Hepatic steatosis and fibrosis produce abnormal echo patterns on ultrasound scanning, but the potential of ultrasound scanning for diagnosing these conditions in routine clinical practice is uncertain. A prospective comparative study of 85 patients with histologically assessed liver conditions was performed, and specificity was assessed in 76 patients with functional bowel disease who were presumed to have normal livers.Histological examination showed steatosis ranging from mild to severe in 48 patients and fibrosis ranging from increased fibrous tissue to established cirrhosis in 35 patients. Ultrasound scanning accurately identified steatosis, recognising 45 cases (sensitivity 94%) with a specificity of 84%. Fibrosis was less reliably detected (sensitivity 57% and specificity 88%). Of the 50 patients with alcoholic liver disease, 47 (94%) yielded abnormal results on scanning. In the 76 patients with functional bowel disease there was only one false positive result, giving a specificity of 99% in this group.As hepatic steatosis is the earliest change in alcoholic liver disease and seems to be of prognostic importance for the development of cirrhosis, ultrasound scanning provides an effective screening procedure, particularly in the occult alcoholic, who often presents with non-specific gastrointestinal complaints.

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A sliding hiatus hernia disrupts both the anatomy and physiology of the normal antireflux mechanism. It reduces lower oesophageal sphincter length and pressure, and impairs the augmenting effects of the diaphragmatic crus. It is associated with decreased oesophageal peristalsis, increases the cross-sectional area of the oesophago-gastric junction, and acts as a reservoir allowing reflux from the hernia sac into the oesophagus during swallowing. The overall effect is that of increased oesophageal acid exposure. The presence of a hiatus hernia is associated with symptoms of gastrooesophageal reflux, increased prevalence and severity of reflux oesophagitis, as well as Barrett's oesophagus and oesophageal adenocarcinoma. The efficacy of treatment with proton pump inhibitors is reduced. Our view on the significance of the sliding hiatus hernia in gastrooesophageal reflux disease has changed enormously in recent decades. It was initially thought that a hiatus hernia had to be present for reflux oesophagitis to occur. Subsequently, the hiatus hernia was considered an incidental finding of little consequence. We now appreciate that the hiatus hernia has major patho-physiological effects favouring gastro-oesophageal reflux and hence contributing to oesophageal mucosal injury, particularly in patients with severe gastro-oesophageal reflux disease.

SUMMARYBackground: Diverticular disease emerged as a common problem in Western countries over the course of the 20th century. Aims: To determine the time trends in diverticular disease for hospital admissions in England between