Non-alcoholic steatohepatitis associated with Netherton syndrome.

A 21-year-old man with Netherton syndrome underwent investigation of a persistently elevated serum alanine transaminase, detected on routine monitoring. He drank no alcohol, was not diabetic or overweight (body mass index 23 kg/m) and had no clinical features of liver dysfunction. A yielded an elevated result of 9.

Cardiomyopathy responsive to gluten withdrawal in a patient with coeliac disease.

A 57-year-old man with iron deficiency anaemia developed general malaise, exertional dyspnoea and features of cardiac failure out of proportion to his anaemia (haemoglobin 120 g/L). Investigations showed a severely dilated left ventricle with an ejection fraction of 15%, due to dilated cardiomyopathy. He was treated with high-dose diuretics, ACE inhibitors and β-blocker therapy.

Renal cell carcinoma presenting with malignant ascites.

It is rare for renal cell carcinoma to involve the peritoneum and cause malignant ascites. Furthermore, it is uncommon for malignant ascites to be a presenting feature of this cancer. An unusual case of renal cell carcinoma presenting with malignant ascites is reported, and its response to sunitinib described.

Surveillance for hepatocellular carcinoma in a mixed-aetiology UK cohort with cirrhosis: does α-fetoprotein still have a role?

Mortality from hepatocellular carcinoma (HCC) in people with cirrhosis is increasing whereas mortality from other causes is declining. Surveillance appears to reduce mortality but the optimal strategy is uncertain. Current guidelines differ by recommending ultrasonography alone or with α-fetoprotein (αFP).

Review article: the diagnosis and management of food allergy and food intolerances.

Background: Adverse reactions to food include immune mediated food allergies and non-immune mediated food intolerances. Food allergies and intolerances are often confused by health professionals, patients and the public.

Aim: To critically review the data relating to diagnosis and management of food allergy and food intolerance in adults and children.

Pyogenic liver abscess.

Pyogenic liver abscess has a variable clinical presentation. Its management requires input from several disciplines and is often coordinated by a gastroenterologist. This review examines demographics, clinical presentation, aetiology, diagnosis and prognosis; a suggested management approach, including antibiotic selection, radiological intervention and indications for surgery, is offered from a physician's perspective.

Persistently elevated alkaline phosphatase.

A 32-year-old overweight asymptomatic man was found to have a persistently raised serum alkaline phosphatase at 250-300 U/l (normal range <130). Other liver function tests were unremarkable apart from an initial marginally elevated alanine transaminase, which normalised with weight reduction. Abdominal imaging revealed a fatty liver but an extensive serological search for significant hepatobiliary disease was negative.

Mental incapacity in hospitalised patients undergoing percutaneous endoscopic gastrostomy insertion.

Background & Aims: Decisions to insert percutaneous endoscopic gastrostomy (PEG) tubes may be difficult because patients have serious underlying disease, and the procedure has associated risks. Patients may also lack mental capacity to consent to PEG insertion. This study aimed to prospectively determine the prevalence of mental incapacity in hospitalised patients undergoing PEG insertion.

Autoimmune hepatitis triggered by nitrofurantoin: a case series.

Introduction: Drugs can occasionally trigger the onset of autoimmune liver disease.

Case Presentation: Three Caucasian women (aged 65, 42 and 74 years old) who were receiving long-term nitrofurantoin as prophylaxis against recurrent urinary tract infections developed hepatitic liver disease. Serological auto-antibody profiles and liver histology appearances were consistent with autoimmune hepatitis.

Changing patterns of coeliac serology requests.

Background: Accurate serological tests have revolutionized the diagnosis of coeliac disease.

Aim: To quantify the volume of coeliac serology requests at a district hospital over a decade, identify their origin, assess positivity rates and subsequent duodenal biopsy and histological confirmation rates.

Methods: Details of patients in whom coeliac serology was requested from 1997 to 2006 were obtained from laboratory databases.

Paediatric endoscopy performed by adult-service gastroenterologists.

Background: Children often travel from district hospitals to teaching centres for endoscopic procedures by paediatric gastroenterologists. A 10-year district hospital experience of 'adult-service' gastroenterologists endoscoping children is reported with the aim of quantifying the workload, indications, sedation/anaesthesia practices, findings and safety of paediatric endoscopy performed by adult-service gastroenterologists.

Methods: Data on endoscopic procedures in patients younger than 16 years of age between 1997 and 2006 were obtained from hospital case-notes and computerized endoscopy/histology databases and were analysed.

Errors of intravenous fluid infusion rates in medical inpatients.

Prescriptions for intravenous (i.v.) fluids in hospitals may not be closely adhered to.

Toxic shock syndrome responsive to steroids.

Background: Toxic Shock Syndrome is a dangerous disease with clinical features mimicking bacterial sepsis. The best management of Toxic Shock Syndrome is not determined.

Case Presentation: A 28 year-old woman presenting with high fever, tachycardia and widespread erythroderma is described.

A surveillance programme for Barrett's oesophagus in a UK general hospital.

Background: Surveillance programmes for oesophageal cancer in patients with Barrett's columnar-lined oesophagus have reported varying efficacies.

Aim: To review the effectiveness of an endoscopic surveillance programme for patients with Barrett's oesophagus in a UK general hospital.

Methods: Patients with Barrett's oesophagus (> or =3 cm histologically proven columnar-lined oesophagus) were identified from endoscopic and histological records and outcomes recorded when surveillance was performed with 2-yearly endoscopies and quadrantic biopsies at 3 cm intervals.