SUMMARY BackgroundThere are many studies investigating quality of life in recently diagnosed patients and following surgery for Crohn's disease, but there are none investigating quality of life changes with disease duration. The response shift model suggests quality of life improves with time following diagnosis.

SUMMARY AimTo investigate the incidence of death in patients diagnosed with Crohn's disease in Cardiff over 20 years ago. MethodsThe Cardiff database of patients with Crohn's disease contains data on all patients diagnosed there since 1934. Patients (394) diagnosed before 1 January 1985 were traced and their mortality status on 31 December 2004 was established. ResultsThe overall standardized mortality ratio (SMR) was 1.29 (95% CI 1.12-1.45) and it has not significantly changed since the 1970s. SMR decreases with age, from 16.95 (95% CI 14.99-18.91) for patients aged 10-19 years (although only one death) to 0.92 (95% CI 0.65-1.19) in those over 75 years. Kaplan-Meier analysis of age at death shows that patients diagnosed aged 10-26 years have median age at death of 58 years, those aged 27-52 years of 66 years, those aged 53-58 years of 74 years, and those over 59 years of 79 years. ConclusionsIt shows a significantly raised SMR, not statistically changed since the 1970s and similar to other chronic conditions. Patients diagnosed younger have worse prognosis than those diagnosed later in life and a reduced life expectancy compared with the general population.

Thirty-eight patients with particularly troublesome irritable bowel syndrome (IBS) were selected for trial on a 2-week exclusion diet. Eighteen patients improved dramatically and, with two exceptions, subsequently identified foods to which they were intolerant. Follow-up by postal questionnaire showed that at least 10 were still following their dietary restrictions 3-45 months later. Twelve of the 16 food intolerant patients were intolerant to more than one food. Fifteen patients found their symptoms did not improve on the exclusion diet. Five patients refused to try or were unable to complete the exclusion diet. The use of an appropriate exclusion diet for selected patients with IBS is recommended.

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A 65-year-old woman with Crohn's disease, who had been on home parenteral nutrition for many years, presented with perioral paraesthesia and a burning sensation in the mouth. Initial blood tests including serum ferritin, vitamin B12 and folate, were normal apart from mild pancytopaenia. Serum copper was low, in spite of receiving regular copper in her parenteral feeds. The copper in her parenteral feeds was increased initially, but when it did not improve, she was started on weekly intravenous copper infusions. She was using dental adhesive, which had zinc in it, and a possibility that this was causing her copper deficiency was raised. Serum zinc levels were normal, but urinary zinc was very high. The patient was advised to use zinc-free dental adhesive and her copper level returned to normal within a few months with normalisation of her pancytopaenia, and partial resolution of her oral paraesthesia.