By operating as a more integrated enterprise - one of the principles underlying our growth strategy - we can leverage the complementary strengths of all our businesses. This adds further momentum to our growth efforts. Even as we extend our global reach, the U.S. and Canadian markets remain vitally important. Last year, the region accounted for more than 60 percent of our sales and revenues as well as most of our profit and spending on capital programs. We are committed to zealously defending our market-leading position with production farmers and other customers in the U.S. and Canada - and are investing accordingly. A cornerstone of SMA Inc.'s success throughout its history, is our corporatecitizenship efforts which continued making a meaningful impact in 2013. Thousands of employees celebrated the company's 175th anniversary through volunteer activities such as planting trees, remodelling schools and assisting local food banks. In this vein, employees enthusiastically embraced the company's recently launched volunteerism initiative, recording more than 40,000 hours of volunteer service. To further encourage employees to give back, a program was introduced in the U.S. that makes cash grants available to charitable organizations at which individual employees devote at least a week of time annually. In other actions, the company and foundation continued supporting education programs with an emphasis on science, technology, engineering and math (STEM) activities.

21 Does the combination of aluminium and magnesium hydroxide, given as an antacid, decrease the absorption of omeprazole if these are co-administered to help relieve heartburn quickly?

22 Should proton pump inhibitors be used with caution in patients with renal impairment?

23 Has cisapride been withdrawn from the market because of the danger of ventricular fibrillation?

24 In peptic ulcer disease: 1. What are the indications for an upper gastrointestinal endoscopy? 2. As this is an invasive procedure, is an oesophagogastroduodenoscopy (OGD) or barium meal X-ray preferable?

25 Is telithromycin as, or more, effective than clarithromycin in the treatment of Helicobacter pylori? If so, what is the recommended dosage and how long should treatment be continued?

26 Currently favoured regimens for eradication of Helicobacter pylori are triple therapy with a proton pump inhibitor along with two antibiotics for 1 week. For example: Omeprazole 20 mg metronidazole 400 mg and clarithromycin 500 mg (all twice daily). Omeprazole 20 mg clarithromycin 500 mg and amoxicillin 1 g (all twice daily). Resistance to amoxicillin has not yet been demonstrated. Previously, regimens such as omeprazole, metronidazole, amoxicillin and clarithromycin were recommended; are these regimens no longer used? The reason behind this question is the 'sky-high' cost of clarithromycin in Pakistan, which is inversely proportional to patient compliance (that is, low-cost regimens tend to have a higher rate of compliance).

27 What is the difference between the management of a gastric and of a duodenal ulcer?

28 How does omeprazole suppress Helicobacter pylori?

29 Does omeprazole cause rebound hyperacidity? Does this also apply to H2-blockers?

30 On (K&C 7e, p. 249), you state that the postsynaptic neurotransmitter that inhibits the relaxation of lower oesophageal sphincter (LOS) is nitric oxide (NO). I have understood NO to promote relaxation of LOS by acting on the non-adrenergic, non-cholinergic (NANC) inhibitory neurones, which inhibits the action of cholinergic excitatory neurones. Could you please explain this paradox?