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The prevalence of Helicobacter pylori was determined using an ELISA technique for IgG antibodies to H. pylori in 76 patients with end-stage renal failure who were

Until recent years the stomach and upper small intestine were believed to be relatively sterile (Hill, 1986; Drasar, 1989). The normal acid stomach (pH

There has been a striking rise in incidence of Crohn’s disease in the last 20 yr, which is not simply due to increased recognition of the condition.’ In these circumstances there may be a major etiological factor operating in the environment, and one possibility, which has been considered, is an infectious agent. Possible infective agents have been identified in human studies, although their significance has not yet been established. A variety of acute and chronic infections affect the terminal ileum and colon of animals, and the pathology often resembles that seen in Crohn’s disease. Animal models of Crohn’s disease have received little attention although they may offer some guide to the etiology in humans. In some cases extensive efforts have been made to identify the causative agent because of economic implications in the food industry. Where such an agent has been identified, it has often been difficult to culture and in some cases is an intracellular bacterium. We do not suggest that these conditions in animals are Crohn’s disease, but in view of the similarity to ileocecal inflammatory bowel disease in humans, it would seem pertinent to review the current literature in the hope that one may identify useful areas for investigation. This may lead to some progress with this difficult problem.

Acute folate deficiency with pancytopenia and megaloblastic haemopoiesis developed in four patients after abdominal operations; all four responded to folic acid over 3-9 days. Three of them had been given intravenous nutrition with aminoacid/ethanol before the blood changes developed. A prospective study of twenty-five surgical patients with gastrointestinal diseases revealed a high frequency of acutely developing negative folate balance. Megaloblastic haemopoiesis and consequent blood changes were found in five patients. Treatment with intravenous nutrition correlated strongly with a fall in serum-folate and megaloblastic haemopoiesis. Some surgical patients develop acute folate deficiency which may proceed to megaloblastic arrest of haemopoiesis. Patients receiving intravenous nutrition containing ethanol are especially prone to this complication, which may be life-threatening if untreated. It is not yet known whether other forms of intravenous nutrition carry a similar risk.

Rectal-biopsy specimens were obtained from a group of patients with proctitis in different stages of activity. Large numbers of brightly fluorescent IgE-producing cells were demonstrated in rectal-biopsy specimens taken from these patients during disease activity and clinical remission. An immediate hypersensitivity reaction is suggested as one of the mechanisms involved in the pathogenesis of proctitis.

28 malnourished patients with Crohn's disease completed a controlled cross-over study to examine the effect of a low-residue liquid supplement on nutrition and disease activity. Patients spent two months on an ordinary diet (control period) and for two months took the nutritional supplement in addition (treatment period): the order of treatment and control periods was randomised. All anthropometric measurements, serum proteins, creatinine height index, and circulating T lymphocyte numbers increased significantly in the treatment period, while serum orosomucoid levels dropped significantly, suggesting that disease activity was reduced. The benefits were apparently due to the higher calorie intake with the enteral supplement. The results show that enteral supplementation can be managed successfully at home and may produce improvements in nutrition and disease activity.

Controversy exists as to whether a transmissible agent is responsible for Crohn's disease. Previous reports have suggested that sarcoid-like granulomas can develop in animals following inoculation of homogenates derived from bowel affected by Crohn's disease. This study involved the injection of Crohn's tissue homogenates into experimental animals under a variety of conditions which might be expected to favour the demonstration of such an agent. Homogenates have been inoculated into the ileum of rats, mice, and rabbits and also given inoculated into ileum and footpads of rats which have previously been rendered lymphoedematous by surgical interruption of the draining lymphatics. Bowel homogenates from a total of 17 patients with Crohn's disease have been injected into 91 experimental animals. No macroscopic or microscopic changes indicative of Crohn's disease were detected. Thus study does not support the suggestion that a transmissible agent is present in Crohn's disease.

Three hundred patients with ulcerative colitis, 200 with Crohn's disease and matched control subjects completed questionnaires about atopic disease. They were asked whether they had ever suffered from asthma, hay fever, allergic rhinitis or eczema; in ulcerative colitis all of these features occurred with twice the frequency, but in Crohn's disease only eczema was more common than in controls.

A study was carried out to examine how reproducible anthropometric measurements were within and between two observers on a group of 24 normal subjects and 20 obese individuals. A further study was performed on 28 malnourished patients with Crohn's disease undergoing a controlled trial of nutritional therapy to assess how weight change correlated with other anthropometric parameters. The measurement that was most reproducible and correlated most with weight change was mid-arm circumference. As it is the simplest measurement to perform, we would recommend that it is used more often in nutritional studies.

Comparaison de malades atteints d'enterite de Crohn ou de colite ulcerative et de sujets normaux. La consommation quotidienne de calories est egale dans les 3 groupes, et la malnutrition est observee seulement dans la maladie de Crohn, ce qui pourrait s'expliquer par: malabsorption, inflammation, perte d'elements nutritifs par diarrhee, et non par une sous-alimentation

Summary Seventy-four patients with a pre-operative diagnosis of stomach or oesophageal cancer were entered into a randomized, controlled clinical trial to assess the value of a short course of pre-operative intravenous nutrition. The effectiveness of this treatment was assessed by the clinical course and monitored by means of immune and biochemical profiles. Pre-operative parenteral nutrition given over a 7–10-day period resulted in a significant reduction in the incidence of postoperative wound infections. Clinical benefit was confined to those patients who had a low serum albumin on admission to hospital. It is doubtful whether this limited benefit justifies the routine use of intravenous feeding, with its attendant hazards, in the pre-operative preparation of patients with upper gastrointestinal cancer.

