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Ramadan fasting may induce changes in gastrointestinal physiology. The effect of this fasting on inflammatory bowel disease (IBD) is not known. We conducted a cohort study in the month of Ramadan in 2006 to assess the effect of Ramadan fasting on IBD. Sixty patients with IBD, who were in remission and undertook fasting according to their own free will underwent assessment of quality-of-life (QoL) parameters, psychological state and the severity of symptoms before and after Ramadan. There was no correlation between the number of fasting days and the severity of the disease, QoL and psychological state of the patients. QoL did not change after Ramadan. Younger patients with ulcerative colitis (UC) fasted for a greater number of days (p=0.01) compared to older patients. The mean score of anxiety, using a modified version of the Hospital Anxiety and Depression Scale was 12.7 (6.0) before Ramadan in women with UC, and decreased to 9.8 (4.4) afterfasting (p=0.026). Men with UC had a mean score of colitis activity index of 3.5 before Ramadan, which decreased to 1.7 after fasting (p=0.008). It appears that Ramadan fasting does not impose serious risks on patients with IBD.

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by cutaneous and gastrointestinal (GI) venous malformations. The treatment of BRBNS is primarily supportive and ablative. Ablative therapy involves endoscopic or surgical treatment of GI venous malformations. We describe a 20-year-old woman who had multiple venous malformations all over the GI tract as well as cutaneous lesions. She had suffered from several episodes of melena, chronic anemia and fatigue for 10 years, which were treated temporarily by iron supplementation and blood transfusion. The endoscopic examination of the GI tract and total colonoscopy revealed multiple bluish sessile and polypoid venous malformations 2-3 cm in size throughout the GI tract. Argon plasma coagulation (APC) and polypectomy was done for all gastric and colonic lesions, respectively. Ileoscopy showed a large wide base vascular polypoid lesion at about 70 cm from the ileocecal valve with active bleeding; this was removed by snare polypectomy. One week later, she was discharged in good condition. At about 6 months' follow up she did not report any bleeding attack. Endoscopic polypectomy can be useful in patients with large and polypoid lesions of BRBNs which are not controlled with supportive therapy. Further experience is needed to evaluate the risks versus benefits of this approach.