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The British Society of Gastroenterology Gut: first published as 10.1136/gut.13.10.836 on 1 October 1972. Downloaded from Gut, 1972, 13, 836-857 The British Society of Gastroenterology The 33rd annual general meeting of the British Society of Gastroenterology was held at Aviemore, Inverness-shire from 28 to 30 September 1972 under the Presidency of Professor W. I. Card. The programme included a very large number of communications of which the abstracts follow, and symposia on 'A new look at gastritis' and 'Gastrooesophageal reflux and its complications'. The Sir Arthur Hurst Memorial Lecture on 'Gut hormones-milestones and signposts' was given by Morton I. Grossman. A general report and a note on the annual business meeting, which was attended by honorary, senior, and ordinary members, is on page 858. Hepatic Damage from Overdose of Paracetamol size and cholesterol and calcium content of gall- stones on rates of dissolution has been studied in R. P. H. THOMPSON, R. CLARK, R. A. WILLSON, V. vitro and in vivo. BORIRAKCHANYAVAT, B. WIDDOP, R. GOULDING, and Selected human gallstones, removed at surgery, R. WILLIAMS (Liver Unit, King's College Hospital and were analysed chemically and by x-ray diffraction Poisons Unit, Guy's Hospital, London) The in- and then exposed to flowing bile of rhesus monkeys creasing use of paracetamol as an analgesic has been with an intact enterohepatic circulation'. Rapid followed by an increased incidence of overdoses. gallstone dissolution was associated with (1) high We have seen 46 patients during two years; 42 who gallstone cholesterol content; (2) bile undersaturated took more than 13 g developed liver damage, and with cholesterol; (3) high surface area: weight ratio. 14 died in hepatic failure. The prothrombin ratio In vitro studies with dog bile showed that the and bilirubin level usually became abnormal within presence of a radioopaque outer rim of calcium 24 hours, but peak levels were not reached until delayed gallstone dissolution. http://gut.bmj.com/ three to six days. An unusual finding was an initial Of 10 gallstone patients treated with chenodeoxy- unconjugated hyperbilirubinaemia. Hepatic his- cholic acid (0'75-1 5 g/day for three months) tology at four to 26 days showed centrilobular cholesterol solubility improved in nine. After six reticulin collapse, congestion, and necrosis of months' treatment, of two patients with radiolucent varying extent, but with considerable recovery at gallstones, complete gallstone dissolution occurred three months, except in one in whom considerable in one, and a significant reduction in stone size in fibrosis persisted. Coagulation tests were improved by the second. on October 2, 2021 by guest. Protected copyright. intensive therapy with heparin and fresh-frozen plasma, and their effect is being assessed in a con- Reference trolled trial. 'Dowling, R. H., Mack, E., Picott, J., Berger, J., and Small, D. M. A new approach to therapy was studied in pigs. (1968). J. Lab. clin. Med., 72, 169-176. Paracetamol administered to hepatectomized animals was completely cleared from the blood when passed Malignancy in Relatives of Patients with Adult in vivo through a column of activated charcoal. This Coeliac Disease may be an easy and effective method for removing this drug if the patient is seen early. P. L. STOKES, P. ASQUITH, J. H. WATERHOUSE, AND W. T. COOKE (The General Hospital, Birmingham, B4 Factors Influencing Human Gallstone Dissolution in 6NH) Previous reports have shown that patients Monkey, Dog, and Human Bile with adult coeliac disease have an increased incidence of malignancy especially of lymphoma and cancer of G. D. BELL, D. JUNE SUTOR, B. WHITNEY, AND R. the gastrointestinal tract'. As adult coeliac disease DOWLING (Departments of Medicine and Radio- frequently occurs in more than one member of a diagnosis, Royal Postgraduate Medical School. family it seemed appropriate to examine the families Ducane Road, London W12, and Crystallography of patients with this disease to assess the incidence Unit, Department of Chemistry, University College, of malignancy. London) The influence of bile composition and of A family history was obtained from 80 patients 836 Gut: first published as 10.1136/gut.13.10.836 on 1 October 1972. Downloaded from The British Society of Gastroenterology 837 with well documented adult coeliac disease. Data (20: 3 w 9) in plasma lecithin, was found in only three obtained by questionnaire were later confirmed in patients, all of whom had undergone intestinal each case during a personal interview. Particular resection. This was successfully treated by the attention was paid to the causes of death of relatives intravenous administration of Intralipid. with recourse to death certificates where possible, The reason why resected patients are so prone to and to the Birmingham Regional Cancer Registry EFA deficiency is uncertain, but these observations for confirmation of cancer and other deaths. The may have clinical implications. EFA