SOFPAPERS 1153 ATOPIC FEATURES IN PATIENTS WITH ULCERATIVE COLITIS. R. V. Heatley, J. Rhodes, D. L. Roberts. Department of Gastroenterology, University Hospital of Wales, Cardiff, Great Britain. A questionnaire was used to establish the prevalence of atopic features in 250 patients with ulcerative colitis, 126 of whom had an ileostomy. Data was also collected from 260 matched controls. The spouses served as controls, giving matched pairs in 106 cases, while the other controls came from a dental outpatients' department. The questionnaire was completed by interview in 140 of the patients and 180 of the controls; the remainder were completed by post. Allergic rhinitis (20% compared with 11X), eczema (21% compared with 9%) and a family history of atopic manifestations (31% compared with 17%) were all more common in patients. There was no significant difference in the prevalence of asthma and hay fever between the two groups. The findings support previous suggestions that colitis is associated with atopic features and lends some support to the hypothesis that a reaginic reaction may be important at some stage in the pathogenesis of ulcerative colitis. LACTOFERRIN LEVELS IN BLOOD, DUODENAL JUICE AND PURE PANCREATIC JUICE IN THE DIAGNOSIS OF PANCREATIC DISEASES. S.S. Fedail, R.F. Harvey, P.R. Salmon and A.E. Read University Department of Medicine, Bristol Royal Infirmary, Bristol, England. A sensitive and specific radioirmnunoassay for lactoferrin has been developed (Fedail et al 1978). The assay was used to measure lactoferrin in plasma, duodenal juice in the basal state and following secretin stimulation, and in pure pancreatic juice obtained endoscopically. Plasma lactoferrin was measured in 12 control subjects and in 10 patients with chronic pancreatitis. Plasma levels in controls were (mean + 1SD) 1942 + 717 ng/ml, in patients with chronic pancreatiTis 6095 + 4742 ng/ml, the difference was statistically significant TP(O.05). Lactoferrin levels in duodenal juice were not significantly different in control subjects compared with patients with chronic pancreatitis. Patients with severe pancreatitis tended to have very high levels. Lactoferrin was also measured in pure pancreatic juice obtained from 23 patients with chronic pancreatitis; 16 control subjects and 10 patients with pancreatic cancer. The median lactoferrin level in controls was 73 ng/ml, range 16-390 ng/ml; in patients with chronic pancreatitis 2310 ng/ml, range 870-11400 nglml; in pancreatic cancer 105 ng/ml range lo-387 ng/ml. In a single patient with both cancer and pancreatitis lactoferrin was high 1300 ng/ ml. Pure pancreatic juice lactoferrin levels distinguish between those with chronic pancreatitis and those with either pancreatic cancer or normal pancreas. MOl-eOVer lactoferrin levels tend to correlate with the severity of pancreatitis as measured by pancreatography. Plasma and duodenal juice lactoferrin show a similar trend but there is considerable overlap between the different groups. Fedail, S.S., Harvey, R.F., Salmon, P.R., Read, A.E. (1978) Lancet I (in press) ROLE OF CELLULAR CALCIUM IN MODULATING THE INITIAL ACTION OF CHOLECYSTOKININ ON PANCREATIC ACINAR CELLS. R. Lopatin and J.D. Gardner. National Institutes of Health, Bethesda, Md. The initial steps in the action of CCK and carbachol on pancreatic acinar cells are to cause a 6-fold increase in the rate of release of membrane-bound calcium and a lofold increase in cellular cyclic GMP. In the present studies we have used dispersed acinar cells from guinea pig pancreas to examine the extent to which changes in cellular calcium can modify the actions of CCK n cellular cyclic GMP. In acinar cells preloaded @,;i ~~;e~,;;cubated with EDTA, membrane-bound t5: ring the first 15 minutes of incubation after which bound Ca decreased at a rate of 0.4% per minute. Under identical conditions the increase in cellular cyclic GMP caused Sy CCK was reduced by 50%. This decrease was maximal by 2 minutes of incubation without calcium and remained constant thereafter. In acinar cells preincubated without extracellular calcium, adding calcium caused a time-dependent increase in the action of CCK on cellular cyclic GMP and by 10 minutes the CCK-induced increase in cyclic GMP was equal to that in cells preincubated with calcium. Extracellular calcium concentrations of l.OmM or greater prevented the decrease in the action of CCK on cellular cyclic GMP. Magnesium, alone or in the presence of calcium, did not alter the increase in cellular cyclic GMP caused by CCK. Although removing extracellular calcium reduced the magnitude of the increase in cyclic GMP caused by CCK, there was no change in the maximally or minimally effective concen;t;$,ons of CCK. Increased cyclic Ge8was detected with M CCK, and was maximal at 3 x 10 M. These results indicate that the effect of removing extracellular calcium results from a decrease in cellular calcium, and that in pancreatic acinar cells there is a rapidly exchanging component of cellular calcium that functions to control the action of CCK on guanylate cyclase and by so doing influences cellular accumulation of cycle