Gut: first published as 10.1136/gut.21.5.A443 on 1 May 1980. Downloaded from Gut, 1980, 21, A443-A468 The British Society of Gastroenterology A joint meeting of the Association of Surgeons, the British Society ot Gastroenterology, and the British Society for Digestive Endoscopy took place in Bournemouth on Wednesday, 26 to Saturday, 29 March. The very full and varied scientific programme was preceded and followed by Symposia, teaching days, and satellite sessions and supported by a varied social programme. Abstracts of scientific communications read before the Societies follow. usual with CDCA but rare with UDCA. risk' for the spread of HBV, independent CLINICAL I We concluded that outcome of dis- of the crowding and social level. Probably solution therapy may be predicted from a as a result of their depressed immuno- six month cholecystogram; UDCA is no responsiveness, the aged, when infected more efficacious than CDCA. with HBV at a late age, tend to have mild, often subclinical, hepatitis and to remain Can a six-month cholecystogram predict HBsAg+ve. eventual response to gallstone dissolution therapy? Hepatitis B virus infection in the elderly: an underestimated problem? M C BATESON, D B TRASH, AND A D 0 http://gut.bmj.com/ BOUCHIER (University Department of M CHIARMONATE, A FLOREANI, AND R NAC- The immune response to bacterial gastro- Medicine, Ninewells Hospital and Medical CARATO (Cattedra di Gastroenterologia, enteritis School, Dundee, and Walsall Manor Clinica Medica 10, Universita di Padova, Hospital, Walsall) Results of treatment Italy) Four hundred and five elderly J LABROOY, D J C SHEARMAN, AND D with chenodeoxycholic acid (CDCA) and subjects (aged 66-98 years) without overt ROWLEY (Department of Medicine and ursodeoxycholic acid (UDCA) for radio- liver disease were tested for HBsAg, Microbiology and Immunology, University lucent gallbladder stones were analysed to antiHBs, antiHBc (radioimmunoassay, of Adelaide, South Australia) The anti- assess whether it was possible to predict Abbott Lab): 214 subjects lived at home, body response in serum and intestinal on September 25, 2021 by guest. Protected copyright. individual response, avoiding prolonged 191 in three homes for the aged (one of secretions after Salmonella and Shigella ineffective therapy. In 46 courses of treat- high and two of poor socioeconomic gastroenteritis has been measured using ment where no response occurred at six level). sensitive radioimmunoassay in 15 adults months, continuation on unchanged dose The three HBV markers' cumulative and 12 controls. Intestinal antibody, for at least another six months showed prevalence is significantly higher in mainly of the IgA class, was consistently subsequent complete dissolution in only (1) the total group of aged compared with detected in paired samples taken one to two patients. Twenty-three patients 1055 randomly selected adults (55.3% vs 10 weeks after infection, whereas antibody achieved complete stone dissolution, 14 21.6 %); (2) the institutionalised people was undetectable in intestinal secretions of at six months, five at one year and four at (without differences between the three most controls. While serum antibody, two years. Seven out of the nine with institutions) compared with the non- mainly of the IgG class, was similarly in- delayed total dissolution had evidence of institutionalised group (72-2 % vs 40.1 %). creased in the patients as a group, there partial response at six months. Of the 24 HBsAg+ve institutionalised was marked dissociation of serum and Using response at six months as a guide subjects, two (8.3 %) had evidence of intestinal antibody responses in indivi- to successful outcome, analysis of treat- chronic liver disease; 18 (75%) were duals. Although serum and salivary IgA ment in 35 patients with CDCA starting asymptomatic carriers; four (16.6%) antibody responses are easier to measure at 1000 mg daily showed eight complete belonged to the group of 15 who had re- than intestinal antibody responses they and 11 partial responses. Sixteen patients covered from acute hepatitis in the last did not correlate with intestinal antibody reviewed similarly after UDCA 1000 mg three years. The HBsAg+ve prevalence responses. Eight patients were studied daily had one complete and five partial increases with age and length of in- again after one to two years and intestinal responses. Nine patients treated with stitutionalisation. antibody was still detectable in the UDCA 500 mg daily had two complete In conclusion, aged people are highly majority. Patients were found to be and one partial response; two had non- exposed to HBV infection and institu- carrying the pathogen responsible for functioning gallbladders. Diarrhoea was tionalisation in itself represents a 'high their infections months after sympto- A443 Gut: first published as 10.1136/gut.21.5.A443 on 1 May 1980. Downloaded from A444 The British Society of Gastroentterology matic recovery and in spite of a marked