biopsy in our patients did not show evidence of Crohn's disease, but there was unequivocal evidence of Crohn's disease elsewhere. Furthermore, the failure of symptoms in patients who do not smoke to respond to treatment suggests peptic ulceration associated with Crohn's disease. Treatment with omeprazole led to prompt relief of symptoms and complete healing of ulceration, which was confirmed by endoscopy. Omeprazole is effective in resistant peptic ulceration,' but there is only one report of its use in Crohn's disease.4 A proton pump inhibitor, it is capable of maintaining high intragastric pH for long periods. Its effectiveness in our two patients suggests that duodenal ulceration in Crohn's disease is dependent on acid. If prolonged active ulceration can cause pyloric stenosis then intermittent omeprazole treatment might prevent this complication in patients with Crohn's disease. Our observations support the view that inhibition of acid production is more likely to heal duodenal ulceration associated with Crohn's disease than steroid treatment, which may lead to complications such as perforation or haemorrhage.

One hundred patients with rectal adenocarcinoma were examined preoperatively with rectal endosonography (ES) and 50 were also examined with computed tomography (CT). ES predicted mesorectal lymph node involvement with an accuracy of 83 per cent, sensitivity of 88 per cent, specificity of 79 per cent, positive predictive value of 78 per cent and negative predictive value of 89 per cent. CT in comparison had an accuracy of 57 per cent, sensitivity of 25 per cent, specificity of 91 per cent, positive predictive value of 75 per cent and negative predictive value of 53 per cent. No particular histological architectural feature could be identified as responsible for false positive diagnosis though nodal size was significantly larger in the true positive and false positive group when compared with the true negatives (P less than 0.001 and P less than 0.01 respectively).

Forty-four patients with primary rectal cancers and six patients with benign rectal lesions were examined pre-operatively digitally, with endorectal sonography (ELU) and also computed tomography (CT). Digital examination of the rectal cancers had an overall accuracy of 68 per cent and predicted invasion beyond the muscularis propria with a sensitivity of 68 per cent, specificity of 83 per cent, positive predictive value of 100 per cent and negative predictive value of 46 per cent. In comparison CT had an accuracy of 82 per cent, sensitivity of 86 per cent, specificity of 62 per cent, positive predictive value of 91 per cent and negative predictive value of 50 per cent. ELU was the most reliable indicator of local invasion in rectal cancer when compared with postoperative histopathology with an accuracy of 91 per cent, sensitivity of 94 per cent, specificity of 87 per cent, positive predictive value of 97 per cent and negative predictive value of 78 per cent.

No abstract

We have evaluated oesophageal function in 34 diabetics and in 16 non-diabetic controls by a timed bolus transit method derived from dynamic oesophageal scintiscans (water transit time: WTT) and barium swallow. The diabetics were screened for autonomic neuropathy using standard cardiovascular responses and 10 patients were classified as abnormal. WTT was significantly prolonged in autonomic neuropaths compared with other diabetics (p less than 0.01) and controls (p less than 0.001). Abnormal peristalsis on barium swallow was seen more frequently in autonomic neuropaths (9/10) than in other diabetics (11/24, p less than 0.002). WTTs from all diabetic patients correlated with abnormal heart rate responses at rest (Rs = - 0.49, p less than 0.005), on deep inspiration (Rs = -0.48, p less than 0.005), and on standing (Rs = -0.39, p less than 0.025) but not with the Valsalva manoeuvre. A weaker correlation was found between the postural fall in blood pressure (Rs = 0.3, p less than 0.05). Diabetics with autonomic neuropathy frequently have asymptomatic oesophageal dysfunction which may result from a vagal neuropathy in view of its association with abnormalities of vagally mediated cardiovascular responses.

The esophageal transit times of small- and medium-sized barium sulfate tablets were measured using x-ray fluoroscopy in 50 patients after swallowing while in both erect and supine positions with a 15-mL drink, and the esophageal transit times of large round and oval barium sulfate tablets were similarly measured in 25 patients. When tablets were swallowed by subjects who were standing, no difference was found between the transit times of small and medium tablets, but large oval tablets had significantly shorter times than did large round tablets (P less than .04). The transit times of both small and medium tablets were significantly shorter than those of oval (P less than .05) and large round tablets (P less than .02). Retention of large oval and round tablets in the esophagus occurred in 20% of patients after swallowing while in the standing position. No medium-sized tablet was retained, but in 4% of patients, a small tablet remained in the esophagus. Tablets that were retained in the esophagus remained there for five minutes, when they were washed down by a further drink. When tablets were swallowed in the lying position, no significant differences in transit times were found between any of the four tablets. Retention of tablets within the esophagus occurred in over 60% of patients with all four tablets after ingestion while in the supine position. Tablets stuck mainly in the lower esophagus above the lower esophageal sphincter, but after swallowing in the standing position, a significant proportion (33% [P less than .01]) stuck in the upper esophagus.(ABSTRACT TRUNCATED AT 250 WORDS)

Eighty-five patients treated surgically for rectal cancer have been followed up by conventional clinical examination, sigmoidoscopy, and endosonography. Local recurrence was diagnosed in 22 patients. Nineteen of these had either sigmoidoscopic or digital evidence of recurrence and three were diagnosed solely by endosonography. In all cases endosonography gave additional information on which to base management decisions. Routine use of endosonography should allow the detection of early recurrence in a larger number of patients.

Thoracic CT appears to improve the accuracy of pulmonary staging in CRC allowing a more appropriate level of intervention. However, CT is likely to identify more benign radiological abnormalities than CXR alone, and investigations should not occur to the detriment of treating the primary tumour.