The oesophageal transit of six commonly used tablets and capsules containing barium sulphate was evaluated radiologically using fluoroscopy in 121 healthy volunteers. To determine the influence of the subject's position and the amount of water taken each subject swallowed three preparations while recumbent and standing and with 25 ml or 100 ml of water. Failure of swallowing (defined as oesophageal transit taking more than 90 seconds) occurred in 22% of 726 swallowings, but globus was complained of in only 33% of these. Sixty per cent of the volunteers had difficulty in taking one or more of the preparations. Many preparations adhered to the oesophageal membrane and started to disintegrate in the lower part of oesophagus.It is recommended that subjects should remain standing for at least 90 seconds after taking capsules or tablets and that all preparations should be taken with at least 100 ml of water. Small tablets are swallowed most easily. Liquid forms of medication (suspensions) should be considered for bedridden patients and those who have difficulty in swallowing.

Background and Objectives:Catabolism and growth impairment are well-known complications of inflammatory bowel disease (IBD). Recent studies have demonstrated significant changes in the IGF system in IBD patients. The aim of the present study was to investigate correlations between the IGF system and markers of inflammation in IBD. Methods:A cross-sectional study comprising 99 IBD patients (Crohn’s disease (CD, n = 50) and ulcerative colitis (UC, n = 49)). Correlations between markers of inflammation and IGF-I, IGF-II and IGFBP-3 were examined in CD and UC patients in remission and relapse. The patients were clinically scored using Crohn’s Disease Activity Index (CDAI) for CD patients and Activity Index (AI) for UC patients. Results: In the UC group we found correlations between IGF-I and CRP (r_s = Spearman’s rho) (r_s = –0.40, p < 0.01) and albumin (r_s = 0.46, p < 0.001), IGFBP-3 and albumin (r_s = 0.36, p < 0.01) and AI score (r_s = –0.31, p < 0.05). IGF-II correlated with CRP (r_s = –0.42, p < 0.01), IL-6 (r_s = –0.65, p < 0.001), albumin (r_s = 0.41, p < 0.01), AI score (r_s = –0.30, p < 0.05) and orosomucoid (r_s = –0.47, p < 0.001). In the CD group we found correlations between IGF-I and CRP (r_s = –0.40, p < 0.05), and albumin (r_s = –0.46, p < 0.01), IGFBP-3 and albumin (r = 0.36, p < 0.01). IGF-II correlated with IL-6 (r_s = –0.65, p < 0.001), albumin (r_s = 0.41, p < 0.01), CDAI score (r_s = –0.30, p < 0.05) and orosomucoid (r_s = –0.47, p < 0.001). Conclusions: IGF-I, IGF-II and IGFBP-3 are correlated to albumin and IGF-I and IGF-II are correlated to CRP in IBD patients. Further, IGF-II is correlated to IL-6 in IBD patients. This may suggest a correlation between inflammation and the IGF system with involvement in muscle and bone catabolism in IBD.

Clinical activity indices are essential instruments in monitoring inflammatory bowel diseases such as Crohn's disease (CD) and ulcerative colitis (UC). To subclassify components of disease indices in CD and UC, investigate technical noise in estimation of the indices, establish a signal-to-noise ratio (SNR), evaluate correlation between indices and calculate the reference change value (RCV) for selected biochemical variables in individual cases, 50 patients with CD and 49 patients with UC were included in the study. Qualitative index variables were assessed for scoring errors. The standard deviation (SD) was estimated according to a rectangular model, while SD in biochemical variable scoring was estimated according to a Gaussian model; a combined SD was also calculated. These values were investigated for their individual contribution to variation. The 95% CI of an index value was based on +/- 1.96 x SD(combined) and a change in separate biochemical variables was calculated as RCV 1.96 x radical2 x SD(combined). Correlation between different disease activity indices was assessed for unexplained variation. The Crohn's disease activity index (CDAI) had the highest variation compared to the van Hees (Hees) and the Harvey-Bradshaw index (HBI) in CD, but it also had the best SNR, whereas HBI had the lowest. In UC the clinical activity index (CAI) showed the highest variance, but the best SNR compared to Seo's activity index (AI). The 95% CI of the CDAI discriminatory activity sum of 150 in individual cases was 105-195, whereas the 95% interval for a change was +/-62.4. Self-reported wellness contributed 40% to total variance in the CDAI. Factors of clinical importance increased errors in estimates and variance of the indices. Poor correlation was obtained between activity indices, with up to 70% unexplained variance. The SD(combined) for estimated errors was as high as 23 points, with the best SNR being approximately 20. Index factors increase the sensitivity of SNRs to errors and lower the disease specificity. Sensitivity optimisation may be achieved by standardisation of the variables and their use.

Summary Background : Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract. Polyunsaturated omega‐3 fatty acids given orally may reduce the secretion of proinflammatory cytokines and hereby downregulate the inflammatory process. Aim : To assess the effects of enteral fatty acids, in the form of Impact Powder (Novartis, Switzerland), as adjuvant therapy to corticosteroid treatment on the proinflammatory and anti‐inflammatory cytokine profiles in patients with active Crohn's disease. Methods : The proinflammatory and anti‐inflammatory cytokines were measured in plasma from 31 patients with active Crohn's disease. Patients were randomized for oral intake of omega‐3 fatty acid (3‐Impact Powder) or omega‐6 fatty acids (6‐Impact Powder). Clinical and biochemical markers of inflammation were studied at baseline and after 5 and 9 weeks. Results : Within the 3‐Impact Powder group, no significant changes in concentrations of interleukin‐6, interferon‐γ, monocyte chemoattractant protein‐1, interleukin‐2, interleukin‐5 and interleukin‐10, whereas a significant differences in concentration of interleukin‐1β and interleukin‐4 were observed during therapy. Within the 6‐Impact Powder group a significant changes in concentrations of interleukin‐1β, interleukin‐6, interferon‐γ, monocyte chemoattractant protein‐1, interleukin‐2, interleukin‐4, interleukin‐5 and interleukin‐10 were observed. Conclusions : The 3‐Impact Powder showed immunomodulatory properties and might inhibit an increase of proinflammatory cytokines in contrast to the 6‐Impact Powder.