SUMMARY In a prospective, randomised clinical trial, 47 patients with severe, acute, noninfective colitis treated with 60 mg intravenous prednisolone daily, received either bowel rest with parenteral nutrition or oral diet. Although those who received 'bowel rest' experienced a reduction in daily stool weight, there were no differences in the operation or mortality rates between the groups. Fourteen of the 27 patients with ulcerative colitis, but none of the 16 patients with Crohn's disease required urgent surgery. Bowel rest did not affect the outcome in severe ulcerative colitis treated with intravenous prednisolone. Ulcerative colitis and Crohn's colitis behaved differently in the acute attack.Severe attacks of colitis are uncommon but potentially dangerous, particularly if urgent surgical treatment is needed.' 2 Medical treatment of severe colitis relies upon intravenous corticosteroids and nutritional replacement. There has been considerable interest in the use of parenteral nutrition as a possible treatment to reduce mucosal inflammation. The concept of 'bowel rest' is theoretically attractive and one might expect that inflamed intestine would heal more quickly if relieved of mechanical trauma, intestinal secretions, and the antigenic challenge of food. The only controlled trial so far published was not encouraging3 and the present trial was designed to study further the effect of 'bowel rest' in patients with severe attacks of non-infective colitis. Methods PATIENTSA diagnosis of non-specific colitis was established by endoscopy and/or barium enema, in the absence of specific infection or possibility of antibiotic associated colitis.Patients were admitted to the trial if they presented with an attack of colitis severe enough to necessitate admission to hospital and to require treatment with intravenous prednisolone. They were excluded from entry if, at the time of presentation, they exhibited Addrcss for corrcspondcncc: Professor J E Lennard-Jones. St Mark's Hospital, London ECI V 2PS.

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Background : The relationship between Helicobacter pylori infection and non‐ulcer dyspepsia is not established. Aim : To determine whether eradication of H. pylori might be of benefit in non‐ulcer dyspepsia patients. Methods : We randomly assigned 129 H. pylori infected patients with severe epigastric pain, without gastro‐oesophageal reflux symptoms, to receive twice daily treatment with 300 mg of ranitidine, 1000 mg of amoxicillin, and 500 mg of clarithromycin for 7 days and 124 such patients to receive identical‐appearing placebos. Results : Treatment was successful (decrease of symptoms at 12 months) in 62% of patients in the active‐treatment group and in 60% of the placebo group (N.S.). At 12 months, the rate of eradication of H. pylori was 69% in the active‐treatment group and 18% in the placebo group (P < 0.001). Complete relief of symptoms occurred significantly more frequently in patients on the active treatment (43%) than in placebo‐treated patients (31%, P=0.048). Within the active‐treatment group, therapeutic success was significantly more frequent in the non‐infected patients (84% vs. 64%, P=0.04). Conclusions : Although eradicating H. pylori is not likely to relieve symptoms in the majority of patients with non‐ulcer dyspepsia, a small proportion of H. pylori‐infected patients may benefit from eradication treatment.