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Objective: To examine the seroprevalence, correlates, and characteristics of undetected coeliac disease in a large adult population sample in Cambridge, UK. Methods: The Cambridge General Practice Health Study invited individuals from 12 general practices, aged 45-76 years, to attend for a health survey that included a bone density measurement, between 1990 and 1995. A total of 7550 participants' serum samples were tested for antiendomysial antibody (EMA). Seroprevalence of undetected coeliac disease was based on EMA positivity. Differences between EMA positive and negative participants of various physiological correlates and reported characteristics were estimated by multivariate logistic and linear regression and adjusted for age, sex, social class, and smoking behaviour. Results: The seroprevalence of undetected coeliac disease in this general population sample aged 45-76 was 1.2% (95% confidence interval (CI) 0.9-1.4). EMA positive participants (n = 87) were on average slightly lighter by 2.2 kg (p = 0.08), were more likely to have reported their general health as being "good or excellent" (odds ratio (OR) 1.76 (95% CI 0.90-3.46)), and were less likely to report being a current smoker (OR for current versus never 0.36 (95% CI 0.14-0.90)) than EMA negative participants. EMA positivity was associated with an 8% reduction in mean serum cholesterol (0.5 mmol/l; p < 0.01) and reductions in mean haemoglobin (0.3 g/dl; p < 0.01), total protein (1.0 g/l; p < 0.05), and corrected serum calcium (0.02 mmol/l; p < 0.05). There was an increased risk of osteoporosis in EMA positive participants (OR 3.1 (95% CI 1.3-7.2)) and of mild anaemia (OR 4.6 (95% CI 2.5-8.2)) compared with EMA negative participants. Conclusions: Undetected coeliac disease is likely to affect approximately 1% of the population of England aged 45-76 years, a value similar to several other countries. Those affected report "better health" but they do have an increased risk of osteoporosis and mild anaemia. In contrast, they have a favourable cardiovascular risk profile that may afford protection from ischaemic heart disease and stroke. [ABSTRACT FROM AUTHOR]

Presents a study assessing effect of risk standardization on variation in outcome after acute upper gastrointestinal hemorrhage. Limitations of mortality as outcome measure; Range of gastrointestinal hemorrhage severity; Characteristics of deaths from the disorder.

Describes the current epidemiology of acute upper gastrointestinal hemmorhage in the United Kingdom. Hemmorhage prone age groups; Hemmorhage incidence in men as compared with women; Mortality rates. INSET: Key messages..

Examines the effects of aspirin and non-steroidal anti-inflammatory drugs on colorectal adenomas in Nottingham, England. Role of aspirin in preventing the development of colorectal neoplasia; Importance of non- steroidal anti-inflammatory drug in residual rectal polyps regression; Association between aspirin and colonic cancer.

Examines the risk of patients who are admitted to hospitals for acute upper gastrointestinal hemorrhage. Use of a risk scoring system to identify low-risk patients; Relation between risk score and length of hospital stay; Effect of time between admission and endoscopy on the length of hospital stay.

Examines the efficacy of azathioprine in ulcerative colitis. Decline in the rate of relapse in the disease; Benefits of azathioprine maintenance treatment; Significance of the drug in patients.

Background: While coeliac disease is now recognised as being associated with both osteoporosis and osteomalacia, the size of any increase in the risk of fracture in patients with coeliac disease compared with the general population has not been quantified. Aim: To examine the fracture experience of adults with coeliac disease compared with the general population. Subjects: Patients with coeliac disease diagnosed in adulthood and born before 1950, selected from two large population based disease registers, and age and sex frequency matched controls identified from local general practitioner lists. Methods: A four page lifestyle and general health questionnaire which included specific questions about fracture experience. Results: Analysis was performed on 244 patients with coeliac disease and 161 controls, giving response rates of 89% and 72%, respectively. Eighty two (35%) coeliac patients and 53 (33%) controls reported ever having sustained one or more fractures, giving an age and sex adjusted odds ratio of 1.05 (95% confidence interval (CI) 0.68-1.62). The most common fracture site reported was the forearm or wrist, with an adjusted odds ratio of 1.21 (95% CI 0.66-2.25) for patients with coeliac disease having had a forearm or wrist fracture. Low trauma fractures were reported by 37 patients with coeliac disease (15.7%) and by 21 controls (13.8%), with an adjusted odds ratio of 1.16 (95% CI 0.65-2.10). The risk of Iow trauma fracture was slightly higher in coeliac men than women (odds ratio 1.28 compared with 1.12), but this difference was not statistically significant (p=0.84). After adjustment for age, sex, body mass index, and smoking status, patients with coeliac disease reported 13% more Iow trauma fractures than controls (odds ratio 1.13, 95% CI 0.60-2.12). There was no difference in Iow trauma fracture risk before and after diagnosis of coeliac disease. Conclusion: No overall increased fracture risk in patients with coeliac disease was observed.... [ABSTRACT FROM AUTHOR]

