The experience with inflammatory bowel disease in a stable, defined population in northeast England is described. In this population, the incidence of inflammatory bowel disease was higher than expected. In particular, a high incidence of colorectal and anal Crohn's disease was found. The literature is reviewed in order to identify some of the factors responsible for this unusual prevalence of inflammatory bowel disease in the study population. No explanation for our unexpected findings can be advanced.

A case of massive subcutaneous emphysema following colonoscopic polypectomy is reported. The incidence of colonic perforation following colonoscopy is 0.1% and may be intraperitoneal or retroperitoneal. Intraperitoneal perforation is usually immediately apparent and likely to require urgent surgical exploration. The development of subcutaneous emphysema or a pneumoscrotum suggests a retroperitoneal perforation and in the majority of cases management is conservative. Contrast studies are often unhelpful but plain x-rays may help to distinguish between intraperitoneal and retroperitoneal perforations.

Summary: Over a period of 16 years There were 7 deaths, three unrelated to liver disease. Survival analysis gives an 86% 5-year survival and 56% 10-year survival. Twenty four patients were treated with steroids (and 6 additionally with azathioprine); 15 (63%) were steroid responsive and 9 were non-responsive. In five patients steroids were successfully discontinued but in 10 patients severe symptomatic relapse occurred on steroid reduction below 7.5-10 mg/day. Steroid non-responders were not typical CAH, 5 with predominantly a rise in alkaline phosphatase, one multisystem disease and one HBV positive. Steroid discontinuation was only possible in one third of the patients responding. Eighteen subjects (69%) were cirrhotic at initial biopsy; 9 had follow-up biopsies, 6 were unchanged but three had progressed to cirrhosis despite apparent steroid responsiveness.

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