DTZ cream caused substantially fewer headaches than GTN ointment. There was no significant difference in the healing or improvement of chronic anal fissure between the treatments. DTZ may be the preferred first-line treatment for chronic anal fissure.

A prospective multifactorial study of symptoms and disturbance of gastrointestinal function has been undertaken in 50 patients with non-ulcer dyspepsia. Objective tests including solid meal gastric emptying studies, gastric acid secretion, E-HIDA scintiscan for enterogastric bile reflux, and hydrogen breath studies were carried out in all patients and validated against control data. Gastroscopy and biopsy were carried out in non-ulcer dyspepsia patients only. Non-ulcer dyspepsia patients were categorised on the basis of predominant symptoms as: dysmotility-like dyspepsia (n=22); essential dyspepsia (n= 14), gastro-oesophageal reflux-like dyspepsia (n= 11); and ulcer-like dyspepsia (n=3). In the total non-ulcer dyspepsia population, solid meal gastric emptying was delayed (T50 mean (SEM)= 102 (6)

Factors have been identified that determine the postoperative length of stay. These data may allow better planning and treatment of patients undergoing colorectal surgery.

Meckel's diverticulum occurs in about 1-3% of general population. The majority of them are asymptomatic and incidentally found at laparotomy. The most common complication due to Meckel's diverticulum in adults is intestinal obstruction. The frequency of symptoms decreases with age. Enteroliths are rarely formed in a Meckel's diverticulum and are known to cause intestinal obstruction. These should be considered in the differential diagnosis of radioopaque shadows in the plain abdominal films. We describe a rare presentation of Meckel's diverticulum in an elderly woman.

The ability to belch was evaluated by a novel test, after gaseous stomach distension to standard volume, in 16 patients after antireflux surgery and nine healthy volunteers. A structured assessment of dyspeptic symptoms was also carried out in both groups. Repeat studies in volunteers showed acceptable reproducibility for the new test of belching capacity (within-subject coefficient of variance 4.5 per cent). After antireflux surgery, patients had lower volume individual belches (median(range) 27.5(0-104) ml in patients versus 76(15-165) ml in volunteers; P less than 0.02) and belched less gas within 1 h of the stimulus than volunteers (median(range) 205(0-1363) ml in patients versus 456(45-818) ml in volunteers; P less than 0.05). Belching frequency was similar in both groups. The incidence and severity of symptoms were unrelated to belched gas volumes.