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SUMMARYWe measured the concentration of bile acids in gastric aspirates from patients who had had operations for peptic ulcer. Some patients were asymptomatic and some had postoperative symptoms of the type that have been attributed to duodenogastric reflux. Samples were obtained via a nasogastric tube when the patients were fasting, after food, after pentagastrin, and overnight. We related the concentration and amount of bile acid and the volume aspirated to the presence or absence of symptoms and compared the results with radiological and endoscopic assessments of duodenogastric reflux. The most useful index to discriminate between symptomatic and asymptomatic patients was the amount of bile reflux in half an hour's aspiration from the fasting stomach; this we have termed 'fasting bile reflux' (FBR) and expressed as ,umol bile acids refluxing/hour. A figure greater than 120 ,umol/h was present in 17 of 22 symptomatic patients and in all who complained of bile regurgitation or bile vomiting. The FBR was less than 120 ,tmol/h in all of 20 asymptomatic patients, although some of them had reflux detected radiologically and endoscopically.

Ingestion of over 60 g of formic acid by an adult is potentially fatal. We report a case of a 36-year-old woman with a history of depression who ingested 110 g of formic acid. She survived a complicated intensive care hospitalization following usage of intravenous folinic acid, urinary alkalinization, intravenous furosemide and supportive care. We suggest a management protocol aimed at minimizing formate toxicity by enhancing hepatic formate degradation via the folinic acid 'one carbon pool' and by enhanced renal elimination of formate.

SUMMARY Eighteen patients with dyspepsia and vomiting which followed surgery for peptic ulcer have completed a study to examine the role of diverting bile from the stomach by a Roux-en-Y procedure. Bile regurgitation and mild epigastric pain relieved by vomiting were abolished. Measurements of bile acids in the fasting gastric aspirate were useful in predicting the outcome of surgery; good results were obtained when initially there was reflux into the stomach of more than 120 ,mol/hour of bile acids. A wider group of patients than those selected in previous series may benefit from this operation, as good results can be obtained in patients with dyspepsia relieved by alkali and without achlorhydria or gastritis. Endoscopy was repeated one year after Roux-en-Y operation. Erythema of the mucosa was improved, but gastritis did not improve.After gastric surgery, many patients experience discomfort associated with regurgitation or vomiting of bile which may persist for several years (Griffiths, 1974). Medical treatment, including cholestyramine, is unsatisfactory (Scudamore et al., 1973), so that reconstructive surgery with a Roux-en-Y operation has been used and may relieve dyspepsia and bile vomiting (Conyers et al., 1960;Coppinger et al., 1973;Herrington et al., 1974;van Heerden et al., 1975). Most series of patients have been selected and include those with epigastric pain unrelieved by alkali or food (van Heerden et al., 1975) 16 September 1977 gastric surgery at least one year previously and recurrent ulceration or biliary disease had been excluded as a cause of their symptoms. Three were women and the average age was 50 years (range 33-66 years). The previous gastric operations were vagotomy and pyloroplasty in four, vagotomy and gastroenterostomy in two, vagotomy and antrectomy in three, Billroth I partial gastrectomy in two, and Billroth II in seven. On average the first operations had been performed 7-4 years ago (range one to 39 years). Ten patients had already had one unsuccessful revision operation that had not accomplished bile diversion. al., 1977b). The severity of the patient's symptoms were assessed by one physician, and the biopsies were examined without knowledge of their order by one person (H.T.) using the criteria of Whitehead et al. (1972) for the stomach and Ismail-Beigi et al. (1970) for the oesophagus.At operation a Roux-en-Y reconstruction was performed with the afferent loop of jejunum anastomosed to the side of the efferent loop at least 45 cm distal to the gastrojejunal stoma. If the insulin test 163 on 9 May 2018 by guest. Protected by copyright.

SUMMARY A review of all patients with ulcerative colitis in one health district between 1975-84 revealed an incidence and prevalence of 7.1 and 84/100000 population respectively. One hundred and ninety five new patients were diagnosed and 313 patients seen and followed up in the clinic for 1168 patient years. None of these patients died from colitis or a complication. On routine colonoscopy three cases had high grade dysplasia and two asymptomatic carcinomas (Duke's stage A and B). Eighty four patients were known to have ulcerative colitis, but were lost to follow up from the hospital clinic; the total time they were not under hospital surveillance was 315 patient years. At the end of the study these patients were contacted or clinical details obtained from their general practitioners. Five of these patients subsequently presented with symptomatic carcinomas (two Duke's B, one Duke's C and two with metastases