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Abstract. Background-Short chain fatty acid (SCFA) deficiency is associated with colitis in animals and humans, and the mucosal metabolism of these compounds is decreased in ulcerative colitis. Aims-To assess the efficacy of topical SCFA treatment in ulcerative colitis. Patients and Methods-103 patients with distal ulcerative colitis were entered into a six week, double-blind, placebo controlled trial of rectal SCFA twice daily; patients who were unchanged on placebo were offered SCFA in an open-label extension trial. Results-Of the 91 patients completing the trial, more patients in the SCFA treated than in the placebo treated group improved (33% v 20%, p=0 14, NS). Those on SCFA also had larger, but statistically non-significant, reductions in every component of their clinical and histological activity scores. In patients with a relatively short current episode of colitis (<6 months, n=42), more responded to SCFA than to placebo (48% v 18%, p=003). These patients also had larger, but statistically non-significant, decreases in their clinical activity index (p=0.08 v placebo). Every patient who improved used at least five of six of the prescribed rectal SCFA irrigations, whereas only 37% who did not improve were as compliant. In the open-label extension trial, 65% improved on SCFA; these patients also had significant reductions (p<0.02) in their clinical and histological activity scores. Conclusions-Although SCFA enemas were not of therapeutic value in this controlled trial, the results suggest efficacy in subsets of patients with distal ulcerative colitis including those with short active episodes. Prolonged contact with rectal mucosa seems to be necessary for therapeutic benefit. (Gut 1997; 40: 485-491) Keywords: short chain fatty acids, distal ulcerative colitis.Treatment of distal ulcerative colitis consists mainly of topical or oral 5-aminosalicylic acid (5-ASA) compounds or corticosteroids, or both. These compounds alter the inflammatory response by decreasing oxygen free radical activity and proinflammatory cytokine release, and by modifying the lipo-and cyclooxygenase pathways of arachidonic acid metabolism.' They are relatively expensive, not uniformly effective, are not free of undesired systemic effects even in their new formula-

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INTRODUCTIONChronic idiopathic constipation is common in the general population, especially in women and the elderly. 1 Constipation is the most common gastrointestinal complaint in the US, resulting in 2.5 million physician visits every year, and hard stool is a complaint often associated with constipation. 2 This suggests that a signi®cant stool softening effect would provide a major bene®t in the treatment of chronic idiopathic constipation. The present study was conducted to compare the stool softening (stool water content) and laxative ef®cacy of psyllium vs. docusate sodium in subjects with chronic idiopathic constipation using objective and subjective measures associated with constipation.Psyllium husk (psyllium) consists of the ground husk of the psyllium seed (Plantago ovata), a mixture of polysaccharides comprised of pentoses, hexoses and uronic acids. Psyllium is a predominantly soluble ®bre in the same class of materials as other natural seed gums and plant exudates used in foods and pharmaceutical products, and is marketed as a bulk ®bre laxative. Numerous clinical studies have evaluated the effect of psyllium on laxation in subjects with constipation. 3±12 Dioctyl sodium sulphosuccinate (docusate sodium) is a synthetic anionic detergent that is marketed as a stool softener laxative. 13 Its mechanism of action is attributed to a decrease in surface tension, allowing penetration of water and fat into the faeces. Literature documenting controlled clinical trials of docusate sodium is SUMMARY Background: Stool softening is a physician's ®rst step in the management of chronic constipation. Aim: To compare stool softening (stool water content) and laxative ef®cacy of psyllium hydrophilic mucilloid vs. docusate sodium. Methods: The multi-site, randomized, double-blind, parallel-design study of 170 subjects with chronic idiopathic constipation involved a 2-week baseline (placebo) phase followed by 2 weeks of treatment. The treatment phase compared psyllium (5.1 g b.d.) plus docusate placebo to docusate sodium (100 mg b.d.) plus psyllium placebo. Stools were collected and assessed. Results: Compared to baseline, psyllium increased stool water content vs. docusate (psyllium 2.33% vs.

Measurement of meal- stimulated gastric acid secretion using manual intragastric titration is demanding in terms of personnel and specialized equipment. In the present study, we used a new method, in vivo gastric autotitration, to determine meal-stimulated gastric acid secretion. Gastric pH was measured every 4 s before, during, and after ingestion of a standard meal in 24 healthy subjects. Placebo, ranitidine (150 mg), ranitidine (75 mg), or famotidine (10 mg) was given 1 h after the beginning of the meal. Meal-stimulated gastric acid secretion was calculated from the amount of HCl required to titrate the homogenized standard meal to pH 2 in vitro (119 mmol) and the time required for the pH of the ingested meal to decrease to pH 2 in vivo. Values for pH were also converted to acid concentration (mM), and integrated acidity was calculated from the cumulative, time-weighted means of the acid concentrations for every fourth second of the postprandial recording period. Control meal-stimulated gastric acid secretion was 60 (40-71) mmol/h (median; interquartile range), and each histamine H(2)-receptor antagonist significantly decreased secretion by approximately 50%. Meal-stimulated acid secretion correlated directly with postprandial integrated gastric acidity (r = 0.72; P = 0.0001). Thus intragastric autotitration is a convenient, reproducible method for measuring gastric acid secretion after ingestion of a solid meal and offers several advantages over manual intragastric titration.

Lansoprazole effectively maintains healing of erosive esophagitis. The 15-mg and 30-mg lansoprazole doses did not differ significantly for use as maintenance treatment.