deficiency causes death of any family member was not included for diarrhoea and dermatitis in human infants and analysis if the cause of death, age at death, or year of gallstones in hamsters: its possible role should be death were not definitely known. considered in the pathogenesis of the watery From this information years-at-risk were obtained diarrhoea and increased incidence of gallstones for all relatives and deaths from cancer and other found after intestinal resection in man. causes noted. Computer programmes have been developed to provide the expected numbers of deaths from cancer of all sites and within each degree of Effects of Cholecystokinin on Colonic Motility and relationship using the mortality rates ofthe Registrar- Symptoms in Patients with the Irritable Bowel Syn- General2. Preliminary results show that the numbers drome of deaths from cancer in first degree relatives of the propositi are greater than expected (p = 0 01) and R. F. HARVEY AND A. E. READ (Department ofMedicine, further analysis is continuing. Royal Infirmary, Bristol) It has been shown that The significance of these findings is discussed with many patients with 'functional' food-induced pain emphasis upon the inheritance ofthe disorder and the have an abnormally marked colonic motor response predisposition to malignancy. to eating' and this may be important in the pro- duction oftheir symptoms2. Little, however, is known References of the mechanisms involved in this response. 1Harris, 0. D., Cooke, W. T., Thomson, H., and Waterhouse, J. H. The effect of intravenous administration of (1967). Malignancy in adult coeliac disease and idiopathic steatorrhoea. Amer. J. Med., 42, 899-912. cholecystokinin (CCK) on motor activity of the 2Cancer Statistics for England and Wales 1901-1955. General Register sigmoid colon was studied in 20 patients with Office. to be due to the irritable abdominal pain believed http://gut.bmj.com/ bowel syndrome. Intraluminal pressure changes were recorded on a Devices M19 recorder, using Essential Fatty Acid Deficiency Secondary to Intestinal miniature balloons3 placed 20-25 cm from the Malabsorption anus. After placing of the balloons, the patients rested quietly for at least 60 minutes, and were then M. PRESS, H. KIKUCHI, AND G. R. THOMPSON (Depart- given a slow intravenous injection of normal ment of Medicine, Royal Postgraduate Medical saline. Following this, motility was recorded for 30 School, London) Malabsorption of essential fatty minutes. CCK (6 CHR units/g/hour) was then given on October 2, 2021 by guest. Protected copyright. acids (EFA) must inevitably lead to EFA depletion over a 10-minute period and motility recorded for a since inadequate intake cannot be overcome by an further 30 minutes. Motor activity during these two increased rate of synthesis, as occurs with non- 30-minute periods was compared by measuring the essential fatty acids. This paper reports an in- percentage duration of pressure waves, their mean vestigation into the fatty acid pattern of plasma amplitude, and a motility index (multiple of the lipids in a group of patients with steatorrhoea. other two indices). The fatty acid composition of lecithin, tri- All three parameters of motor activity increased glyceride, and cholesterol ester in fasting plasma was after CCK administration (% activity 22-2 to 33 7, determined by GLC. The percentage of linoleic acid P<0-025; mean amplitude 9-0 to 11 1 cm H20, (18:2) in each of these fractions was significantly NS; motility index 244 to 397, 0 05<P<010) but lower in 23 malabsorbers (15, 8, and 30%) than in 14 these increases were almost entirely confined to controls (27, 17, and 49 %, p < 001). These changes. patients whose pain was usually precipitated by indicative of EFA depletion, were more severe in eating. In this group of eight patients the changes patients who had undergone intestinal resection were much greater (13-7 to 41-3%, P<0 001; 4 9 to than in those with malabsorption due to adult 12-3 cm H20, p<0-02; 71 to 497, p<0-02), and four coeliac disease or other causes, even though the of these eight patients developed a severe attack of faecal fat excretion of the three groups was similar. their usual pain after CCK administration, at a time The classical picture of EFA deficiency, character- when markedly increased motor activity was seen. ized by the appearance of an abnormal fatty acid These results suggest that the abnormally increased Gut: first published as 10.1136/gut.13.10.836 on 1 October 1972. Downloaded from 838 The British Society of Gastroenterology postprandial colonic motor response in patients with tion of its presence in the plasma of patients with 'functional' food-induced pain may be mediated by gastrointestinal cancers, and the subsequent develop- cholecystokinin. ment of a quantitative measurement of the CEA in plasma has given rise to considerable optimism about References the availability of a simple technique likely to be 'Connell, A. M., Avery Jones, F., and Rowlands, E.
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