Introduction Patients with Crohn’s disease (CD) often have low levels of vitamin D (Vit D). Initially considered to be secondary to active disease, there is growing evidence that Vit D has a role in immune regulation and that deficiency might contribute to flares of disease. If this hypothesis is correct, CD should exhibit discernible seasonal fluctuations in activity, associated with changing Vit D levels, but studies over three decades have produced conflicting results. Method Severely active CD requires hospitalisation. We retrospectively analysed consecutive admissions over 44 months (Feb 2010-Sept 2013) to our two district general hospitals in outer North East London, where the primary diagnosis was CD. Admissions lasting less than two days were excluded, to avoid counting patients attending for elective investigations or treatment. Variation in Vit D levels in our locality was modelled from the proportion of primary care patients deficient in Vit D (serum total 25(OH)D <25 nmolL) each month from Oct 2012 to Sept 2013. 31,000 requests for Vit D levels were made by GPs during this period. Seasonal variations in and associations between Vit D levels and admissions for CD were assessed by Hewitt’s test1and Spearman rank correlation, respectively. Results 385 admissions for CD were recorded in the 44 month period. 40% more admissions occurred December–May than June–November (p < 0.05). We observed the expected seasonal variation in Vit D levels (p < 0.01). The curves for monthly admissions plotted alongside percentage of Vit D deficiency coincide, with a correlation coefficient of 0.65, p < 0.05, see Figure 1. Conclusion Our study confirms seasonal variation in admissions to hospital for CD in outer NE London and suggests for the first time in the UK that more than 40% of this fluctuation might be accounted for by changes in Vit D levels. Since we used community levels as a surrogate for the Vit D levels of our patients, the influence of active disease secondarily lowering Vit D can be discounted. Our results justify the systematic assessment of Vit D levels in patients with CD and give further impetus to evaluation of Vit D supplementation. Disclosure of interest None Declared. Reference Walter SD. Exact significance levels for Hewitt’s test for seasonality. J Epidemiol Community Health 1980;34:147–149

The prothrombin time with Manchester and ox thromboplastins, the 'P & P' test of Owren and Aas, the partial thromboplastin time, the thrombin time and assays for factors II, V, VII, VIII:C, IX and X were performed by one observer in 18 patients with liver disease and 27 normal subjects; the prothrombin time and partial thromboplastin time were also carried out on another 28 similar patients by various observers. Routine liver function tests were measured in all patients. The prothrombin time with Manchester thromboplastin was well correlated with other clotting tests, and performing the other tests did not add to the information. Discriminant function analysis confirmed that clotting tests did not distinguish between different types of liver disease. Correlations between clotting tests and liver function tests reflected liver cell damage but were also influenced by acute phase reactions.

Background and aims Dietary microparticles, which are bacteria-sized and non-biological, found in the modern Western diet, have been implicated in both the aetiology and pathogenesis of Crohn's disease. Following on from the findings of a previous pilot study, we aimed to confirm whether a reduction in the amount of dietary microparticles facilitates induction of remission in patients with active Crohn's disease, in a single-blind, randomized, multi-centre, placebo controlled trial. Methods Eighty-three patients with active Crohn's disease were randomly allocated in a 2×2 factorial design to a diet low or normal in microparticles and/or calcium for 16 weeks. All patients received a reducing dose of prednisolone for 6 weeks. Outcome measures were Crohn's disease activity index, Van Hees index, quality of life and a series of objective measures of inflammation including erythrocyte sedimentation rate, C-reactive protein, intestinal permeability and faecal calprotectin. After 16 weeks patients returned to their normal diet and were followed up for a further 36 weeks. Results Dietary manipulation provided no added effect to corticosteroid treatment on any of the outcome measures during the dietary trial (16 weeks) or follow-up (to 1 year); e.g., for logistic regression of Crohn's disease activity index based rates of remission (P=0.1) and clinical response (P=0.8), in normal versus low microparticle groups. Conclusions Our adequately powered and carefully controlled dietary trial found no evidence that reducing microparticle intake aids remission in active Crohn's disease.

