The diagnostic value in coeliac disease of circulating antibodies to casein, crude gliadin, and a gliadin was assessed using an adaption of the enzyme linked immunosorbent assay system. a Gliadin was the only antigen which consistently separated 26 patients with untreated coeliac disease from 26 normal controls and 13 patients with chronic inflammatory bowel disease. The mean assay index for the 26 patients was 3-1 (SD 1-2) compared with 1-05 (0-5) for the normal controls and 1-1 (0-6) for patients with chronic inflammatory bowel disease. The a gliadin antibody levels of six patients with coeliac disease who had maintained a gluten free diet for at least two years were not significantly higher than normal (10 (0-4)). The validity of the test was determined in 90 consecutive patients who were being investigated for the presence of coeliac disease. Levels of a gliadin antibody were raised in 36 out of 44 patients found to have histologically proved coeliac disease and in six out of 46 subjects whose jejunal mucosa was normal. Serial a gliadin concentrations were measured in 12 patients with coeliac disease who had repeat jejunal biopsies performed six months after starting a gluten free diet. The levels of antibody fell in seven of the eight patients whose jejunal mucosa improved on maintaining the

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Objective To critically evaluate the infection rate associated with the use of a nonre¯uxing irrigation system for outpatient¯exible cystoscopy, by comparing it with conventional irrigation systems, and to determine the costs and bene®ts of this system of irrigation delivery. Patients and methods All patients undergoing¯exible cystoscopy on scheduled outpatient lists were considered for inclusion in the study; 143 patients of 220 undergoing cystoscopy ful®lled the study criteria. The study group of patients underwent cystoscopy with a new single-use nonre¯uxing valve inserted into the same irrigation delivery system that was used for the whole endoscopy session, and the control group had the complete irrigation system changed after each endoscopic examination. Midstream urine samples were taken for analysis before cystoscopy and again 3±4 days later. Infection was de®ned as a pure growth of o10 5 organisms/mL, with associated pyuria de®ned as o10 pus cells per high power microscopic ®eld. Results Complete data were available on 133 patients, with a further nine being excluded from the statistical analysis because they had a pre-existing urinary tract infection, leaving 64 patients in the study and 69 in the control groups. The overall infection rate for exible cystoscopy was 3.2%, with no signi®cant difference between the study and control groups. Cost savings of >35% can be expected using the nonre¯uxing valve method of irrigation delivery. Conclusion The nonre¯uxing valve caused no detectable increase in patient morbidity from bacterial infection when compared with conventional irrigation systems for¯exible cystoscopy, and can save considerable costs.

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