Four patients with familial hypophosphataemic rickets developed significant hypercalcaemia which persisted after discontinuation of vitamin D therapy. They had increased PTH levels and were operated for hyperparathyroidism at the ages of 18, 20, 24 and 45 years, respectively. Three of the patients had previously received phosphate treatment and one patient developed hyperparathyroidism 7 years after treatment with calcitriol. Histological evaluation revealed different degrees of parathyroid hyperplasia in all patients, with persistently increased PTH and/or calcium levels after surgery. The possibility of autonomous hyperparathyroidism should be evaluated in the follow-up of patients with X-linked hypophosphataemic rickets.

Patients with functional dyspepsia have discomfort centred in the upper abdomen in the absence of oesophagitis, ulcer, cancer or other pathology which could have explained the dyspepsia. It is generally accepted that neither endoscopy, nor other imaging modalities give any positive findings supporting the diagnosis. However, recent investigations have shown that both endoscopic and ultrasonographic imaging show changes: erosive prepyloric changes (EPC) and accommodation abnormalities, respectively, in a high percentage of the patients. The diagnostic sensitivity and specificity of the changes are not yet known, but the fact that they are also seen in several other conditions characterised by dyspepsia, for instance in gallstone disease, may simply indicate that they are linked to epigastric discomfort in general, and not to a specific dyspeptic condition. Ultrasonographic imaging is a non‐invasive, widely available, convenient, and reliable method for evaluation of gastric emptying, gastric motility, transpyloric flow and accommodation disturbances, which may play a crucial role in the pathogenesis of dyspepsia. Copyright © 1998 Taylor and Francis Ltd.

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