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The British Society of Gastroenterology Gut: first published as 10.1136/gut.16.10.821 on 1 October 1975. Downloaded from Gut, 1975, 16, 821-845 The British Society of Gastroenterology The 36th annual meeting was held in Oxford on 25-27 September under the Presidency of Dr S. C. Truelove. The meeting proper was preceded by a teaching day on 24 September when there were two sessions, one on liver disease (Chairman: Dr J. Badenoch), and the other on gastrointestinal disorders (Chairman: Sir Francis Avery Jones). There were 14 sessions each allocated to a different subject, and in addition there was a plenary session and panel discussion on 'The management of ulcerative colitis'. The Sir Arthur Hurst Memorial Lecture, 'Towards an artificial liver', was given on this occasion by Dr Roger Williams. Abstracts of the scientific papers follow and a more general report of the meeting and of the social events can be found on page 846. Distribution of gut hormones monkeys though some variation in total influx mechanism is inhibited by cAMP, amount was seen due to different organ this model also satisfies the paradoxical S. R. BLOOM, M. G. BRYANT, AND J. M. weights. Immunocytochemical data on effect of bile acids in congenital chlor- POLAK (Departments of Medicine and hormone distribution were in substantial idorrhoea. Subsequently, a clinical trial Histochemistry, The Royal Postgraduate agreement. was done. Following oral administration Medical School, Hammersmith Hospital, These hormone maps provide baseline of coated theophylline the frequency and London) Although several new gut hor- data for physiological studies. the volume of the diarrhoeas decreased mones have recently been described there significantly. is little precise information on their site of Bile acid-mediated absorption in the ileum origin. of a patient with congenital chloridorrhoea Reference Four adult baboons and three monkeys 1Nellans, H. N., Frizzell, R. A., and Schultz, S. G. which had been maintained on human J. RASK-MADSEN, J. KAMPER, AND E. KRAG (1974). Brush-border processes and trans- diet for a number of years were studied. (Medical Departments F and B, Glostrup epithelial Na and Cl transport by rabbit The gastrointestinal tracts were removed and Gentofte University Hospitals, Copen- ileum. Amer. J. Physiol., 226, 1131-1141. from the freshly slaughtered animals, hagen, Denmark) In an 8-month-old http://gut.bmj.com/ rapidly divided into nine anatomical child with congenital chloridorrhoea bi- Investigation and treatment of a recurrent regions and plunged into freezing acid directional fluxes of Na, K, and Cl, and vipoma ethanol. The hormones were solubilized net transfer of water and HCO3 were by three separate tissue homogenizations measured simultaneously with the trans- J. R. LENNON, W. SIRCUS, S. R. BLOOM, and solid material was removed by mural potential difference (pd) during S. J. MITCHELL, J. M. POLAK, G. M. BESSER, centrifugation. The supernatants were steady state perfusion of the intestine. R. HALL, D. H. COY, A. J. KASTIN, AND then neutralized, dried down and re- In ileum, water, Na, K and Cl were A. V. SCHALLY (The Gastrointestinal Unit, dissolved on buffer for radioimmuno- secreted, and HCO3 was absorbed from Western General Hospital, Edinburgh, and on October 2, 2021 by guest. Protected copyright. assay. isotonic perfusates. The lumen side was Departments of Medicine and Histo- In the baboons the greatest amount of 953 mV negative to blood. Only Cl was chemistry, The RoyalPostgraduate Medical gastrin was found in the antrum (10 + transported against both electrical and School, Hammersmith Hospital, London) 1 (SE) ug) and duodenum (5-1 ± 03) chemical gradients but discrepancies Vasoactive intestinal peptide (VIP) has and pancreatic glucagon in the gastric between observed and predicted flux been extensively studied in a case of the fundus (1l1 ± 003 ug) and pancreas ratios indicated that a Na-absorbing Vemer-Morrison syndrome'. The patient (259 ± 32 ,ug). Enteroglucagon was mechanism was active as well. Tracer developed severe electrolyte-depleting greatest in the ileum (66 ± ,ug) but sig- fluxes showed that the epithelium was diarrhoea in 1967 which promptly nificant amounts were also found in the impermeable to Cl in the direction lumen disappeared after removal of a pancreatic colon (40 + 19 ug). Secretin was greatest plasma. In the presence of 2-5 mMol islet cell tumour2' 3. Diarrhoea recurred in the duodenum (3-6 + 03 ug) and glycochenodeoxycholic acid, Na and with hepatic metastases showing VIP jejunum (6-9 + 1P2 ,g) and gastrointes- water were absorbed, while net transfer immunofluorescence in August 1974. tinal peptide (29 + 4 ,Ag) and motilin of Cl was abolished. No significant The plasma VIP concentrations, measured (31 + 3 ,ug) in the jejunum. Vasoactive changes in pd, luminal pH or pCO2 could by radioimmunoassay, were 300-400 intestinal peptide was present in largest be demonstrated. In jejunum, water and pg/ml (n < 50). The diarrhoea stopped amount in the colon (235 i 84 j,g) and electrolyte transport was normal, and the with prednisolone therapy and VIP fell ileum (105 ± 23 ,ug) but significant PD -3 mV. The abnormal transport in to less than 150 pg/ml. On temporary quantities were present in the fundus ileum can be explained by the model of withdrawal of steroids diarrhoea returned (24 + 2*5 jig), duodenum (12 ±3 jAg) and Schultz and colleagues' if an inversion of and the VIP rose concomitantly. Follow- jejunum (28 ± 5 jig). The concentration the brush border transport processes is ing three months of steroid control per gram gut was very similar in the postulated. Since only the neutral NaCI diarrhoea appeared again and break- 821 Gut: first published as 10.1136/gut.16.10.821 on 1 October 1975. Downloaded from 822 The British Society of Gastroenterology through of VIP release was found, the Polymyxin. No histological damage or al- jejunal biopsy before and after cow's milk levels rising to over 600 pg/ml. teration in brush border disaccharidase challenge as essential in the management The volume of fluid aspirated from the activity was detected in mucosa exposed to of children suspected of this condition. distal duodenum was reduced from a Polymyxin under these conditions. Poly- mean of 8*7 ± 0-9 (SE) ml/10 min in the myxin inhibited the fluid secretory Inhibition of aspirin and taurocholic basal hour to 3-7 ± 0 7 ml/10 min during response to E. coli enterotoxin, as well as acid-induced gastric mucosal bleeding an 80-minute intravenous infusion of to CT. Activation of mucosal adenylate by prostaglandin 15(R)15 methyl-E2 methyl 750 yg of somatostatin, with a rebound cyclase by CT was partially inhibited by ester rise to 16'3 ± 2-5 ml/10 min in the hour pretreatment with Polymyxin. Polymyxin following infusion. Vasoactive intestinal or similar agents, which act on the intes- H. A. CARMICHAEL, L. NELSON, V. CHANDRA, peptide levels fell rapidly during infusion tinal mucosal cell surface, may have A. LYON, K. M. COCHRAN, AND R. I. from 800 pg/ml to 550 pg/ml with a a therapeutic role in control of entero- RUSSELL (Gastroenterology Unit, Royal rebound to 950 pg/ml following. Vaso- toxin-induced diarrhoeal fluid loss. Infirmary, Glasgow) It has been shown active intestinal peptide was unaffected by that conjugated bile acids, in particular meals,intravenous secretin and iv calcium. Jejunal biopsy in the management of taurocholic acid, significantly increase Three intrahepatic artery infusions of infants suspected of cow's milk protein the incidence of aspirin-induced gastric streptozotocin have stopped all diar- intolerance mucosal erosions in rats.1 Prostaglandins rhoea, though profuse watery stools have been shown to inhibit the production occurred in the hour after each infusion. MARGOT SHINER, JANET BALLARD, C. G. D. of stress-induced and indomethacin- The effect of streptozotocin on plasma BROOK, S. HERMAN, AND D. LOVELL induced gastric ulceration in rats.' levels of VIP and gastrin will be reported. (Medical Research Council Gastroenterol- We have investigated the effect of ogy Unit and Department of Paediatrics, prostaglandin 15(R)15 methyl E2 methyl References Central Middlesex Hospital, London) ester on taurocholic acid and aspirin- 'Bloom, S. R., Polak, J. M., and Pearse, A. G. E. Cow's milk protein intolerance in infancy induced gastric mucosal bleeding in rats. (1973). Vasoactive intestinal peptide and remains a controversial entity, since the Aspirin (64 mg/kg) and taurocholic watery diarrhoea syndrome. Lancet, 2, acid (2-5 mM) (solution adjusted to 14-16. clinical reaction of infants suspected of 'Sircus, W., Brunt, P. W., Walker, R. J., Small, sensitivity to cow's milk is variable. pH 4-5) caused mucosal bleeding in W. P., Falconer, C. W. A., and Thompson, We have attempted to put the diagnosis 53-6 % of rats. The addition of prosta- C. G. (1970). Two cases of 'pancreatic on an patients glandin (50 pg/kg) under control con- cholera' with features of peptide-secreting objective basis by taking adenomatosis of the pancreas, Gut, 11, suspected ofcow's milk protein intolerance ditions significantly reduced the incidence 197-205. off cow's milk, substituting a hydrolysed of bleeding to 19 5 % (p < 0 01). Aspirin 'Cleator, I. G. M., Thomson, C. G., Sircus, W., casein or soya bean formula, and by alone (128 mg/kg) caused bleeding in and Coombes, M. (1970). Bio-assay evi- 80% of rats: this incidence was sig- http://gut.bmj.com/ dence of abnormal secretin-like and gastrin- following this elimination diet by cow's like activity in tumour and blood in cases of milk challenge studies several weeks nificantly reduced to 20% by adding 'choleraic diarrhoea'. Gut, 11, 206-211. later. prostaglandin (50 itg/kg) (p < 0{002). Before the challenge lactose intoler- No significant bleeding was induced by Inhibition of enterotoxin-induced intestinal ance was excluded and the following increasing concentrations of taurocholic secretion by the polypeptide antibiotic, examinations were carried out: (1) acid alone (up to 20 mM).
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