R

Figure 5 (a) An illustration of some of the conformations of the gastric H+ /K+-ATPase, showing the movement of the cytoplasmic domains and also movement of the transmembrane segments that catalyze the outward transport of protons. The arrow shows where access by PPI occurs. E-, is the resting conformation, with ion-binding sites facing the cytoplasm; E-,P is the conformation after phosphorylation of the pump before export of the proton (or hydronium); and E2P is the phosphorylated conformation after release of the proton but before binding of K+, which returns the pump to the E-, form to complete the cycle. (b) Location of the two cysteine residues covalently bound by pantoprazole or tenatoprazole.

Figure 5 (a) An illustration of some of the conformations of the gastric H+ /K+-ATPase, showing the movement of the cytoplasmic domains and also movement of the transmembrane segments that catalyze the outward transport of protons. The arrow shows where access by PPI occurs. E-, is the resting conformation, with ion-binding sites facing the cytoplasm; E-,P is the conformation after phosphorylation of the pump before export of the proton (or hydronium); and E2P is the phosphorylated conformation after release of the proton but before binding of K+, which returns the pump to the E-, form to complete the cycle. (b) Location of the two cysteine residues covalently bound by pantoprazole or tenatoprazole.

ranitidine bismuth subcitrate, along with two antibiotics.40'41 This regimen provides eradication rates of about 80% in the field, and is increasingly confounded by either clarithromycin or metronidazole resistance. The reduction of acidity presumably increases the proportion of the organisms in the log phase, making them sensitive to amoxicillin and clarithromycin. More current therapy involves triple therapy, a combination of a PPI and, usually, amoxicillin and clarithromycin or metronidazole taken twice a day for at least 10 days. Analysis of infection is performed either by biopsy or measuring the 13CO2 released from labeled ingested urea by a breath analyzer. Given the acid activation of UreI, it is important to ensure acidity of the gastric lumen for maximal sensitivity of this test.42

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