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The British Society of Gastroenterology Gut: first published as 10.1136/gut.15.10.822 on 1 October 1974. Downloaded from Gut, 1974, 15, 822-841 The British Society of Gastroenterology The following are abstracts of papers given at the annual meeting held at the University of Birmingham on 19-21 September. On 19 September there was a discussion organized by the Liver Group (Convener, Professor Sheila Sherlock) on 'The carrier of hepatitis B antigen'. In the afternoon there was a symposium shared by the British Society for Digestive Endoscopy on 'Diagnosis of pancreatic disease' (Moderator, Dr Sheila Waller), and a clinicopathological conference on 'Progressive intestinal disease in an adolescent' (Moderator, Dr W. T. Cooke). The Sir Arthur Hurst Memorial Lecture was given by Dr A. F. Hofmann on 20 September. The scientific sessions followed on 20 and 21 September. -A fuller account of the meeting appears in 'Notes and activities' on page 844, together with the names of the officers of the Society and.those of the newly elected Council. P1 recorded and multiple biopsies taken rhoea, although serum levels of vitamin from different parts of the rectum at each A, D, and E are normal. In contrast to The extent of rectal premalignant change examination, (b) consideration should be the adult, a normal diet usually is indicated In ulcerative colitis given to a policy of colonoscopy with two years after extensive resection ofileum multiple biopsy in all patients with ex- in childhood. R. H. RIDDELL (introduced by B. C. tensive colitis who are statistically at in- MORSON) (St Mark's Hospital, London) It creased risk of malignant change. The P3 has been suggested that in patients with frequency with which colonoscopic ex- ulcerative colitis regular rectal biopsy can aminations should be performed has yet Perianal Crohn's disease be used for detecting premalignant change to be determined. and that this reflects similar changes in J. ALEXANDER-WILLIAMS, D. M. STEINBERG, http://gut.bmj.com/ the proximal colonic mucosa1. To assess Reference J. S. FIELDING, H. THOMPSON, AND W. T. the accuracy of this policy the frequency 'Morson, B. C., and Pang, L. S. (1967), Gut, 8, 423. COOKE (Nutritional and Intestinal Unit, The and extent of premalignant change in the General Hospital, Birmingham) The nat- rectum was measured using an eyepiece P2 ural history and results of surgical treat- micrometer on slides of rectal mucosa ment of perianal disease were assessed in from 56 proctocolectomy specimens. Diet and growth after resection of ileum in 418 patients with Crohn's disease. Forty of these specimens had carcinoma childhood A prospective review was made of 109 (25 rectal and 15 above the rectosigmoid patients initially diagnosed as having on September 30, 2021 by guest. Protected copyright. junction), and a further 16 had premalig- H. B. VALMAN (Northwick Park Hospital perianal Crohn's disease in 1968. All but nant change anywhere in the large intes- and Clinical Research Centre, Harrow, five have been followed and examined tine but no carcinoma. Middlesex) Twelve children who have after five years, following a policy of con- Five out of the 25 patients with rectal survived resection of more than 45 cm of servative management. In the majority carcinoma had premalignant change ileum (eight during the neonatal period (78Y) the disease status was unchanged; around the tumour only and this involved and four later in childhood) have been re- in only 16% had the disease deteriorated less than half of the mucosa examined. In assessed at periods between three and 16 in the five years. Continued or intermit- two out of the 15 patients with cancer in years. Two children received a low-fat, tent symptoms occurred in 35 %. the colon there was no evidence of pre- high-protein diet for nine and 13 years A separate review of 96 local anal malignant disease in the rectum and in a after resection and showed no advantage operations in 68 patients with Crohn's further two patients it involved less than in growth compared with 10 children who disease has shown that the anal lesions are half of the rectal mucosa. Among the 16 had a normal diet two years after resec- not necessarily serious or progressive and specimens without carcinoma premalig- tion. No child had persistent diarrhoea for simple establishment of drainage gave nant change in one patient did not extend longer than two years after resection. The good results in 70 %. Incontinence is to the rectum, and in a further five half weights of individual children are appro- likely to be the result of aggressive surgery or less of the rectal mucosa examined was priate for their heights. Their heights tend not of progressive disease. involved. These changes were least marked to be less than those of their siblings but Even in the presence of underlying in the rectum in four patients and most only one is less than the third centile. Two active bowel disease good results occur in marked in three. children are below the