Gut: first published as 10.1136/gut.16.5.392 on 1 May 1975. Downloaded from Gut, 1975, 16, 392-409 The British Society of Gastroenterology The spring meeting was held at the University of Southampton on 10 to 12 April 1975. On the first morning scientific papers were read at a meeting of the Liver Club and the Council of the British Society of Gastro- enterology met in the afternoon. On Friday morning a symposium on 'Immunology of liver disease' was held jointly with the Liver Club with Professor Ralph Wright in the Chair, and there was a meeting of the Path- ologists' Group in the afternoon. The spring meeting banquet was held at Beaulieu Abbey on Friday evening. Also on Friday afternoon and on Saturday morning there were sessions devoted to scientific papers on 'Coeliac syndromes' (Chairman: Dr M. H. Sleisenger), 'Biliary diseases' (Chairman: Dr K. W. Heaton), 'Stomach' (Chairmen: Dr G. Milton-Thompson and Dr D. Colin-Jones), 'Intestinal transport-polypeptides' (Chairman: Professor C. C. Booth), 'Liver' (Chairmen: Professor Sheila Sherlock and Professor A. E. Read), 'Inflammatory syndromes' (Chairman: Dr S. C. Truelove), 'Oesophagus, stomach' (Chairman: Dr J. Bamforth), 'Pancreas' (Chairman: Mr J. E. Trapnell), 'Stomach hormones' (Chairman: Professor Ian McColl), and 'Colon' (Chairman: Professor J. C. Goligher). Abstracts ofthese papers follow. Jejunal colonization with enterobacteria in two patients relapsed with high bacterial was only threefold. Protein synthesis, as symptomatic tropical residents without counts. Failure to clear mucosal entero- measured by the incorporation of 14C acute sprue bacteria may with folate deficiency leucine into trichloracetic acid-precipi- predispose to mucosal changes in tropical table protein, was twofold greater in the A. M. TOMKINS, S. WRIGHT, W. P. T. JAMES, residents. coeliacs than in the controls. Subcellular AND B. S. DRASAR (Clinical Nutrition and fractionation experiments on the cultured Metabolism Unit, Department of Human Use of an improved jejunal culture system biopsies from normal subjects indicated http://gut.bmj.com/ Nutrition, London School of Hygiene and for the study of normal and coeliac mucosa that much of the newly synthesized Tropical Medicine, London, and Bacterial protein was in the cytosol with smaller Metabolism Research Laboratory, Colin- C. L'HIRONDEL, W. F. DOE, AND T. J. amounts in the microsomal and mito- dale, London) Colonization ofthe mucosa PETERS (Department of Medicine, Royal chondrial fractions and only trace amounts and luminal fluid by enterobacteria in Postgraduate Medical School, Du Cane in the brush borders. numbers of 103 to 108 organisms/g appears Road, London) A culture system (Mit- These studies demonstrate striking to lead to the development of the mucosal chell, Mitchell, and Peters, 1974), modified abnormalities of enzyme activities and lesion of acute tropical sprue. Patients by the incorporation of a rotating wire protein synthesis rates in coeliac jejunal on September 28, 2021 by guest. Protected copyright. with less severe symptoms present more mesh, has been used to maintain jejunal mucosa compared with controls when frequentlyin the UK., and their diarrhoea, biopsies from both control subjects and maintained in an in-vitro culture system. sometimes accompanied by malabsorp- patients with untreated coeliac disease for tion, may persist after their return. Two 24 hours. The viability of the biopsies Reference 'control' groups without malabsorption during culture was established by dis- Mitchell, J., Mitchell, J., and Peters, T. J. (1974). were studied. Only two out of eight secting and optical microscopy and by Gut, 15, 805. overland travellers with steadily decreasing autoradiography with tritiated thymidine diarrhoea were found to have low counts and leucine. Before culture the protein Depletion of thymus-dependent lympho- (< 103/g) whereas six of eight long-stay concentration of the control biopsies cytes in adult coeliac disease residents (professional expatriates) with (expressed as mg protein/mg DNA) was persistent diarrhoea had 103 to 105 entero- twice that of coeliac tissue. During culture D. P. O'DONOGHUE, M. LANCASTER-SMITH, bacteria/g. the protein and DNA contents of the AND PARVEEN J. KUMAR (Department of A third group of nine patients with tissue decreased by approximately one- Gastroenterology, St Bartholomew's Hos- tropical enteropathy and decreased folate third but the total amount of DNA pital, London) Although in adult coeliac levels had more marked symptoms, in six (tissue + culture medium) remained disease (ACD) thymus-dependent lympho- were colonized by enterobacteria in constant and it was therefore used as a cytes (T cells) may be involved in the numbers of 103 to 106 per g, and had reference. pathogenesis