Lack of efficacy of a reduced microparticle diet in a multi-centred trial of patients with active Crohn's disease.

Background And Aims: Dietary microparticles, which are bacteria-sized and non-biological, found in the modern Western diet, have been implicated in both the aetiology and pathogenesis of Crohn's disease. Following on from the findings of a previous pilot study, we aimed to confirm whether a reduction in the amount of dietary microparticles facilitates induction of remission in patients with active Crohn's disease, in a single-blind, randomized, multi-centre, placebo controlled trial.

Methods: Eighty-three patients with active Crohn's disease were randomly allocated in a 2 x 2 factorial design to a diet low or normal in microparticles and/or calcium for 16 weeks.

What proportion of dyspeptic patients having H. pylori breath test subsequently undergo endoscopy?

Background: Helicobacter pylori (HP) testing in young patients with uncomplicated dyspepsia has been recommended. A test and treat strategy for dyspeptics positive for HP is recommended by the European H. pylori Study Group and the American Gastroenterology Association.

Barium enema or colonoscopy for the investigation of iron deficiency anaemia?

Objective: To determine whether double contrast barium enema is adequate for excluding carcinoma of the colon in patients with iron deficiency anaemia.

Design: Prospective audit.

Subjects: One hundred and twenty-three patients with iron deficiency anaemia.

Drinking before endoscopy: milk or water?

Background: The traditional fluid fast prior to endoscopy is unnecessary. We have previously shown that drinking water prior to endoscopy does not affect either the quality of mucosal views or residual gastric fluid volumes when compared to patients undergoing endoscopy after a standard fast. The present study was designed to establish whether milk, which may delay gastric emptying, could also be drunk prior to endoscopy without adverse effect.

Assessment of residual gastric volume and thirst in patients who drink before gastroscopy.

Background: Before endoscopy patients undergo an uncomfortable fluid fast to reduce the risk of gastric acid aspiration and to ensure good endoscopic views are obtained. However, fluids rapidly leave the stomach and thus a long fluid fast before endoscopy may not be required.

Aims: The object of this study was to establish whether drinking before endoscopy is safe and relieves patients' symptoms of thirst.

'Solubile': decision-making in the diagnosis of jaundice.

We have designed a computer program 'Solubile' to aid clinicians in the diagnosis of jaundice. Based on Bayes' theorem, 'Solubile' uses up to 47 items of information about the patient to produce the most probable diagnosis from 22 possible diseases. In a prospective analysis of 50 patients, 74% were correctly diagnosed in first place and 94% within the first three choices.

Specialized gastrointestinal units for the management of upper gastrointestinal haemorrhage.

In 1986, 292 patients were admitted to a joint medical-surgical gastrointestinal unit with upper gastrointestinal haemorrhage. Fourteen patients died (4.8%) a mortality considerably lower than recorded in most series.

Is Nd-Yag laser treatment for upper gastrointestinal bleeds of benefit in a district general hospital?

104 consecutive patients with upper gastrointestinal bleeding admitted to a district general hospital over a period of 20 months were considered for laser photocoagulation. 58 patients were found to have peptic ulcers, of which 42 had stigmata of recent haemorrhage accessible to laser photocoagulation. 17 were treated with a Nd-YAG laser and 25 were managed conservatively.

Carcinoma of the colon, sclerosing cholangitis, pericholangitis, and bronchiectasis in a patient with chronic ulcerative colitis.

We report a patient with long-standing ulcerative colitis who developed carcinoma of the colon, sclerosing cholangitis, pericholangitis, and bronchiectasis over the course of 10-15 years. Occurrence of these rare conditions in the same patient supports their reported association and reemphasizes that there may be multisystem involvement in ulcerative colitis.

Coexisting retroperitoneal and mediastinal fibrosis.

A rare case of coexisting retroperitoneal and mediastinal fibrosis is reported. Increasing awareness of this association may lead to earlier recognition of significant symptoms and more effective therapy.

Iron release from isolated hepatocytes.

The isolated hepatocyte suspension was evaluated as an experimental procedure for investigating liver iron metabolism. Following prelabelling in vivo with transferrin-59Fe, isolated hepatocytes released radioactive iron in vitro by a temperature dependent process, without change in cell viability. Iron mobilization was increased by serum, apotransferrin and a range of iron chelators, of which the most effective were citrate, desferrioxamine and the ionophore A 23187.

Double-blind trial of the use of transfer factor in the treatment of Crohn's disease.

We have undertaken a double-blind controlled trial of the use of transfer factor in Crohn's disease. Thirty-three patients with known Crohn's disease completed the trial in which half the patients had three injections of transfer factor and the other half were given saline. After six months there was no significant difference in the clinical condition of either of the two groups compared with before receiving treatment.

Ultrasound and hepatic metastases.

Recent advances in ultrasonic technology have permitted differentiation of tissue within an organ. Fifty-nine patients in whom satisfactory follow-up could be obtained underwent grey-scale ultrasonic examination of their livers. Fifty-three patients were scanned successfully and of these a correct diagnosis as to whether metastases were present or not was given in 46.

Ultrasonography in the management of haemophilia.

Ultrasonography was used to demonstrate retroperitioneal haemorrhages and intramuscular haematoma in three patients with antibodies to factor VIII and one with von Willebrand's disease in whom major bleeding episodes occurred. Scans were useful in demonstrating the presence, location, size and regression of haemorrhages.

Ultrasound and amoebic liver abscess.

Eight of 12 patients referred to an ultrasound clinic were eventually found to have a liver abscess. All 8 abscesses were confirmed positively by ultrasonic examination. Using ultrasound, an amoebic abscess can be accurately located within the liver and the optimal site for needling suggested to the clinician.

Ultrasound and jaundice.

We have examined 26 consecutive jaundiced patients referred to the ultrasound clinic. A differentiation between extrahepatic and other causes of jaundice was possible in 23 of the 24 patients satisfactorily examined. The use of ultrasonic techniques in the jaundiced patient offers a high degree of accuracy to the clinician, and little or no discomfort to the patient.

Ultrasound and abdominal hydatid disease.

Twenty-two hydatid cysts have been accurately located in the abdomens of seven patients by ultrasound B-scanning. Lapartomy has confirmed the presence of 19 of these cysts. Grey-scale techniques do not appear to add appreciably to the ease of diagnosis in this condition.