Elevations in tumor necrosis factor in alcoholic hepatitis are most marked in severe cases, suggesting that tumor necrosis factor plays a role in the pathogenesis.

SUMMARY Treatment of patients with coeliac disease with a low gluten containing diet (LGD) remains controversial. We have studied jejunal morphology and antigluten (AG) antibody titres by ELISA in patients on a LGD of 2.5-5 g/day for three to 14 months (median six months) and compared results with patients on a strict gluten free diet (GFD) for six to 27 months (median 13 months). We found no significant difference in villous height or crypt depth (eight LGD v 10 GFD patients) or serum AG-IgA, -IgG, and -IgM titres (13 LGD v 12 GFD patients). There was however, a significant increase (p<005) in intra-epithelial lymphocytes in those patients on a LGD. We conclude that adult coeliac patients can tolerate a LGD without gross morphological change and without initiating significant AG antibody responses.After the discovery that gluten is involved in the pathogenesis of coeliac disease,' the medical profession has maintained that a life long strict gluten free diet is mandatory for the health of all patients.' Although there is no doubt that dietary gluten withdrawal results in improvement of clinical symptoms and jejunal morphology, the necessity for total dietary gluten exclusion has been challenged.4 Furthermore, despite physicians' recommendations, many patients are unable to maintain a restrictive GFD and continue to ingest small quantities of gluten.`5 A proportion of these patients remain asymptomatic with normal haematological and biochemical parameters.7 In view of these findings we believe that a low gluten containing diet (LGD) may be a more realistic treatment for coeliac disease in some patients. This concept, however, remains controversial. 9 The aim of the present study was to determine the effects of a LGD on jejunal morphology and serum antibody levels to gluten in a group of coeliac patients we have maintained on a controlled LGD.

We compared the diagnostic accuracy of microscopical examination of multiple faecal specimens with duodenal juice examination in the diagnosis of giardiasis. Of 292 patients who had stool microscopy and duodenal aspirate, Giardia were identified in either stools or duodenal fluid from 73 patients (25%). Giardiasis was diagnosed in 62 (73%) with the first faecal specimen, but examination of 3 specimens increased the diagnostic yield to 85%. Giardia, however, were found in only 32 of 73 duodenal aspirates examined (44%). This finding is contrary to the widely held belief that duodenal fluid examination is superior to stool microscopy for the diagnosis of giardiasis. The 2 approaches are complementary, however, since Giardia was found in duodenal fluid, only, from 15% of patients.

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