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Chenodeoxycholic acid (cheno) and ursodeoxycholic acid (urso) dissolve cholesterol gallstones in man. In the present study the effects of cheno and urso were investigated in a prospective study in 10 patients in which every patient served as his own control. Five patients were first treated with cheno and subsequently with urso, and 5 patients were first treated with urso and subsequently with cheno. Each of the treatment periods lasted for 3 months. Cheno and urso were administered in daily doses of 12.7 to 17.9 mg per kg. In the control period biliary bile acids consisted of 40.7 ± 4.0% cheno, 1.4 ± 0.2% urso, 1.1 ± 0.1% lithocholic acid, and 0.7 ± 0.2% lithocholic acid sulfate. During treatment with cheno this bile acid increased in bile to 84.3 ± 1.6%, urso to 4.6 ± 1.2%, lithocholic acid to 2.0 ± 0.2%, and lithocholic acid sulfate increased to 1.6 ± 0.2%. In plasma cheno, lithocholic acid and lithocholic acid sulfate were increased. During treatment with urso this bile acid increased in bile to 57.1 ± 3.5% while cheno decreased to 17.9 ± 1.3%, lithocholic acid to 0.6 ± 0.1%, and lithocholic acid sulfate to 0.5 ± 0.1% of total biliary bile acids. In plasma only urso increased. Cholesterol saturation of bile decreased during both treatment periods but was significantly lower during urso treatment (0.6 ± 0.1) than during cheno treatment (0.8 ± 0.1). In 4 patients maximal SGPT values were elevated during the cheno treatment period in comparison to the control period and urso treatment period. All other liver function tests and also serum lipids were unchanged during both treatment periods.

The purpose of this study was to evaluate the effect of intravenous pentagastrin and gastric alkalinization on the lower esophageal sphincter (LES) pressure in seven patients with diffuse esophageal spasm as compared to nine normal controls. Intravenous injections of 0.2 and 0.4 mug pentagastrin/kg body weight increased LES pressure significantly more in patients than in control subjects (p less than 0.05, p less than 0.01). Following gastric alkalinization both groups showed increases in LES pressure, but these were significantly greater for patients with diffuse esophageal spasm (p less than 0.05) than for controls. The results of our study indicate that the LES in patients with diffuse esophageal spasm is supersensitive to pentagastrin and gastric alkalinization.

In the European Cooperative Crohn's Disease Study patients from 14 centers were included in whom diagnosis was made within 2 years before study entry on the basis of generally accepted radiological, endoscopical and/or histological criteria or a combination of all. Reasons for exclusion were: diagnosis older than 2 years in patients who did not require active treatment, age less than 18 years, duration of symptoms less than 3 months, presence of complications which potentially required emergency surgery. Data on clinical features were obtained in 633 patients, of whom 452 were eligible to participate in the study. In 110 patients randomized to placebo the natural course of Crohn's disease was studied. Patients with ileocolonic involvement were younger than patients with either colonic or small intestinal involvement only. Classic ileitis terminalis was present in 14% of the patients. 49% of the patients had combined involvement of both the small and large intestine. 30% of patients had only small intestinal involvement, and in 21% colonic disease was present. Small intestinal involvement was associated with a significantly lower Crohn's Disease Activity Index (CDAI) than other anatomical locations of the disease. Perianal disease was more often associated with colonic than with small intestinal involvement. 60% of placebo patients with active disease at entry achieved at least a transient remission within the initial 5 months of study. After 2 years, 23% of patients with active disease at entry and 68% of patients with quiescent disease had reached or maintained a remission, respectively. By stepwise multiple linear regression analysis long duration of disease between diagnosis and randomization, normal serum albumin and combined involvement of small intestine and colon were identified as predictors of a more favorable outcome of patients treated with placebo. In contrast, extensive small bowel disease, treatment with steroids and bowel resection prior to study entry correlated with a less favorable outcome. However, by life table analysis outcome of previously untreated and treated patients in the placebo group was similar.