SUMMARY Campylobacter pyloridis was isolated from 77% of 220 (35%) unselected adults undergoing gastroscopy. Isolation was significantly associated with histological gastritis (p < 0-0001), duodenal ulcer (p > 0-0001), and to a much lesser extent, with gastric ulcer (p < 0 05). The relation between the isolation of C pyloridis and peptic ulcer seemed to be independent of coexisting gastritis. In those with no endoscopic or histological evidence of disease there was no relation between isolation and increasing age.Antibody responses to a whole cell sonicate of a strain of C pyloridis were measured by means of an enzyme linked immunosorbent assay (ELISA). Increased IgA (p < 0-0001) and IgG (p < 0-0001) antibody titres were found in patients with C pyloridis. Peptic ulceration or gastritis were present in 78% and 100% of patients with a high concentration of IgG and IgA, respectively, but in only 9% and 18% of those with low titres.These results provide further evidence for a possible pathogenic role of these organisms in gastric disease and suggest that immunological markers of their presence might be useful non-invasive indicators of disease.
An observation that fewer people with ulcerative colitis smoked cigarettes than would be expected' has been confirmed by further studies.2-4 The relevance of this finding is at present not clear,5 but it has been suggested that smoking may protect against ulcerative colitis. The reports received widespread publicity, and we are often asked by patients with the disease for advice on smoking. We therefore studied smoking habits in patients with inflammatory bowel disease to ascertain whether smoking is associated with less severe disease.
Patients, methods, and resultsA total of 252 consecutive outpatients with inflammatory bowel disease were interviewed and their case notes reviewed. Details were obtained of smoking habit, frequency of relapse, symptoms in remission and relapse, extent of disease, complications, and the numbers of admissions to hospital ana of operations. The means of the three most recent full blood cell counts, white cell counts, erythrocyte sedimentation rates, albumin concentrations, and platelet counts were recorded. Patients were subdivided into three groups on conventional clinical grounds: 102 patients had ulcerative colitis, 96 Crohn's colitis, and 54 Crohn's disease of the small bowel. Patients with Crohn's disease in both the small bowel and the colon were included in the third group. Analysis of 172 variables for each patient was carried out with an ICL 2970 computer, using the statistical package for the social sciences
Endoscopic duodenal biopsies were taken from 27 patients with suspected coeliac disease and compared with intubation capsule jejunal biopsies. The specimens were reported without knowledge of the patients' names or symptoms. In 24 patients (89%), coeliac disease could either be diagnosed or excluded with 100% accuracy, despite the inability to orientate the biopsies correctly. Six biopsies were considered technically unsatisfactory, but only in three (11%) was it impossible to exclude coeliac disease. Duodenal biopsies were also taken from 118 consecutive patients attending for routine upper gastrointestinal endoscopy, and 1 patient with coeliac disease was discovered. We conclude that endoscopic duodenal biopsies are a reliable and worthwhile screening test for coeliac disease in certain patients attending for routine upper gastrointestinal endoscopy.
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