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Background-H 2 receptor blockers and proton pump inhibitors reduce intestinal output in patients with short bowel syndrome. Aims-To evaluate the eVect of intravenous omeprazole and ranitidine on water, electrolyte, macronutrient, and energy absorption in patients with intestinal resection. Methods-Thirteen patients with a faecal weight above 1.5 kg/day (range 1.7-5.7 kg/day and a median small bowel length of 100 cm were studied. Omeprazole 40 mg twice daily or ranitidine 150 mg twice daily were administered for five days in a randomised, double blind, crossover design followed by a three day control period with no treatment. Two patients with a segment of colon in continuation were excluded from analysis which, however, had no influence on the results. Results-Omeprazole increased median intestinal wet weight absorption compared with no treatment and ranitidine (p<0.03). The eVect of ranitidine was not significant. Four patients with faecal volumes below 2.6 kg/day did not respond to omeprazole; in two absorption increased by 0.5-1 kg/day; and in five absorption increased by 1−2 kg/day. Absorption of sodium, calcium, magnesium, nitrogen, carbohydrate, fat, and total energy was unchanged. Four high responders continued on omeprazole for 12-15 months, but none could be weaned from parenteral nutrition. Conclusion-Omeprazole increased water absorption in patients with faecal output above 2.50 kg/day. The eVect varied significantly and was greater in patients with a high output, but did not allow parenteral nutrition to be discontinued. Absorption of energy, macronutrients, electrolytes, and divalent cations was not improved. The eVect of ranitidine was not significant, possibly because the dose was too low. (Gut 1998;43:763-769) Keywords: short bowel syndrome; human; diarrhoea; ranitidine; omeprazole Patients with a short bowel and high intestinal output are at risk of developing malnutrition, and salt and water depletion due to the excessive faecal loss of energy, fluid, and electrolytes. A negative energy, fluid, and electrolyte balance may necessitate prolonged parenteral supplementation, imposing the need for a central venous catheter. A high intestinal output thus has a major impact on the quality of life in these patients, who experience restrictions in social and leisure activities.

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With the current protocols for HPN treatment, the annual decline in BMD is moderate and not significantly larger than in age- and sex-matched healthy subjects. A considerable part of the metabolic bone disease in these patients is related to the underlying disease for which the HPN was indicated.

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At inclusion the BMC of the spine and femoral neck was low in patients with Crohn's disease. During the study significant bone loss was only demonstrated in the femoral neck. BMC or rate of change in BMC was not related to treatment with steroids or length of the resected small intestine.

To examine the effect of endogenous oestrogens on calcium metabolism during the menstrual cycle, fasting blood and urinary samples were obtained every day throughout the menstrual cycle in 5 young women.Bone turnover was estimated by serum alkaline phosphatase and fasting urinary excretions of hydroxyproline and calcium. Serum levels of oestradiol (E2), oestrone (E1), and androstenedione (A) showed the well known cyclic fluctuations, the serum 1,25-dihydroxyvitamin D (1,25(OH)2D) nearly doubled from the early follicular phase to the time of ovulation, although 25-hydroxyvitamin D (25OHD) and 24,25-dihydroxyvitamin D (24,25(OH)2D) were almost unchanged. No correlation between the rise in the serum 1,25(OH)2D level and the measured parameters of calcium metabolism was observed.

Tjellesen, L. & Christiansen, C. Vitamin D metabolites in normal subjects during one year. A longitudinal study. Scand f. d i n . Lab. invest. 43, 85-89, 1983. The serum concentrations of 25-hydroxycholecalciferol (250HD,), 25hydroxyergocalciferol (250HD,), 24,25-dihydroxyvitamin D (24,25(OH),D), and 1,25-dihydroxyvitamin D (1,25(OH),D) were measured in 10 normal sub jects every 2 months for 1 year.Parallel seasonal variations were found in serum 25-hydroxycholecalciferol and 24,25-dihydroxyvitamin D reaching maximum values in June. Moreover, a highly significant correlation between changes in these two metabolites was observed (r = 0.89, P