Non-steroidal anti-inflammatory drugs, aspirin and newly diagnosed colitis: a case-control study.

BACKGROUND: There have been a number of reports of colitis following exposure to non-steroidal anti-inflammatory drugs (NSAIDs) and salicylates. AIM: To conduct a case-control analysis of new cases of colitis, with particular reference to the usage of NSAIDs and salicylates prior to the development of the disease. METHODS: One hundred and five consecutive new cases of colitis presenting to a single gastroenterologist were questioned about their recent usage of NSAIDs and salicylates. For comparison, the frequency of usage of these compounds was studied in two groups of 105 age- and sex-matched controls taken from hospital in-patients and community cases attending the Accident and Emergency Department. RESULTS: Of the 105 cases of colitis studied, 78 patients (74%) had been taking NSAIDs or salicylates prior to or during the development of their disease. By comparison, 20% of community controls were using NSAIDs or salicylates (P < 0.001) and 30% of hospital in-patients were taking these compounds (P < 0.001). Comparison of these frequencies with those of the colitis group gave odds ratios of 9.1 (4.5, 21.9) with the community controls and 6.2 (3.2, 13.5) with the hospital controls. CONCLUSIONS: In new patients presenting with colitis, there is a significantly high frequency of antecedent exposure to NSAIDs or salicylates, supporting the concept that these agents may be important in the pathogenesis of colitis.

Assessing dyspepsia in general practice.

The value of the symptom pattern in achieving an accurate diagnosis in dyspeptic disease is still controversial. A number of investigators have used it to distinguish those patients who are at a high risk of serious disease (ulcer or cancer) from those who are not. Such findings have important implications for patient management, both in clinical and economic terms.

A survey of peptic ulcers associated with NSAIDs.

A five year retrospective analysis of endoscopically proven peptic ulceration related to the administration of non-steroidal anti-inflammatory drugs (NSAIDs) was carried out in the Island of Jersey. The results were compared with those of a control group of patients who had not been taking these drugs. Analysis of the data showed a high incidence of pre-pyloric and pyloric rim ulcers in those patients taking NSAIDs, and this was particularly evident in elderly females. Additionally, combined ulcers (i.e. ulcers in two or more anatomical sites) were more prevalent in the patients taking NSAIDs, and such induced ulcers were more liable to bleed and require surgery. The author poses a number of questions to which answers may be found in a more controlled prospective study into the phenomenon.

Plasmaphoresis and plasma exchange in the treatment of hyperlipaemia and xanthomatous neuropathy in patients with primary biliary cirrhosis.

Two patients with primary biliary cirrhosis who were increasingly incapacitated by xanthomatous neuropathy are described. Treatment with a low fat diet and cholestyramine was unhelpful but repeated plasmaphoresis by simple venesection in one and plasma exchange using an IBM blood cell separator in the other over a period of several months completely relieved the symptoms of the neuropathy, caused skin xanthomata to recede, and lowered plasma lipid levels in both patients. There was no evidence that this procedure was associated with any deleterious effects on the liver. The size of the cholesterol pool in xanthomata in one patient was estimated to be approximately 35 g, and from the plasma cholesterol response to plasmaphoresis at varying frequency it was suggested that the excess of cholesterol synthesis over degradation was less than 0.3 g/day in one patient and less than 0.4 g/day in the other. On the basis of the response in these patients it is suggested that the turnover rates of lipid pools are relatively slow in biliary cirrhosis and that cholesterol accumulation is more likely to be due to a reduced catabolic rate than to an increased synthetic rate of cholesterol. Plasmaphoresis or plasma exchange are useful methods of treatment for the rare patient afflicted by this resistant and distressing complication of biliary cirrhosis.

Human leucocyte antigens in Crohn's disease and ulcerative colitis.

The frequency of occurrence of 15 of the commoner human leucocyte antigens was determined in 18 patients with Crohn's disease and in 16 patients with ulcerative colitis, using an in-vitro lymphocyte cytotoxicity test (Harris, Wentzel, Cocking, Dodsworth, and Ukaejiofo, 1970). The overall results showed that, with the exception of human leucocyte antigen 3 in patients with Crohn's disease, in neither disease was there any major difference in any of the other antigen frequencies compared with a panel of 50 healthy controls. Nor was there an excess frequency of any particular antigen occurring in both Crohn's disease and colitis.

Endocrine tumour in kidney affecting small bowel structure, motility, and absorptive function.

A 44-year-old woman is described with an endocrine tumour arising in the kidney. There were associated abnormalities of small intestinal morphology, motility, and absorptive function. These abnormalities reversed on removal of the tumour. Detailed studies showed that the tumour contained, and was secreting, glucagon. It is postulated that the intestinal abnormalities may have resulted from glucagon itself or another, as yet unidentified, hormone.