is unlikely to affect PG synthesis by multiple gastric apudomas, and was also local antibody response. homogenates, we have examined its effect found to have an asymptomatic para- The feasibility of measuring intestinal on PG synthesis in tissue culture. thyroid adenoma. One female, aged 53 antibody over a prolonged period of time Rectal biopsies from 28 patients with years, had an early mucosal cancer in the and its dissociation from the immune ulcerative colitis or irritable colon syn- antrum, and underwent total gastrectomy. response at other sites emphasise the im- drome were bisected and put into tissue Thirteen of the patients were also portance of its measurement in the study culture, with or without prednisolone, studied by barium meal examination, of intestinal infection. This is particularly concentration 8.33 x 10-7 M. The super- which revealed abnormalities in only one relevant to programmes aimed at develop- natant was sampled at 16, 26 and 40 of five patients with endoscopically ing effective vaccines against bacterial hours, subjected to extraction and thin visible lesions. disease of the gut. layer chromatography, and assayed bio- The study is continuing, and patients logically for PG E2 using laminar flow with moderate and severe dysplasia are superfusion. Two biopsies not showing a being followed up. Controlled trial of alternate day pred- significantly linear rate of production of nisolone as a maintenance treatment for PG E2 were excluded. ulcerative colitis in remission Mean synthesis of PG E2 over 40 hours Low lgA plasma cell counts in the jejunal by biopsy halves not exposed to predniso- mucosa of atopic children J POWELL-TUCK, R L BOWN, T J CHAMBERS, lone was 2665 pmol/mg wet weight AND J E LENNARD-JONE,S (St Mark 's Hospit- (0-537 pmol,!~g protein). Biopsy halves K SLOPER, D SMITH, C G D BROOK, AND S al, London) Prednisone, 15 mg daily in exposed to prednisolone synthesised 10-26 HERMAN (Department of Paediatrics, divided doses, did not prevent relapse in pm/mg wet weight (0.217 pmol,',ug pro- Central Middlesex Hospital, London, and patients with ulcerative colitis in remission tein), representing significant inhibition D KINGSTON, J R PEARSON, AND M SHINER and some patients experienced trouble- (61-5%, P<0-001, and 59.6%, P<<0001, (Intestinal Stuidies Group, Division of some side-effects. In other diseases, respectively). Clinical Sciences, Clinical Research Centre, higher doses of corticosteroids have Biopsies from inflamed mucosae syn- Harrow, Middlesex) IgA deficiency has proved beneficial without increasing side- thesised more PG E2 than from unin- been postulated as a cause of gastro- effects when given in single doses on flamed mucosae (mean 33-87 pmol tmg intestinal allergy and diarrhoea in atopic alternate days. An alternative to sul- vs 9-70 pmol/!mg, wet weight P< 0.05, and infants. We studied, by immunofluo- phasalazine is needed to prevent frequent 0-674 pmol/,ug vs. 0-195 pmol '~tg pro- rescence, the plasma cells of the jejunal relapses of ulcerative colitis in a small tein, P< 0 05). mucosa obtained by peroral biopsy of all group of patients intolerant to the drug This is the first demonstration that children referred for symptoms of diar- http://gut.bmj.com/ or for whom it is ineffective. A randomised therapeutic concentrations of predniso- rhoea and,'or failure to thrive, who had double-blind crossover trial has therefore lone can inhibit PG synthesis by rectal eczema (n 15) or atopy in first degree been performed among such patients of mucosa, an action which may underly its relatives (n=four). Patients' ages were: prednisolone, 40 mg given orally in one clinical effectiveness in ulcerative colitis. 0-5 months: four; 6-11 months: four; dose on alternate mornings, against 12-23 months: six; 24 months onwards: control tablets. Results were assessed on five. The histology of the jejunal mucosa the basis of symptoms, sigmoidoscopic was normal in four (only two were under Gastroscopy survey in pernicious anaemia and rectal biopsy appearances. The study 23 months) and showed a partial villous on September 25, 2021 by guest. Protected copyright. was conducted over two periods of three atrophy (PVA) in 15 (12 under 23 months). months with a two-week crossover R W STOCKHRUGGER, G G MENON, R R Compared with the IgA and IgM plasma period. Of 24 patients who completed MASON, J 0 W BEILBY, R BOURNE, AND cell counts of non-eczematous children both periods, 11 relapsed while taking PB COTTON (Gastrointestinal Unit and under 23 months with PVA (n= 12) a control tablets but did not while taking Department of Radiology, The Middlesex significantly lower IgA cell count prednisolone, and one relapsed while Hospital, London, Bland Sutton Institute of (P< 0001) was found in eczematous (or taking prednisolone but did not while Pathology, The Middlesex Hospital atopic family history) children of the same taking control tablets (P< 0-01). One Medical Sc.hool) We have performed age group.