The cause of postoperative liver dysfunction is often unclear, but a decrease in liver blood flow during anesthesia and/or major surgery may be important. Plasma half-life and clearance of indocyanine green were therefore measured in 42 patients before, during and after anesthesia and abdominal surgery. In 13 patients, liver blood flow was also estimated from indocyanine green extraction using hepatic vein catheterization. The major finding was an early decrease in estimated liver blood flow after induction of anesthesia, but not later during or after surgery. Mean indocyanine green half-life increased by 26% (p < 0.005), mean indocyanine green plasma clearance decreased by 19% (p < 0.01) and mean estimated hepatic blood flow decreased by 36% (p < 0.005) during the first 30 min of anesthesia. These changes were greater in males and in patients older than 55 yr, but changes were similar with each of three anesthetic groups. Half-life, but not indocyanine green clearance, was also significantly prolonged by mid-operation in the older (> 55 yr) patients and in those undergoing lower abdominal surgery. We suggest that this period of reduced liver blood flow during anesthesia is caused by the effects of neuromuscular blocking agents and may contribute to postoperative liver damage.

A double-blind trial of low versus high osmolar contrast media in ERCP was performed. The results provide convincing evidence that the incidence of both biochemical and clinical pancreatitis is higher when the conventional high osmolar medium is used. It is therefore suggested that low ionic contrast media should be used routinely in ERCP.

We have studied intestinal function and liver blood flow in Thai adults with complicated and uncomplicated falciparum malaria. The absorption of 3 orally administered test sugars, D-xylose, 3-O-methyl-D-glucose, and L-rhamnose, was greatly reduced in complicated malaria, while the lactulose/rhamnose absorption ratio was significantly increased. Hepatic blood flow was concomitantly reduced in severe malaria. These deviations reverted to normal in convalescence. Neither sugar absorption nor liver blood flow was reduced in uncomplicated falciparum malaria.

Two patients with autoimmune hepatitis B negative chronic hepatitis and febrile panniculitis are described. On each occasion the panniculitis responded to increasing the doses of prednisolone.

Acute pancreatitis has a high morbidity and significant mortality. Among its many causes ethanol is pre-eminent, but many other drugs have also been incriminated. This article begins with a definition of the mechanisms, pathogenesis and clinical features of acute pancreatitis; it then critically reviews the evidence for drugs, excluding ethanol, as being causative. The drugs which have been implicated are considered under 3 headings: definite associations, probable associations and unlikely associations. A brief outline of possible treatment, strategies and prognosis associated with acute pancreatitis concludes the article.

Acute pancreatitis has a high morbidity and significant mortality. Among its many causes ethanol is pre-eminent, but many other drugs have also been incriminated. This article begins with a definition of the mechanisms, pathogenesis and clinical features of acute pancreatitis; it then critically reviews the evidence for drugs, excluding ethanol, as being causative. The drugs which have been implicated are considered under 3 headings: definite associations, probable associations and unlikely associations: A brief outline of possible treatment, strategies and prognosis associated with acute pancreatitis concludes the article.

elimination half-life 125 -, kinetics 129

The effects of cimetidine (400 mg b.d.) and ranitidine (150 mg b.d.) on high-density lipoprotein (HDL) subclasses and other plasma lipoproteins were studied in 18 men and 15 women with reflux oesophagitis and/or duodenitis. Serum testosterone and sex hormone binding globulin (SHBG) concentrations were also measured. Treatment with either drug was continued for 12 weeks. Ranitidine had no significant effect on any measured variable in either men or women. Cimetidine had no effect in men, but in women it raised the cholesterol concentration in the HDL2 subclass by 15% after 8 weeks, and by 48% after 12 weeks. In females, cimetidine also reduced the concentrations of SHBG (by 24% at 12 weeks) and of total testosterone (by 25% at 12 weeks). The significance of these latter changes is uncertain, however, as estimates of the biologically active free testosterone concentration were unchanged.

In patients undergoing upper gastrointestinal endoscopy, benign oesophageal strictures were significantly more frequent (p less than 0.01) in those with severe tooth loss than in controls of the same age. This may be because of edentulous patients eating less solid and more liquid food, which would otherwise dilate the lower oesophagus, or poor salivary flow leading to both tooth loss and impaired neutralisation of refluxed gastric acid, or malnutrition. No association was found, however, between either oesophagitis or hiatus hernia and dentition.