symptoms. I believe that the authors' claim, that H. pylori re-infection in England is rare following successful eradication, remains unproved.

The majorityof cases were diagnosed in secondary care. In Suffolk, over the time course of thestudy, the only test to which primary care physicians had access without referralto secondary care was serological testing which does indeed have weaknesses.Urea breath testing and gastric biopsy were only available through referral to ourdepartment. Only a minority of patients were diagnosed by serology alone (20%).In a previous study in which cases were only included if diagnosed by biopsy-based methods,