of the jejunal lesion' and abnormalities in mucosal morphology. A Alkaline phosphatase activity (ex- disturbances of lymphocyte function can fourth group of 10 patients with tropical pressed as mUnits/mg DNA) was four occur", circulating T cells have not been sprue was followed after tetracycline times higher in control biopsies than in measured. therapy: improvement at six months was coeliac mucosa. After culture alkaline A sheep red cell rosetting technique less satisfactory in those six with a few phosphatase levels in controls increased has been used to detect T cells in the remaining mucosal enterobacteria, and sixfold whereas in coeliacs the increase blood of ACD patients and controls. The 392 Gut: first published as 10.1136/gut.16.5.392 on 1 May 1975. Downloaded from The British Society ofGastroenterology 393 relative and absolute numbers of T cells ence of grade, at each site and for an An alternative pathway for bile acid were decreased in untreated ACD patients overall difference of grade between the metabolism in cholestasis involving 6oa- compared with controls (p < 0 002) and two sites. hydroxylation treated patients (p < 0 002) who had Twenty-one patients (four with DH) normal values. Total blood lymphocyte showed patchiness, which was more J. A. SUMMERFIELD, C. H. L. SHACKLETON, counts, however, were significantly re- common in the jejunum. There was an AND BARBARA H. BILLING (Department of duced only in the untreated ACD group. overall difference of abnormality between Medicine, Royal Free Hospital, Pond In those patients studied both before and the jejunum and duodenum in 13 patients Street, Hampstead, London, and Division after treatment T cells always increased and in some the duodenum was less of Clinical Chemistry, Clinical Research following a gluten-free diet (p < 001). severely abnormal. Centre, Watford Road, Harrow, Middlesex) There was an inverse relationship between Examples ofpatchiness will be presented Bile acids have been isolated from the both relative (p < 0001) and absolute and the relevance discussed. urine, serum, and bile of eight patients (p < 001) numbers of T cells in the with cholestasis. Using gas liquid chroma- blood and numbers of lymphocytes in the tography and combined GLC-Mass epithelial cell layer of the jejunum but spectrometry lithocholic acid and 3 p- there was no correlation with jejunal Recurrent aphthous ulceration and its hydroxy-5-cholenoic acid were shown to lamina propria lymphocytes. association with coeliac disease bepresent mainlyas sulphates. In addition, The depletion of circulating T cells hyocholic acid (3ox, 6cx, 7a-dihydroxy- might be explained by excess accumulation R. FERGUSON, M. J. BASU, P. ASQUITH, AND 5fl-cholanoic acid) and hyodeoxycholic in the jejunal epithelium and loss of W. T. COOKE (The Nutritional and Intestinal acid (3a, 6a-dihydroxy-5#-cholanoic acid) lymphocytes into the small bowel lumen3. Unit, The General Ilospital, Birmingham) were found in most of the samples from These findings are compatible with in- Although aphthous ulceration has been cholestatic patients but not in those from volvement of T cells in the pathogenesis of considered common in idiopathic steator- normal subjects. Hyocholic acid com- ACD and might also explain the impaired rhoea and coeliac diseasel12, a recent prised up to 12-2% of the total bile acids blast transformation and cytotoxic capa- editorial3 on recurrent oral ulceration did excreted in the urine (mean 41 %). Only city of coeliac lymphocytes2. not mention this association. It seemed trace amounts of hyocholic acid were detected in the serum and bile. Up to References relevant, therefore, to deternmine the incidence of coeliac disease in patients 4.9 %of the urinary bile acids (mean 1 -3 %) 'Ferguson, A. (1974). 2nd International Coeliac with recurrent aphthous ulceration atten- werepresentas hyodeoxycholic acid; mean Symposium. of 2-5 % for serumandO-4 % for bile 2Asquith, P. (1974). 2nd International Coeliac ding the dental and general medical out- values Symposium. were obtained. Since26-hydroxycholesterol patient departments. Thirty-five consec- http://gut.bmj.com/ 3Wheetman, A. P. (1974). Gut, 15, 823. utive patients with recurrent aphthous sulphate was also detected in the chole- ulceration were studied. Seven patients had static specimens, these findings provide Patchiness of the mucosal abnormality in the 'flat' jejunal biopsies characteristic of support for the hypothesis that an coeliac disease (CD) and dermatitis coeliac disease, and 28 had normal alternative pathway for bile acid meta- herpetiformis (DH) jejunal biopsies. Although the seven bolism may exist in cholestasis, similar subjects had lower mean haemo- to that suggested by Mitropoulos and BRIAN B. SCOTT AND M. S. LOSOWSKY