The study of Kuipers et al is often misrepresented as a controlled trial. It began as an uncontrolled descriptive study of corpus biopsy changes during chronic omeprazole treatment in H pylori infected GORD patients living in the Netherlands. After the fact, the authors identified a group of Swedish patients treated with antireflux surgery and used their gastric biopsy data for comparison. Lack of randomisation to an appropriate control group introduced bias. Omeprazole treated patients were older than surgery patients by an average of nine years. Glandular atrophy increases with age: its prevalence is twice as high inH pylori infected subjects aged 57–68 years than in those aged 46–56 years.6 A comparison of glandular atrophy in two different populations may also be significant because of the influence genetic, socioeconomic, nutritional, and dietary factors have on the development of atrophy. The most troubling aspect of Kuipers' study was a total absence of atrophy at baseline in the omeprazole cohort combined with the absence of any increase in atrophy over a period of five years in the surgery cohort. These findings differ from all other studies that show at least some atrophy in populations with H pylori gastritis and at least some progression over time if the infection is untreated (see below). This combination of unusual findings was responsible for the difference reaching statistical significance.