third centile for 54 % and the eradication of proximal In view of these findings it is suggested the height expected from their parents' active disease is not a necessary prerequi- that (a) ideally the site of rectal biopsy to heights. Despite the lack of diarrhoea the site, contrary to the views of Garlock detect premalignant change should be older children still have marked steator- (1967). Some patients may remain in good 822 Gut: first published as 10.1136/gut.15.10.822 on 1 October 1974. Downloaded from The British Society of Gastroenterology 823 health with minimal symptoms even in the DOUGLAS (Gastroenterology Group, of Medicine, University of Rhodesia, presence of gross anal stenosis with Department of Medicine, Royal Victoria Salisbury, Rhodesia) The objects of this fissures and fistulae. Infirmary, and Department of Medical study was to demonstrate the existence of Although an occasional indication for Physics, General Hospital, Newcastle upon tbopical sprue said not to occur in Africa. radical surgery, perianal Crohn's disease Tyne) Normal small intestinal epithe- We investigated 38 megaloblastic anae- can be managed conservatively in most lium contains interepithelial lymphocytes mias and three patients clinically thought patients. but their fate is unknown'. The observa- to have malabsorption syndrome. Full tion that in both coeliac disease' and haematological investigation and compre- Reference Crohn's disease2 there is an increase in hensive small intestinal work up was done. Garlock, J. H. (1967). 'Surgery of the small intes- the number of interepithelial lymphocytes Twenty-four patients had tropical sprue. tine' in surgery of the alimentary tract. in the small intestine suggested that in The following details concern only these London: Butterworths. these conditions there may be an increased 24. Clinically they presented typically with P4 loss of lymphocytes into the bowel lumen. anaemia, weight loss, anorexia, abdominal Such a situation is known to occur in pain, and diarrhoea. Of the 21 with mega- The HL-A system and the immunological lymphangiectasia3. We have therefore loblastic anaemia, the mean haemoglobin response to dietary antigens studied the distribution and faecal loss of was 5-4 g; six had a low serum B12 and peripherally harvested lymphocytes label- folate, two a low B12 only, and nine B. B. SCOTT, L. M. SWINBURNE, S. M. RAJAH, led with 51-Cr and reinjected into human either a low serum or red cell folate AND M. S. LOSOWSKY (Department of subjects. Localization of these labelled Twenty-one had severely abnormal jejunal Medicine, StJames's (Universitv) Hospital, lymphocytes has been made by external biopsies. Twenty-two had abnormal D- Leeds) There is ample evidence ofrelation- counting and by counting of faecal, urine, xylose absorption. All 24 had impaired ships between histocompatibility antigens and blood samples daily for five days. The Co57 vitamin B12 absorption. Steator- and immune responses in animals but not distribution of the lymphocytes within rhoea occurred in only eight, perhaps due in man. The close association between the body was different from normal in to inadequate fat-loaded diets, but the HL-A8 and coeliac disease (CD) might patients with coeliac disease. In five tropical sprue group excreted markedly suggest that immunological abnormalities normal subjects enteric loss of lympho- more faecal fat than a control group. in CD are related to the HL-A system. cytes over five days was 0-24% (SD ± Eighteen had malabsorption patterns on High levels of serum gluten antibodies 0-16). In three cases of lymphangiectasia small intestinal radiology. Six had atro- are common in CD and in other condi- the five-day faecal loss was 0 47 %, 0 55 %, phic gastritis and achlorhydria, five tions with damaged gut mucosa and may and 0 95 % respectively. In two untreated superficial gastritis, and 12 hypochlorhy- merely reflect absorption of dietary pro- coeliac patients faecal loss was 0-66 % and dria. There was no statistical difference teins. However, gluten antibodies are not 1-85 % and in two patients with Crohn's between the diets of the patients and http://gut.bmj.com/ found in all such patients and are found disease faecal loss was 1-45 % and 2-11 %. matched controls. Patients were rein- in some patients with chronic liver disease. The results have been correlated with vestigated in three groups. After six The relationship between these immune interepithelial lymphocyte counts in months tetracycline and haematinics, the responses to gluten and histocompatibility mucosal biopsies and with measurement combined regimen; after six months tetra- antigens is not known. of 51-Cr in resected intestine. cycline alone; and some, that subsequently Serum gluten and milk antibodies and Our observations suggest that there is joined one or other of these groups, HL-A-status were studied 'blind' in 124 normally a pathway of lymphocyte re- after two to three weeks' tetracycline subjects with various conditions.
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