Biomedical subjects
P Asquith
Publications and source records attributed to P Asquith.
Pneumatosis coli: complication of practolol.
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IgG myeloma presenting as ulcerative colitis.
Two patients who presented with ulcerative colitis are described. Both were found to have evidence of IgG monoclonal gammopathy and Bence-Jones proteinuria. This association has been reported previously only in the presence of myelomatous infiltration of the gastrointestinal tract or in amyloidosis, and hence the cases reported appear to be unique.
Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration.
Jejunal biopsies in 33 patients with troublesome recurrent aphthous ulceration seen over one year showed eight with flat mucosa compatible with coeliac disease. All remitted completely on a gluten-free diet, both clinically and haematologically, and the aphthous ulceration did not recur. Gluten sensitivity is aetiologically important in patients with recurrent aphthous ulceration and flat mucosa, and patients with recurrent ulceration should undergo jejunal biopsy.
Histocompatibility antigens in inflammatory bowel disease. Their clinical significance and their association with arthropathy with special reference to HLA-B27 (W27).
Histocompatibility (HLA) antigen phenotypes have been studied in 100 patients with ulcerative colitis, 100 with Crohn's disease, and 283 normal controls. In addition the incidence of ankylosing spondylitis, sacroiliitis, and "enteropathic" peripheral arthropathy was determined in the patients with inflammatory bowel disease (IBD). There was no significant difference in antigen frequency between patients and controls. However, the incidence of HLA-B27 was increased in the patients complicated by ankylosing spondylitis and/or sacroiliitis in both ulcerative colitis and Crohn's disease. In contrast, none of the 29 IBD patients with "enteropathic" peripheral arthropathy had B27 antigen. Furthermore, ankylosing spondylitis was found more frequently in ulcerative colitis bearing HLA-B27 compared with non-B27 patients (P less than 0-01). The same was found in Crohn's disease, although this difference was not statistically significant. In addition, 12 of 14 ulcerative colitis patients and five out of six Crohn's patients with HLA-B27 had total colitis, compared with the frequency of total colitis in non-B27 patients (P less than 0-024 and less than 0-03 respectively). The data suggest that B27 histocompatibility antigen could be a pathogenetic discriminator between the arthropathies in IBD and may be of prognostic significance with respect to extension and severity of the disease.
Anticonnective tissue and other antitissue 'antibodies' in the sera of patients with coeliac disease compared with the findings in a mixed hospital population.
Serum IgG specificities directed against various components of basement membrane and reticulin have been described, and their incidence in 138 patients with coeliac disease has been compared with that in 110 hospital inpatients, 100 normal blood donors, and 1441 other patients. A wide variety of antitissue specificities were observed but only a few appeared to be of any significance. The 'antireticulin' specificities have been subdivided into different groups according to their distinctive histological staining patterns. Specificity directed primarily against endothelial basement membrane was found most frequently in the sera of patients with hiatus hernia (35%) or coeliac disease (22%). The same specificity was also observed in patients with myasthenia gravis and to a lesser extent in Crohn's disease and in a mixed group of patients with unspecified organic gastrointestinal disease. An epithelial basement membrane reactivity was found in patients with rheumatoid arthritis but only rarely in other conditions. Staining of perivascular connective tissue represented a third type of 'antireticulin' specificity. It was found only rarely, although in coeliac disease this reactivity was found more frequently in combination with other connective tissue specificities.
Serum lysozyme in inflammatory bowel and coeliac disease.
Serum lysozyme levels were determined by a turbidometric method using egg white lysozyme as standard in 100 patients with Crohn's disease, 86 with ulcerative colitis, 31 with coeliac disease, and in 38 normal control subjects. Though the levels in Crohn's disease were significantly higher than those in ulcerative colitis and in coeliac disease, there was marked overlap between the disorders and control subjects, and so they were of no value in differential diagnosis. There was some evidence that serum lysozyme levels reflected disease activity in Crohn's disease but not in ulcerative colitis.
Cell-mediated immunity to gluten fraction III in adult coeliac disease.
Peripheral blood lymphocytes were obtained from twenty-seven healthy control subjects, twenty-one coeliac patients on a gluten-free diet and fourteen patients on a normal diet. When the cells were cultured in vitro in the presence of 2 and 4 mg of gluten fraction III, there were significant increases in the mean ratios of response for lymphocytes from gluten-free coeliacs compared to healthy controls after 4, 5 and 6 days of culture, but for those on a normal diet significant increases were found only when using 4 mg of gluten on the 4th and 5th days of culture. When three further patients were changed from a normal to a gluten-free diet, the ratios of response for their lymphocytes increased. The results suggest that certain coeliacs may exhibit a weak delayed hypersensitivity reaction to gluten. Its more ready demonstration in patients on a gluten-free diet could be explained on the release of sensitized lymphocytes from the intestinal mucosa into the peripheral circulation after gluten withdrawal.
