SUMMARY Oesophageal mucosal biopsies were incubated in 20, 2, and 0.2 mM solutions of cholic, chenodeoxycholic, ursodeoxycholic, and deoxycholic bile acids. Both conjugated and unconjugated bile acids were studied at pH 1 and 7 singly and in combination. Observations were also made using 0.1 N hydrochloric acid and human gastric juice at pH 1-3 and 7-8. After incubation for up to 15 minutes the mucosa was examined under transmission electron microscopy. We concluded that high and moderate concentrations of all the common bile acids damaged the oesophagus irrespective of the pH, that low concentrations of bile acids were damaging only at high acid levels, and that damage to the epithelium did not occur when the pH of the gastric juice had been raised.Oesophagitis is a common problem which is related to retrograde reflux of gastrointestinal secretions.' 4 We have developed a system of incubation of mucosal biopsies to examine which components of gastrointestinal fluids are important in causing damage,56 and have demonstrated that many constituents could be toxic.5 The roles of bile acids and hydrogen ions are particularly important because they are major components of refluxing material. H2-receptor antagonists effectively reduce the hydrogen ion content of gastric secretion and thus the composition of material to which the oesophagus is imposed during an episode of reflux. It was therefore decided to study the effects of different physiological concentrations of human bile acids and the effects of both high and low hydrogen ion concentration. Methods PATIENTSThirty-five patients were studied. All were undergoing investigation by upper gastrointestinal endoscopy for abdominal symptoms. The patients were taking a variety of drugs all of which were omitted for six hours before the endoscopy. Four patients were receiving a course of therapy with cimetidine. None of the patients had endoscopic evidence of oesophagitis. After the endoscopic examination had been completed using a forward-viewing instrument, Received for publication 18 November 1980 the endoscope was withdrawn to a point 10 cm proximal to the apparent junction of the oesophageal and gastric mucosa and multiple biopsies were taken with the endoscopy forceps. The biopsies were incubated immediately at 37°C in the test solutions for five, 10, or 15 minutes, and then immersed in 3 % glutaraldehyde at 4°C at pH 7.2 in 0 1 M cacodylate. To confirm the normality of the oesophageal mucosa, control biopsies taken at the same time were immediately fixed in glutaraldehyde. All the samples were post-fixed with osmium tetroxide, dehydrated, and embedded in Araldite. Thin sections were cut, stained with uranyl acetate and lead nitrate, and examined with a Jeol Cx100 electron microscope at 60 KV.All the incubations were performed in duplicate, triplicate, or quadruplicate. The incubation mixtures were as follows, with number of patients studied in parentheses.1. Model conjugated bile acid solutions at pH 7, in concentrations of 20, 2, and 0-2 mM, containing a mixtur...

Gallstones were definitely more common in both sexes at all ages over 40 in the last 25 years. Changes in the cholecystectomy rates are only partly explained by changes in gallstone prevalence, and are more determined by surgical practice.

SummaryIn a series of 645 patients with epilepsy only 38 had attacks exclusively during sleep. A further 111 had attacks while waking and sleeping. The total number of patients whose epilepsy started with sleep attacks and who later developed attacks when waking increased with each successive year. The prognosis of sleep epilepsy is important in relation to the granting of driving licences. IntroductionThe recent revision of the regulations concerning driving and

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Summary:The direct urease test was used in 462 patients with normal upper digestive tracts, 108 with duodenal ulcers and 43 with gastric ulcers who attended for upper digestive endoscopy in a prospective study. There was a strong association between Helicobacterpylori infection and current cigarette smoking in patients with normal endoscopy (49.6% vs 35.5%, P < 0.01). The associations of peptic ulcer both with H. pylon infection and cigarette smoking were also confirmed.