SUMMARY A new spiral bacterium, distinct from Campylobacter pylori, was found in the gastric mucosa ofsix patients with gastrointestinal symptoms. All patients had chronic active type B gastritis and four had oesophagitis. Culture and microscopy for C pylori infection was negative. These unculturable spiral organisms were probably an incidental finding in patients presenting for upper gastrointestinal endoscopy, but it is not possible to say from this small series whether these organisms cause chronic active gastritis.The organism is helical, 3 5-7-5 um long and 0 9 gm in diameter with truncated ends flattened at the tips, and up to 12 sheathed flagella 28 nm in diameter at each pole. It is proposed that this spiral bacterium should be called "Gastrospirillum hominis Gen.nov., Sp.nov." Spiral organisms were first reported in the gastric mucosa of a dog in 1881 by Rappin'; and his observations were confirmed and extended in the dog and other mammalian species by other authors.2' In 1906 Krienitz described three types of spiral bacteria in the base of a gastric ulcer in a patient with gastric carcinoma.5 Since 1983 when Warren6 and Marshall' first described Campylobacter pylori and its association with gastritis, there has been much renewed interest in gastric microbiology and histopathology.89 Between July 1986 and July 1987, while studying patients attending endoscopy clinic for the investigation of upper gastrointestinal symptoms, we found spiral organisms unlike C pylori on Gram stained tissue smears from the gastric mucosa. Following our preliminary report on three patients,'0 we found the bacterium in a further three patients and obtained regional biopsy specimens from three of the six. Material and methodsThe patients were part ofa large study to determine the prevalence of Cpylori in the gastric mucosa ofpatients attending for upper gastrointestinal endoscopy. The study was approved by the Gloucestershire Royal Hospital ethical committee. Patients gave informed consent for endoscopy and biopsy; patients with a contraindication to biopsy were excluded. Demographic details, symptoms, medical, surgical, family, Accepted for publication 2 February 1989 social and drug history were entered on to a computer database. When these unusual spiral organisms were found in Gram stained tissue smears of the gastric mucosa the patients' notes were examined in more detail and four patients were asked to return for a second endoscopy; three agreed (cases 1-3). ENDOSCOPYThe oesophagus, stomach, and duodenum were examined and the appearances noted. Four mucosal specimens were taken from within 5 cm ofthe pylorus. Two specimens were sent for histological examination in 10% formol-saline, and two specimens, placed near the top of a 5 ml bijoux bottle containing 100 pl saline to maintain humidity, were sent for microbiological examination. Between each examination the flexible endoscopes (including all the channels) and biopsy forceps were disinfected by immersion in 2% glutaraldehyde for at least 10 minutes, rinsed in water...

In this paper we describe an endoscopic appearance of the sigmoid colon characterised by mucosal swelling, erythema and haemorrhage strictly localised to the crescentic mucosal folds. In a 5-year period these changes were seen in 34 (1.42%) of 2380 colonoscopies and fibreoptic sigmoidoscopies. The majority of patients were middle-aged or elderly. Diverticular disease was present in most (82%) but the abnormalities were confined to the crescentic mucosal folds with sparing of the diverticular orifices. The majority of patients presented with a history of bleeding per anum. Histologically there was a spectrum of changes varying from minor vascular congestion to florid active inflammatory disease with crypt architectural abnormalities mimicking ulcerative colitis, but rectal biopsies were invariably normal. Three patients later progressed to typical distal ulcerative colitis and two other patients presenting to us with endoscopic crescentic fold disease had a previous histologically documented history of distal ulcerative colitis. In three patients the histological features were of mucosal prolapse. About half the patients required some form of therapy to control their symptoms. Steroids and/or sulphasalazine were of value although two patients subsequently underwent sigmoid resection, one to control bleeding and the second for a diverticulosis-associated stricture. Whilst endoscopic crescentic fold disease represents a specific endoscopic appearance the clinical and histological features indicate a wide spectrum of disease.

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Summary:Eleven adult patients with nocturnal asthma, and gastro-oesophageal reflux documented by endoscopy or ambulatory oesophageal pH monitoring completed a double-blind cross-over study (4 week treatment, one week run-in and cross-over periods) comparing the effects of omeprazole 20 mg daily and placebo on asthma control assessed by symptoms, peak expiratory flow rate and bronchodilator usage. Omeprazole treatment did not improve asthma symptoms during the day or night, or peak expiratory flow rate readings. There was no difference in bronchodilator inhaler usage during omeprazole therapy.Treatment of gastro-oesophageal reflux with omeprazole in patients with nocturnal asthma and gastro-oesphageal reflux does not improve asthma symptoms or peak expiratory flow rate. This suggests that gastro-oesophageal reflux does not exacerbate bronchoconstriction in nocturnal asthma.

Symptomatic patients with endoscopicaily verified reflux oesophagitis were randomised to a double blind trial in which they received either omeprazole (20 mg once daily) or cimetidine (400 mg four times daily) for four, and if necessary, eight weeks. In an 'intention to treat' analysis, oesophagitis was found to have healed after four weeks in 77 of 137 (56%)

The SeHCAT test was used to investigate possible bile acid malabsorption in 166 patients presenting to a district general hospital with chronic diarrhoea of uncertain cause. Eighty-four (51%) patients had impaired SeHCAT retention. These included 23 of 28 patients with a possible type I abnormality (terminal ileal resection or disease, previous pelvic radiotherapy), 20 of 74 with a possible type II abnormality (idiopathic diarrhoea), 32 of 45 with a possible type III abnormality (post-cholecystectomy, post-vagotomy), and 9 of 19 with diarrhoea associated with diabetes. Patients with severe bile acid malabsorption demonstrated a good response to cholestyramine whereas the response in patients with a mildly abnormal SeHCAT retention was variable. Bile acid malabsorption is an important cause of diarrhoea in patients presenting with unexplained chronic diarrhoea.

From 5 centres 154 patients with ulcerative colitis and a history of smoking completed a questionnaire about the temporal relationship between diagnosis of colitis and cessation of smoking. One hundred and thirty-eight of these were ex-smokers and 107 (69.5%) had stopped smoking before the diagnosis of colitis was made. Fifty-six patients (52%) developed colitis within 3 years of stopping smoking. The findings suggest that smoking exerts protective effect against the development of ulcerative colitis.

Gastric mucosal concentrations of erythromycin, amoxycillin, ampicillin and ciprofloxacin were determined in patients at upper gastrointestinal endoscopy 38-480 min after a 500 mg dose of erythromycin ethyl succinate, erythromycin stearate, amoxycillin, pivampicillin or ciprofloxacin. All the agents attained concentrations greater than the MIC 90 for Campylobacter pylori. The macrolides attained the lowest concentrations. There was no significant difference between concentrations attained with erythromycin ethyl succinate and stearate. High concentrations were attained by amoxycillin (range 14.6-322 mg/kg) and pivampicillin (range 47.5-209 mg/kg). Ciprofloxacin attained very high concentrations (range 35-1762 mg/kg); inhibitory concentrations 35 mg/kg) were still present at 6 h after the dose. Ciprofloxacin and erythromycin are ineffective in vivo despite these high gastric mucosal concentrations. Penetration into the gastric mucus and crypts where C. pylori is found will be determined by physicochemical properties of the antimicrobials, such as pKa, stability, activity over a wide range of pH, and lipid solubility.