Introduction: The relationship between Barrett's oesophagus and extra-oesophageal malignancies (EOM) has been a matter of controversy. Some researchers have pointed out that the incidence of colon cancer is higher in Barrett patients while others have found no such association. The current study explores the relationship between Barrett's oesophagus and EOM in general and colon cancer in particular in 27 813 subjects in General Practice Research Database (GPRD). Methods: The mean follow-up experience was about 6 years and the study subjects constitute four groups: Barrett's oesophagus group (1677), oesophagitis group (6392), simple reflux group (6328), and normal group (13 416). Respectively the last three groups were 4/1, 4/1, and 8/1 matched to the Barrett group according to their GP practice, date of birth and sex. All malignancies occurring before or in the first year after the diagnosis of Barrett's, oesophagitis, or reflux were regarded as prevalent and excluded from the analysis. Risk of occurrence of an unrelated condition such as cataract was also explored for comparison. Number of visits to the GP was defined as a date on which there are both medical and drug records available and its confounding effects were control[ed. Hazard ratios were calculated using Cox-proportional hazard regression analysis. Results: A total of 2167 EOM, 260 colorectal cancer, and 1918 cataract diagnoses were identified in study subjects of which 1119, 113, and 853 cases were excluded respectively as being prevalent. The hazard ratios have been presented in the table after adjusting for age, sex, and number of visits to the GP. Conclusion: The risk of colorectal cancer was not specifically higher in any of these groups. There were small increases in risk of EOM in the Barrett's oesophagus, oesophagitis and reflux groups in comparison to the general population. The explanation for these increases is unclear but they may be mediated by smoking if smoking rates are increased in... [ABSTRACT FROM AUTHOR]

Presents abstracts of articles published in the August 2003 issue of 'Gut' journal. 'Screening and surveillance for Barrett's esophagus in high-risk groups: A cost-utility analysis'; 'Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips'; 'Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases.'

Background: Only a small number of trials have directly addressed the management of patients with "uninvestigated" dyspepsia. The design of trials to determine cost effectiveness is more complex than efficacy trials, and can be enhanced by pre-trial modelling. Methods: A simulation model of 72 alternative management strategies for a dyspeptic patient was constructed. The model simulated the flow of individual patients with potential upper Gl disorders through potential investigations and therapies, including endoscopy, non-invasive testing for H pylori, acid suppression therapy, and H pylori eradication. Epidemiological data and meta-analyses were used to specify parameters within the model. The model was used to establish the important comparisons for future research and to establish likely effect sizes in terms of cost and efficacy. Sensitivity analysis explored potential effect modifiers and the MRC-CUBE study was designed and powered on the basis of the model. Results: Recent trials have supported some of the model's findings, in that only empiric acid suppression with either an antacid or a PPI, or H pylori "test and treat", followed by acid suppression were cost effective. Test and treat was more effective, but more costly than empiric acid suppression alone. Based on the model, the minimum effect size would be 7%, assuming a maximum willingness to pay For a patient free of dyspepsia for a year of 100, and a control event rate of 70%. 1940 patients would be required for an α of 0.05 and β 0.1. Conclusions: The MRC-CUBE trial is about to start recruitment in 60 practices, a large, multi-centre trial being justified on the basis of the model. As well as informing the selection of appropriate comparisons, pre-trial modelling enables cost effectiveness trials to be powered for cost as well as effectiveness outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Barrett's oesophagus is recognised to be a pre-malignant condition and the incidence of oesophogeal adenocarcinoma (OAC) in people with Barrett's is much higher than general population. Nevertheless, it has been suggested that gastro-oesophageal reflux per se is a more important determinant of risk. The current study was set up to explore the risk of oesophageal cancer (OC) and specifically OAC in Borrett's using a total of 166 228 person-years follow-up experience from General Practice Research Database (GPRD). Methods: The 27 813 study subjects constitute four groups: Barrett's oesophagus group (1677), oesophagitis group (6392), simple reflux group (6328), and normal group (13 416). The last three groups were 4/1, 4/1, and 8/1 matched to the Barrett group according to their GP practice, date of birth, and sex, respectively. All prevalent cases of OC, including those diagnosed before or in the first year after the diagnosis of their condition, were excluded from the analysis. Hazard ratios were calculated using Cox-proportional hazard regression analysis. Using the England and Wales cancer registry data, the incidence of non-AC cancer of oesophagus and subsequently the estimated number of observed AC were worked out in study groups and the relative rate were calculated by standardised incidence ratio method. Results: A total of 137 oesophageal cancer cases were identified in study subjects of which 80 cases were excluded as being prevalent. 57 were entered into the analysis. The results have been presented in the table. Conclusion: Barrett's oesophagus increases oesophageal cancer risk about 20 times and oesophageal adenocarcinoma about 50 times in comparison to general population. There is only a modest increase in risk of oesophageal cancer in patients with reflux but no record of Barrett's. Given that the person-years follow-up in Barrett's group is about twice the largest previous study lower relative risk estimates further emphasises the... [ABSTRACT FROM AUTHOR]

