The authors thank Pat Belt (NASH CRN Data Coordinating Center) for her

assistance with the data preparation and Jay H. Hoofnagle, M.D. (National Institute of Diabetes and Digestive and Kidney Diseases), for his careful review of and contributions to the final manuscript. Additional Supporting Information Proteasome inhibitor may be found in the online version of this article. “
“Despite the current increase in interest in the role of the microbiota in health and disease and the recognition, for over 50 years, that an excess of “colonic” type flora in the small intestine could lead to a malabsorption syndrome, small intestinal overgrowth remains poorly defined. This lack of clarity owes much to the difficulties that arise in attempting to arrive at consensus with regard to the diagnosis of this condition: there is currently no gold standard and the

commonly available methodologies, the culture of jejunal aspirates and a variety of breath tests, suffer from considerable variations in their performance and interpretation, thereby leading to wild variations in the prevalence of overgrowth in a variety of clinical contexts. Treatment is similarly supported by a scanty evidence Selleckchem PD0325901 base and the most commonly employed antibiotic regimes owe more to custom than clinical trials. “
“Since the discovery of Helicobacter pylori in 1982, the development of several treatment guidelines has allowed a consensus on the indications for H. pylori eradication. Beyond these currently accepted indications, including various upper gastrointestinal disorders and extragastric diseases, a significant amount of new information regarding H. pylori eradication is emerging. Certain types of acute gastritis, such as nodular gastritis, hypertrophic gastritis, Ménétrier’s disease, hemorrhagic Urocanase gastritis, and granulomatous gastritis are reversible after H. pylori eradication. Further, for chronic gastritis, closed-type atrophic gastritis and complete-type intestinal metaplasia appear to be more reversible after H. pylori

eradication than open-type atrophic gastritis and incomplete-type intestinal metaplasia. Eradication can also be considered in subjects younger than 40 years who have a family history of gastric cancer and in subjects with long-term medications that might lead to bleeding (antiplatelet agents) or atrophy (proton pump inhibitors). Emerging evidence indicates that H. pylori eradication could be an effective treatment for some extragastric diseases that are unresponsive to conventional therapy. In such conditions, routine screening for eradication of H. pylori has not previously been recommended; a “test-and-treat” approach is suggested in the aforementioned situations. Given that H.