Gut: first published as 10.1136/gut.28.10.A1328 on 1 October 1987. Downloaded from Gut, 1987, 28, A1328-A1412 The British Society of Gastroenterology The Jubilee Meeting of the British Society of Gastroenterology was held in the University of London on 15-18 September 1987 under the Presidency of Mr John Alexander-Williams. Below are printed the abstracts of the 364 oral and poster communications selected for presentation at the meeting. Hospital, London, and Amersham Inter- paratuberculosis and M avium. Restricted INFLIAMMATORY BOWEL DISEASE national, Bucks) "'Indium labelled leuco- total DNA from a CD mycobacterial cytes are an accurate means of detecting bacillary isolate was used to generate a Enteral nutrition in severe colitis inflammation, particularly inflammatory genomic library in pGEM-1. Resulting bowel disease (IBD). Tc 99m as an alterna- specific cloned DNA probes precisely dis- SS C RAO, C [) HOLDSWORITH, ANI) A R W tive radioisotope offers advantages of con- tinguished different mycobacteria on the FORREST (Gastroinitestinial U,iit and Depart- venience, lower radiation dose, and basis of restriction fragment length poly- meait of Clinical Chemistry, Royal Hallam- theoretically higher image resolution. A morphisms (RFLP). A novel insertional shire Hospital, Sheffield) Small intestinal new Tc 99m chelate, HMPAO (hexamethyl element of about 1-5 kb (pMB22) was absorption and tolerance of enteral nutri- propylene amine oxime) is a moderately identified, repeated 1()-20) times through- tion was assessed prospectively in nine efficient leucocyte label with selectivity for out the mycobacterial genome. DNA patients with severe colitis. After admis- neutrophil leucocytes. We evaluated restricted and probed with pMB22 gave a sion, the patients were starved for 24 hours abnormal scans after reinjections of auto- multiple banding pattern RFLP identical in during which stool output was collected. logous Tc 99m HMPAO leucocytes in 32 the DNA from each of three independent Thereafter 2 I/day of Fortison standard subjects with proven or suspected IBD. The CD, and three Johne's disease M para solution was given enterally via a fine bore normal distribution of radioactivity is isolates, but not other mycobacterial DNA tube for six days, after which patients ate a similar to that seen with indium labelled suggesting a specific relationship between normal diet. During enteral feeding, a 5 g d cells, with additional activity in urine soon this insertional element and pathogenicity. xylose test and a five day faccal fat estima- after injection, and some bowel distribution Similar studies on nanogram quantities of tion were carried out. Stool output, symp- in normal subjects after four hours. DNA from one CD spheroplast isolate tom scores, daily weight, Hb, ESR and Occasional activity in the gall bladder indi- using a novel cloned DNA probe for Mpara http://gut.bmj.com/ albumin were also monitored throughout cates that this normal bowel activity follows 16S ribosomal RNA identified the sphero- the 10 day study period and prednisolone biliary excretion of free complex. Bowel plasts as mycobacterial but distinct from any sulphate was given intravenously. One hour activity resulting from labelled neutrophil known mycobacteria so far examined. blood xylose and five hour urinary xylose migration to inflamed areas could be identi- Crohn's disease derived mycobacterial values were normal in all except one patient fied much earlier than four hours, however, isolates appear heterogenous. with Crohn's disease. Fat absorption was and as a result IBD could be confidently normal in every patient. In spite of enteral diagnosed. Twenty five of 32 patients had feeding, there was a significant reduction in abnormal scans showing inflamed bowel. stool weight (p<0)(01) and stool frequency The resolution of small bowel involvement Adhesion of colitic E coli (EC) to isolated on September 26, 2021 by guest. Protected copyright. (p<0O001) over the 1i) day period. There is clearly superior to that with indium leuco- human colonocytes was a signiticant improvement in symptom cytes. No false positives or false negatives scores (p<0(0l), ESR (p<t)05) and per- were encountered. D A BURKE AND A T R AXON (Gastroenterology centage weight loss (p<0.05). Serum Unit, The General Infirmary, Leeds) Tissue albumin improved [32 (28-37 g/l) v 28 culture and buccal epithelial cell adhesion (23-36 g/l), median (range)l. All patients assays have shown that E coli (EC) isolated achieved medical remission and one under- Use of cloned DNA probes to identify from patients with ulcerative colitis possess went an elective panproctocolectomy. We Crohn's disease microbial isolates an adhesive property. In this study human conclude that even in severe colitis, small colonocytes have been used to assess in vitro intestinal absorption is normal, enteral JJ MCFADDEN, J THOMPSON, E GREEN, S J adhesion. Colonocytes from mucosal biop- feeding is well tolerated and parenteral HAMPSON, J