Objective-To determine whether azathioprine can prevent relapse in ulcerative colitis.Design-One year placebo controlled double blind trial of withdrawal or continuation of azathioprine.Setting-Outpatient clinics of five hospitals. Subjects-79 patients with ulcerative colitis who had been taking azathioprine for six months or more. Patients in full remission for two months or more (67), and patients with chronic low grade or corticosteroid dependent disease (12) were randomised separately. 33 patients in remission received azathioprine and 34 placebo; five patients with chronic stable disease received azathioprine and seven placebo.Main outcome measure-Rate of relapse. Relapse was defined as worsening of symptoms or sigmoidoscopic appearance.Results-For the remission group the one year rate of relapse was 36% (12/33) for patients continuing azathioprine and 59% (20/34) for those taking placebo (hazard rate ratio 0-5, 95% confidence interval 0 25 to 1-0). For the subgroup of 54 patients in long term remission (greater than six months before entry to trial) benefit was still evident, with a 31% (8/26) rate of relapse with azathioprine and 61% (17/28) with placebo (p<001). For the small group of patients with chronic stable colitis (six were corticosteroid dependent and six had low grade symptoms) no benefit was found from continued azathioprine therapy. Adverse events were minimal.Conclusions-Azathioprine maintenance treatment in ulcerative colitis is beneficial for at least two years if patients have achieved remission while taking the drug. Demonstration of the relapse preventing properties of azathioprine has implications for a large number of patients with troublesome ulcerative colitis, who may benefit from treatment with azathioprine.

The natural history of gastric epithelial dysplasia and its relation to gastric cancer are ill defined. A consecutive series of 40 patients with an initial diagnosis of gastric epithelial dysplasia based on examination of endoscopic biopsies has been reviewed to determine the clinical outcome and to evaluate a two tier histological grading system as a predictor of the risk of cancer. On review, only 20 of the 40 patients were considered to have true dysplasia: seven patients had low grade dysplasia and 13 had high grade dysplasia. Of the 13 patients with high grade dysplasia, 11 (85%) were found to have gastric cancer within 15 months. Of the 10 patients with high grade dysplasia who underwent gastrectomy, six were found to have early gastric cancer, three had cancer invading into the muscularis propria, and none had lymph node metastases.

We conclude that (i) PE can establish a diagnosis in a high proportion of patients with undiagnosed gastrointestinal bleeding/anaemia; (ii) heater probe ablation therapy of vascular lesions can be performed routinely at the time of PE; (iii) a significant proportion of patients (42%) referred for enteroscopy have lesions in the stomach/proximal duodenum that are missed at diagnostic endoscopy; (iv) PE provides helpful information in routine clinical practice and is perceived as a helpful test by requesting physicians; (v) PE improves certainty of diagnosis as perceived by requesting physicians, and plays an important role in altering management plans.

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SUMMARY This paper reports a double‐blind placebo‐controlled trial of oral tobramycin in acute ulcerative colitis. Eighty‐four patients with an acute relapse of ulcerative colitis were randomized to receive oral tobramycin or placebo for 1 week as an adjunct to steroid therapy. At endpoint, 31 of 42 (74%) in the tobramycin group achieved complete symptomatic remission compared with 18 of 42 (43%) in the placebo group (P= 0.008). The tobramycin group achieved better histological scores (P < 0.05) at endpoint. These findings show that treatment with oral tobramycin improves the short‐term outcome of patients with ulcerative colitis in relapse.