A greater understanding of the mechanisms of IFALD has led to promising interventions to prevent and treat the condition. Other possible therapeutic targets require more formal evaluation, and further work is required to develop noninvasive tools for the assessment and prognosis of IFALD that will guide treatment and help in the selection of patients and timing of transplantation.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a widely used diagnostic and therapeutic modality in the management of biliary and pancreatic disease. Some of the complications of the procedure, although rare, may carry significant morbidity and mortality risks. We describe the case of a 68-year-old female who underwent elective ERCP for ductal stone clearance. Immediately postprocedure, the patient developed subcutaneous emphysema and bilateral pneumothoraces. Further imaging revealed the presence of free intra-abdominal air. The patient made a very quick recovery after bilateral chest drain insertion and no further intervention was required. We propose that pneumothorax, pneumomediastinum, and subcutaneous emphysema during ERCP, in the absence of duodenal perforation may be explained by leakage of air from a site of low resistance such as the sphincterotomy site, or as a result of copious Valsalva manoeuvres performed by a patient tolerating the procedure poorly.

Introduction Corticosteroids are important treatments for acute exacerbations of infl ammatory bowel disease (IBD). In severe fl ares, or when oral steroid has proven unsuccessful, high dose intravenous steroid can be given in a hospital setting. Two intravenous corticosteroids are in common usage: hydrocortisone (HC) and methylprednisolone (MP). As well as the therapeutic glucocorticoid effect, both agents have mineralocorticoid effect. The mineralocorticoid effect of HC is greater than MP at the doses commonly used. It has been noted that high dose HC can cause life threatening hypokalaemia. To the authors' knowledge, the effects of MP and HC on serum potassium levels have not been assessed for a group of patients being treated for fl ares of IBD. Methods The case notes of patients with IBD were studied and details of admissions requiring intravenous steroid were noted. Blood potassium (K) levels on admission and throughout the inpatient stay were recorded. Disease extent and severity on admission was noted. Length of admission, length of steroid course, and whether the patient had surgical intervention or started ciclosporin or biologic therapy was also noted.

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