During its initial years of operation, FieldFresh had found out how difficult it was to build a supply chain for produce in India. The company had been through a phase of experimentation where it tried different sourcing models, logistical options, and crops. After less than stellar results, the company had decided to concentrate on one crop, baby corn. Over the next 24 months, the FieldFresh team adapted logistics to overcome crowded and crumbling roads, irregular power supply, and bureaucratic procedures. The company worked with thousands of farmers to gain their trust. By 2010, the FieldFresh team had been able to createg an efficient supply chain for baby corn across Punjab and Maharashtra at all levels input delivery, credit, irrigation, timely scientific advice, production as per specifications of European market, careful harvesting, improved produce handling, clean and fast transportation, proper management of cold chain storage environment, gaining safety certification, as well as grading, packaging, and labeling to meet international standards.

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23 Has cisapride been withdrawn from the market because of the danger of ventricular fibrillation?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