaftor mw Headache was classified into 14 groups with 4 primary headache groups, including migraine, tension-type headache, cluster headache, and other primary headaches. The other 10 groups concerned secondary headaches. Operational diagnostic criteria

were described for each entity like migraine without aura and migraine with aura (see Tables 3 and 4). This classification with operational diagnostics ensured that scientific research could be performed globally in comparable patients’ populations. Similar to the Ad Hoc Classification from 1962, migraine was subdivided, now on scientific grounds, into migraine without aura, formerly “common migraine,” and migraine with aura, formerly “classic migraine.” As discussed above, pathophysiologically these 2 forms differ mainly in rCBF during attacks: in migraine with aura there is a decrease in rCBF, a spreading oligemia, during aura and into the headache phase,12,76 Glycogen branching enzyme whereas rCBF is unchanged during migraine without aura.75 These differences in rCBF were among the

most convincing arguments for the separation of the 2 migraine forms and against a continuum model of migraine. The classification was first used on a large scale in the extensive clinical trials program of sumatriptan120 and later in the trial program of the other triptans.121,122 A second revised version was published in 2004 (International Classification of Headache Disorders-II).123 The major changes were in the migraine with aura group where typical aura could be followed by either migraine headache or just headache. Sporadic hemiplegic migraine was recognized as a new subtype of migraine with aura and chronic migraine was recognized as a complication of migraine. The criteria for chronic migraine were later revised in 2006 resulting in a broader concept of this disorder.124 A New Drug for Migraine – The Discovery of Sumatriptan (1988).

This study had more cases homozygous for the C282Y substitution t

This study had more cases homozygous for the C282Y substitution than other studies of breast and colorectal cancer, and provides most of the evidence regarding whether C282Y homozygotes Vorinostat cost have increased risks for these cancers. The pooled estimates for breast and prostate cancer were both close to the estimate derived from our study. No pooled estimate was calculated for colorectal cancer because two studies had no homozygous cases. For compound

heterozygotes, the pooled estimate was consistent with a small increase in risk for colorectal cancer, albeit not significant. For breast cancer, the pooled estimate was close to one, but a modest association cannot be excluded. For C282Y heterozygotes, the pooled estimates for breast, colorectal, and prostate cancers were all one or close to one and had narrow confidence intervals, suggesting that C282Y heterozygotes have no increase in risk for breast, colorectal, or prostate cancer. Elevated body iron stores is one potential explanation for an association between HFE genotype and risk for cancer. The strongest evidence for a direct role

of body iron stores comes from a secondary analysis of a randomized controlled trial of phlebotomy for patients with peripheral arterial disease.23 The risk for cancer was lower for the phlebotomy group (ferritin 79.7 ng/mL versus 122.5 ng/mL) with an HR of 0.65 (95% CI, 0.43, 0.97). Results from several cohort studies have also been reported. Buspirone HCl Positive associations were found between serum ferritin and Selleckchem Cyclopamine risk for liver cancer and for combined all other cancers combined in a Taiwanese cohort study.24 In an analysis of participants in a French

antioxidant trial, women with serum ferritin levels above 160 μg/L had 1.88 (95% CI, 1.05, 3.35) times the cancer risk of those with levels below 30 μg/L, but no association was seen for men.25 Other studies found little evidence of positive associations with colorectal adenomas,13, 26 or some evidence of inverse associations with colorectal cancer.27, 28 Other cohort studies have considered risk of cancer in relation to transferrin saturation and total iron binding capacity, which examined an iron transport compartment and hence not iron stores. Three analyses from follow-up of the first National Health and Nutrition Examination Survey (NHANES) have been reported.29–31 Stevens et al. reported a relative risk for all cancer of 1.81 (95% CI, 1.21–2.71) comparing people with a baseline transferrin saturation of 60% or higher with people with a transferrin saturation of 30% or less.29 The risk was only slightly elevated for those with transferrin saturation between 50% and 60% (relative risk, 1.38 [95% CI, 1.00–1.90]) and not elevated at lower levels. The latest analysis with more cases found weakly elevated risks for colorectal cancer.

Hence, it is clinically obvious that the term progression needs t

Hence, it is clinically obvious that the term progression needs to be refined to become a valid surrogate of outcome. This justifies the novel concept of “untreatable progression” (Fig. 1), defined by progression associated

with a profile that prevents retreatment or, by this failing, to induce an objective response. Untreatable progression includes major progression (e.g., massive liver involvement, extrahepatic spread, and vascular invasion), but also minor intrahepatic progression with impaired liver function and performance status that contraindicate treatment. Accordingly, chemoembolization should not be repeated in the following situations: (1) when it fails to achieve significant necrosis after two treatment sessions; (2) when follow-up treatment fails to induce significant tumor necrosis of progressed tumor sites; and (3) when the evaluation of the patient with progression prevents safe retreatment. The first option indicates treatment failure, and the second options should be registered as untreatable progression and its

occurrence during follow-up is time to untreatable progression (TTUP). Tumor-burden reduction has been the backbone of the evaluation of systemic agents.21, Regorafenib research buy 22 Rate of objective response (including complete and partial) was used to capture promising efficacy signals of novel agents before phase III trials. This approach may have discarded agents that, though not reducing tumor mass, could have had a benefit on survival by delaying tumor progression and death. This possibility has been proven with sorafenib, an oral multikinase inhibitor. In the initial phase II study,36 the rate of objective responses was marginal, but the observed TTP became the background for the design

of the phase PDK4 III trials that had survival as endpoint.37, 38 Interestingly, treatment was not interrupted at the time of progression. This already took into account that progression may be a heterogeneous event, as already mentioned, and that its detection by follow-up imaging may not always reflect treatment failure. The demonstration that a beneficial effect could be achieved without tumor reduction has primed the research of functional imaging that would capture the effects of drugs in tumor tissue. Antiangiogenics induce changes in tumor vascularization, and this may be identified by parameters such as blood flow, blood volume, permeability perfusion, or K-trans value.39, 40 To date, there are no data to support the use of these techniques to define whether a drug has any efficacy or whether it fails. Assessment of the reduction of tumor density after contrast administration aiming to reproduce the Choi criteria for gastrointestinal stromal tumors41 has not provided useful criteria for HCC. It is important to note that even if antiangiogenics may decrease tumor density upon contrast administration, this should not be taken as tumor necrosis.