OBJECTIVES:Inflammatory bowel disease (IBD) is usually diagnosed as a result of symptoms but occasionally is found during investigation for other conditions. An earlier report from Nottingham had found a high prevalence of previously undetected “asymptomatic” IBD detected as a result of colorectal cancer screening, and the aim of this study was to reassess the prevalence, symptoms, and outcome in these patients.METHODS:We investigated subjects found to be fecal occult blood (FOB) positive in a randomized trial of FOB screening for colorectal cancer. All FOB-positive subjects were investigated by colonoscopy or flexible sigmoidoscopy and barium enema. Subjects with IBD were referred back to their general practitioner for any further investigation and treatment.RESULTS:Seventy-five thousand two hundred fifty-three subjects (aged 45–74) were sent FOB tests and 44,838 (60%) completed a series of tests on one or more occasions. Of 133,000 test series, 1.5% were positive. During investigation 53 cases of previously undetected IBD (52 of ulcerative colitis) were found; 52% (27/52) had proctosigmoiditis only, whereas 25% (13/52) had pancolitis. Only 17% (9/52) were completely asymptomatic, with a half or more reporting some rectal bleeding (54%) or diarrhea (50%). The overall prevalence of undetected ulcerative colitis was 69/105 (95% CI = 50–88/105) in people offered screening and 116/105 (95% CI = 85–147/105) in people accepting screening and was higher in men. Of 32 subjects followed up 2–12 yr after diagnosis, 91% (29) continued to have few or no symptoms, with only 12 currently receiving any treatment for their colitis.CONCLUSIONS:In comparison with detected disease, undetected ulcerative colitis is relatively common but does usually cause some symptoms. It generally appears to follow a benign course, but a significant proportion have extensive colitis and may therefore be at an increased risk of colorectal cancer. [Copyright &y& Elsevier]

Presents letters related to medicine to the editors of the 'British Medical Journal' in Great Britain. List of problems facing medical research; Statistics on the number of suicide in young adults; Decline in the incidence of gastric cancer.

Presents a study for the determination of the effects of varying efficacy and cost of two antibiotic regimens for the eradication of Helicobacter pylori, on the overall cost effectiveness of H pylori eradication in duodenal ulcer disease. Information on the two decision analysis models used in the study; Results of the study; Discussion based on the results. INSETS: Model 1;Key messages.

Investigates the therapeutic role of omeprazole in patients with upper gastrointestinal bleeding in Nottingham, England. Use of a double blind placebo controlled parallel group study; Measurement of mortality rates from all causes; Effect of treatment on endoscopic appearances.

Studies whether month of birth is related to the risk of developing inflammatory bowel disease (IBD) early in life among individuals in Great Britain. Comparison with similar research in Denmark; Characteristics of IBD patients included in the study.