L STANFORD, AND J HERMON- sies were isolated by gentle agitation in the nutrition should not normally be necessary. TAYLOR (Department ofSurgery, St George's presence of hyaluronidase at 37°C. The test Hospital Medical School, and of Medical bacterial suspension was incubated with the Microbiology, the Middlesex Hospital isolated colonocytes in Ham FIO at 37°C for Diagnosing inflammatory bowel disease Medical School, London) Crohn's disease 30 minutes. Adhesion was assessed under (IBD) with Tc 99m HPMAO labelled (CD) microbial isolates in longterm cultures phase contrast and expressed as the number leucocytes from several laboratories have included of bacteria adherent to brush border (BB) bacillary forms of mycobacteria, as well as and BB/basolateral (BL) adhesion ratio. M E RODDIE, M PETERS, M J CARROI.I., J CALAM, the scant growth of apparant spheroplasts The BB score of 12 colitic EC isolates to H J F HODGSON, AND P J lAVENDER (Depts of whose identity has been uncertain. Conven- colitic colon, mean=2()3, is significantly Radiology and Medicine, Royal Post- tional tests do not readily distinguish higher than control EC, mean=-028, graduate Medical School, Hammersmith between some mycobacteria such as M p=(0.Ol. The BB/BL ratio of colitic EC, A 1328 Gut: first published as 10.1136/gut.28.10.A1328 on 1 October 1987. Downloaded from 7he British Society of Gastroenterology A1329 mean=0-33 compared with a mean of 0-1 J ALEXANDER-WILI-IAMS (T/ic Gen1eral required a further 14 SP between 12 and 36 for control EC is significantly higher, Hospital, Birmingham) From a series of 59 (median 18) months after the initial SP. All p (0001. Buccal epithelial cell adhesive patients with enterocutaneous fistulae com- but one of the previous SPs were patent. No ability correlates with both the BB adhesion plicating Crohn's disease, 31 occurred in 23 postoperative complications arose from the index and the BB/BL ratio, p=0)001. This patients within a month of operation. SP sites. Intraperitoneal abscess developed study shows that colitic EC have a greater Four were referred having presented the in one patient from a duodenal leak. Our ability to adhere to human colitic colon than fistula within 10 days of appendicectomy by further experience indicates that SP is an controls. The higher BB/BL ratio for colitic surgeons inexperimented in Crohn's effective and safe procedure which has a EC suggests that adhesion is specifically disease. All were ileocutaneous, three had place in minimal surgery of both active and directed to the brush border. These data resection and one a stricturoplasty; all inactive CD, provided no distal obstructing support the view that EC may have a role in resolved. lesions are overlooked. the pathogenesis of this disease. Suture line leakage accounted for 18 fistulae and nine, presumed to be caused by operative trauma, originated from a dis- Delayed-release 5-aminosalicylic acid sected area of gut not affected by Crohn's (5-ASA) and sulphasalazine (SSZ) in the disease. Previous reports suggest that the treatment of mild to moderate ulcerative majority of such fistulae will heal spontane- colitis (UC) relapse ously. In this series, however, only 12 of the I IVER 27 resolved without further operation. S A RIl EY, V MAN!, M J GOODMAN, AND L A The principal predisposing factors in Effect of hepatic artery embolisation on I URNBER(G (University Departmenit of suture line leakage were adjacent septic survival in carcinoid syndrome Medicine, Hope Hospital, Salford; Leigh foci, hypoproteinaemia and colonic anasto- Infirinary, atid Bury General Hospital, mosis. In some severely compromised M COUPE, A HEMMiN(iWAY, Ii J F HIODGSON, Manchester) Sulphasailazine is of benefit in patients a primary stoma with delayed ANI) 1) J AL ISON (Depis of Medicine antd( UC relapse but side effects may limit its use. anastomosis might avoid leakage. Radiology, Royal Postgraduate Medicial 5-ASA appears less toxic. We have there- In another series of patients having exten- School, Hammersmith Hospital, Lonidon) fore compared SSZ, equivalent dose 5-ASA sive dissections, occult operative trauma Hepatic artery embolisation relieves and high dose 5-ASA in mild to moderate has been rendered overt by CO, distension systemic hormonally mediated symptoms in UC relapse. of the gut and underwater inspection (cycle the carcinoid syndrome, and local symp- Sixty one patients (32M:29F, aged 20-78 tyre puncture manoeuvre). All such toms of hepatic pain. We documcnt here the years) were randomly allocated to either detected bowel breaches have been sutured effect of this procedure on survival in a SSZ 2 g, 5-ASA 80X) mg or 5-ASA 2-4 g daily without subsequent fistulae. We suggest retrospective survey of 63 patients with in a double blind four week trial. One that routine adoption of the insufflation carcinoid syndrome seen in one centre over http://gut.bmj.com/ patient defaulted leaving 19 SSZ, 20 5-ASA manoeuvre might have prevented five of the 10 years.