Letter: Lymphoid cells in jejunal mucosa.
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The importance of an innervated and intact antrum and pylorus in preventing postoperative duodenogastric reflux and gastritis.
This study has investigated the relationship between duodenogastric reflux, gastritis and certain symptoms 6-12 months after three operations for uncomplicated duodenal ulcer. The operations studied were proximal gastric vagotomy (PGV, 20 cases), truncal vagotomy and pyloroplasty (TV+P, 22 cases) and truncal vagotomy and antrectomy (TV+A, 21 cases). Duodenogastric reflux was assessed both by a radiological technique and by measuring the concentration of bilirubin in the gastric aspirate before and after operation. Incidence and severity of postoperative gastritis were determined by endoscopic biopsy. Symptoms were assessed by symptomatic score and Visick grading. There was a significant correlation between duodenal reflux and histological evidence of both severe superficial gastritis and glandular atrophy (P less than 0-01). There was also a close association between the degree of reflux and the presence of severe heartburn, epigastric pain and bile vomiting after operation. The amount of reflux did not differ before operation. There was significantly less reflux following PGV than after either TV+P (P less than 0-025) or TV+A (P less than 0-001). The results indicate that an operation which preserves an innervated and intact antrum and pylorus will protect against postoperative duodenogastric reflux, gastritis and symptoms.
Duodenogastric reflux: a cause of gastric mucosal hyperaemia and symptoms after operations for peptic ulceration.
This study has investigated the possible association between duodenogastric reflux, gastritis, and symptoms in 35 patients with or without dyspepsia one to 15 years after gastric surgery. Five patients were excluded because of biliary disease, hiatus hernia, or recurrent ulceration. The remaining 30 were assessed by a symptomatic score, measurement, of bilirubin and sodium concentrations in samples of fasting gastric juice, endoscopy, gastric biopsy, and the presence of radiological reflux. In 15 patients with a symptom score of less than the median, gastric bilirubin levels were less than 1 mg/100 ml in 80%; severe endoscopic changes were seen in only one patient and reflux was not observed. In contrast, in patients with a symptom score in excess of the median fluoroscopic and biochemical reflux was seen in 69 and 80% respectively and severe mucosal hyperaemia in half. There was a significant correlation between symptoms, gastric hyperaemia, and duodenal reflus ( P smaller than 0-02).
Oral manifestations of Crohn's disease.
In a systematic study of 100 patients with Crohn's disease, 100 with ulcerative colitis, and of 100 normal subjects matched for age, sex, and denture status, nine patients with Crohn's disease, two with ulcerative colitis, and one normal control were found to have oral lesions. In Crohn's disease, the macroscopic and histological appearances resembled those encountered elsewhere in the gastrointestinal tract and their incidence was related to the activity of the disorder. The lesions in the other two groups were different macroscopically and histologically. Production of salivary IgA was found to be reduced in Crohn's patients with active bowel disease. It is suggested that the occurrence of oral lesions in patients with Crohn's disease might represent a local immunological reaction to oral antigens.
Proceedings: Recurrent aphthous ulceration and its association with coeliac disease.
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Proceedings: A symptomatic discriminant between two important causes of dyspepsia following gastric surgery.
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Proceedings: Transfer factor in the treatment of Crohn's disease.
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Adult coeliac disease and malignancy.
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Rickets, growth, and alkaline phosphatase in urban adolescents.
Calciferol therapy for 12 months in white, Asian, and West Indian schoolchildren resulted in a highly significant increase in height and weight when compared with schoolchildren not so treated. The rate of fall of serum alkaline phosphatase was similar in both the treated and untreated schoolchildren and in other children treated in hospital for rickets. Dietary studies on 9% of the total survey by weighed inventory methods showed a low average intake of vitamin D, while random estimates of 25-hydroxycalciferol levels on 6% of the children were less than 3.8 ng/ml in 40% of those studied (principally Asian). It was concluded that there was a significant problem of vitamin D deficiency among Asian and West Indian teenagers and that white children were also affected to a less degree.
Histocompatibility antigens in patients with inflammatory-bowel disease.
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