Objective: To study trends in multiple pregnancies not explained by changes in maternal age and parity patterns. Design: Trends in population based figures for multiple pregnancies in Denmark studied from complete national records on parity history and vital status. Population: 497 979 Danish women and 803 019 pregnancies, 1980-94. Main outcome measures: National rates of multiple pregnancies, infant mortality, and stillbirths controlled for maternal age and parity. Special emphasis on primiparous women >30 years of age, who are most likely to undergo fertility treatment. Results:The national incidence of multiple pregnancies increased 1.7-fold during 1980-94, the increase primarily in 1989-94 and almost exclusively in primiparous women aged >30 years, for whom the adjusted population based twinning rate increased 2.7-fold and the triplet rate 9.1-fold. During 1989-94, the adjusted yearly increase in multiple pregnancies for these women was 19% (95% confidence interval 16% to 21%) and in dizygotic twin pregnancies 25% (21% to 28%). The proportion of multiple births among infant deaths in primiparous women >30 years increased from 11.5% to 26.9% during the study period. The total infant mortality, however, did not increase for these women because of a simultaneous significant decrease in infant mortality among singletons. Conclusions: A relatively small group of women has drastically changed the overall national rates of multiple pregnancies. The introduction of new treatments to enhance fertility has probably caused these changes and has also affected the otherwise decreasing trend in infant mortality. Consequently, the resources, both economical and otherwise, associated with these treatments go well beyond those invested in specific fertility enhancing treatments.

Small intestinal permeability is frequently abnormal in diarrhea-predominant IBS. Those without a history of infectious onset appear to have a more severe defect.

Background Small-bowel capsule endoscopy is advocated and repeat upper gastrointestinal (GI) endoscopy should be considered for evaluation of recurrent or refractory iron deficiency anemia (IDA). A new device that allows magnetic steering of the capsule around the stomach (magnetically assisted capsule endoscopy [MACE]), followed by passive small-bowel examination might satisfy both requirements in a single procedure. Methods In this prospective cohort study, MACE and esophagogastroduodenoscopy (EGD) were performed in patients with recurrent or refractory IDA. Comparisons of total (upper GI and small bowel) and upper GI diagnostic yields, gastric mucosal visibility, and patient comfort scores were the primary end points. Results 49 patients were recruited (median age 64 years; 39 % male). Combined upper and small-bowel examination using the new capsule yielded more pathology than EGD alone (113 vs. 52; P < 0.001). In upper GI examination (proximal to the second part of the duodenum, D2), MACE identified more total lesions than EGD (88 vs. 52; P < 0.001). There was also a difference if only IDA-associated lesions (esophagitis, altered/fresh blood, angioectasia, ulcers, and villous atrophy) were included (20 vs. 10; P = 0.04). Pathology distal to D2 was identified in 17 patients (34.7 %). Median scores (0 – 10 for none – extreme) for pain (0 vs. 2), discomfort (0 vs. 3), and distress (0 vs. 4) were lower for MACE than for EGD (P < 0.001). Conclusion Combined examination of the upper GI tract and small bowel using the MACE capsule detected more pathology than EGD alone in patients with recurrent or refractory IDA. MACE also had a higher diagnostic yield than EGD in the upper GI tract and was better tolerated by patients.

Background: Active distal ulcerative colitis is often resistant to topically acting oral formulations. We speculated that the left side of the colon is underexposed to orally‐dosed topical agents in patients with active distal colitis. Methods: Twenty‐two healthy volunteers (12 males, aged 22–47 years), and 10 patients (6 males, aged 33–73 years) with active left‐sided ulcerative colitis ingested a Eudragit‐coated gelatine capsule containing 111In‐labelled amberlite resin on four successive days. Regional colonic distribution, transit times and percentage of daily dose resident were calculated from the average of four serial gamma camera images on the 4th day. Results: (mean [95% CI]). When compared to controls, patients with colitis had significantly faster total colon transit (24.3 h [9.5–39.1] vs. 51.7 h [41.1–62.3]) as well as faster proximal colon transit (18.7 h [9.1–28.3] vs. 36.7 [28.5–44.9]), and distal colon transit (3.1 h [−0.5 to 6.8] vs. 15.0 h [10.5–19.5]), respectively (all P < 0.01). Material was asymmetrically distributed in health (proximal colon 69% [63–76] vs. distal colon 31% [24–37]). This asymmetry was more extreme in colitis, with corresponding values of 91% [85–96] vs. 9% [4–15]. As a result colitics had less material in the left‐sided colon (9% [4–15] vs. 31% [24–37]), P < 0.001. Colitics had a significantly lower percentage of the daily dose resident within the left side of the colon compared to controls (13% [−2 to 28] vs. 63% [44–81]), P < 0.01. Conclusions: Delayed release oral formulation is asymmetrically distributed within the colon in health. This asymmetry is exaggerated in active left‐sided ulcerative colitis and, together with faster colonic transit, results in reduced exposure of the distal colon to orally‐dosed topical agents.

Bran accelerates small bowel transit and ascending colon clearance without causing symptoms in controls. Small bowel transit is rapid in IBS patients with bloating and, unlike in healthy control subjects, cannot be further accelerated by bran, which nevertheless aggravates symptoms of pain and bloating. We speculate that bran-induced bloating may originate in the colon rather than the small bowel.