2,5 Several investigators have proposed updated ULN of serum ALT<

2,5 Several investigators have proposed updated ULN of serum ALT

levels (Table 1). However, the ULN varies slightly in different reference populations. Prati et al.5 suggested ULN values of 30 IU/L for men and 19 IU/L for women in an Italian population, whereas Kang et al.11 proposed 31 IU/L for men and 23 IU/L for women among Koreans living in Asia. The higher proposed ULN values for the Korean population are likely due to the higher proportion of patients with mild NAFLD. Although ultrasonography screening was performed to exclude patients with NAFLD from the “healthy” population, this technique cannot consistently identify mild fatty liver affecting less than 33% of the liver, and some of these

patients were likely included in the reference population.13 Another reason for the PD0325901 nmr elevated Korean ULN values might be the higher mean age of the patients in the Korean study. Since serum ALT levels increase from the first to the fourth HM781-36B decade of life and decrease thereafter, different age distributions might thus affect ALT distribution. The ideal approach to the resolution of such confounding variables is to recruit patients with histologically-normal livers. However, in most cases, an invasive procedure, such as liver biopsy, is not a feasible ethical screening method. The establishment of the ideal ULN for serum ALT ultimately depends on the appropriate use of non-invasive diagnostic tools to successfully exclude patients with subclinical diseases in the liver and other organs from healthy reference populations.14 Skepticism about the need to update the current normal range of

serum ALT levels still exists due to a variety of concerns. First, such an undertaking might involve unnecessary testing and consultation, ultimately increasing the financial burdens of health-care provision.15 Second, potential many blood donors might be rejected solely because of minimally-elevated ALT values. Finally, a lowered ULN might bring about heightened patient anxiety and medicolegal concerns. A more practical solution to these concerns could be to divide the current ULN (40 IU/L) into optimal (< 30 IU/L) and borderline (30–39 IU/L) levels. Individuals with borderline ALT levels might be candidates for further studies of the secondary prevention of CLD.2,5 In conclusion, physicians should be cautious in interpreting the current normal range of serum ALT levels. Meticulous examination and education of patients with borderline serum ALT levels are recommended. To minimize selection bias in establishing the true normal range of serum ALT, further well-designed prospective studies are warranted. "
“This study was undertaken to evaluate the clinical characteristics, prognostic factors, and long-term outcomes of patients with mucosa-associated lymphoid tissue (MALT) lymphoma in the gastrointestinal (GI) tract.

TNF-α induced a relocalization of tight junction protein occludin

TNF-α induced a relocalization of tight junction protein occludin and increased

the lateral diffusion speed of HCV receptor tetraspanin CD81 in polarized HepG2 cells, providing a mechanism for their increased permissivity to support HCV entry. High concentrations of HCV particles could stimulate macrophages to express TNF-α, providing a direct mechanism for the virus to promote infection. Conclusion: This study shows a new role for TNF-α to increase virus entry and highlights the potential for HCV to exploit existing innate immune responses in the liver to promote de novo infection events. (Hepatology 2014;59:1320-1330) “
“Background and Aim:  The widely accepted range of upper limits of normal (ULN) alanine aminotransferase (ALT) levels (ULN < 40 U/L) was recently challenged by several reports. Both ALT and aspartate aminotransferase click here (AST) are commonly used as surrogate markers of liver disease, but almost all studies of aminotransferase activity were conducted on ALT. We investigated not only ULN of ALT but MAPK inhibitor also AST activity and to identify factors modulating them in healthy Korean. Methods:  A cross-sectional study of 411 240 registered blood donors in all nationwide blood banks belonging to the Korean Red Cross were conducted. ULN of ALT and AST was evaluated adjusting their age according to the national population census database.

“Decision tree model” was used to identify the affecting factors of ALT and AST and optimal cut-off points of affecting factors. Results:  “ULN of ALT” was 34 U/L in men and 24 U/L in women and “ULN of AST” was 32 U/L in men and 26 U/L in women in the blood donor database. Decision tree analysis showed that ALT levels

were mostly influenced by body mass index level and its critical two cut-off points were 23.5 kg/m2 and 25.8 kg/m2, respectively. The most affecting factor of AST was gender. Conclusion:  Upper limits of normal of ALT and AST in Koreans were lower than conventional accepted values (< 40 U/L) but higher than recently suggested values (male < 30 U/L and female < 19 U/L). Body mass index was the most determining factor for ALT and gender was the most influencing factor for AST activity. "
“Nonsteroidal anti-inflammatory drugs (NSAIDs), including low-dose aspirin, else are very frequently prescribed in older patients in order to palliate or prevent age-related degenerative joint diseases or cardiovascular events. From the perspective of the gastrointestinal system, their most frequent serious adverse effect is hemorrhage from gastric or duodenal ulcers, occurring overall in about 0.5–2.0% per patient year of continuous use. Much more common are gastric erosions – at least a few will be found in most patients if an endoscopy is performed – but these usually heal uneventfully and are normally asymptomatic. Dyspepsia is a common side-effect but there is little correlation with the macroscopic injury and the pathogenetic mechanisms are less well understood.