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Abstract. Effects of i.v. somatostatin on the gastric mucus output during a 60 min infusion of pentagastrin were examined in five healthy subjects. Experiments were also made with prior indomethacin administration to suppress the synthesis of endogenous prostaglandins. N‐acetyl neuraminic acid, a sialic acid, was measured in the gastric aspirates as an index of gastric mucus. Somatostatin increased significantly the gastric mucus output in a dose‐related way. The output increased to 158 ± 14% and 216 ± 24% of the control level by 1 and 2 μg kg‐1 h‐1 somatostatin, respectively. The increase induced by somatostatin was prevented by prior indomethacin. With indomethacin alone the mucus output was not different from in controls. Thus somatostatin has augmentory effects on the gastric mucus, which can be blocked by indomethacin, indicating that endogenous prostaglandins are involved in the augmentation. Somatostatin prevents stress ulcerations in the rat, assumedly by inhibiting the gastric acid secretion. This study suggests that additional mechanisms may contribute to the protective action of somatostatin on the gastric mucosa.

Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

The presence of intraepithelial inclusion bodies (Leuchtenberger bodies) was recorded in rectal or colonic specimens from 130 patients. Large to moderate number of intraepithelial bodies were recorded in 81.8 percent of 55 colorectal adenomas from patients with familial adenomatous polyposis (FAP). Conversely, none of the 55 non-FAP adenomas or of the 20 specimens with ulcerative colitis (10 with dysplasia) had similar amounts of intraepithelial granules. Feulgen studies demonstrated that the granules contain DNA and are probably nuclear fragments of destroyed lymphocytes. Although the pathogenesis of this phenomenon remains obscure, it appears that the presence of large to moderate number of intraepithelial bodies in colorectal adenomas should strongly raise the suspicion of FAP.

The effect of an H,-receptor blocking agent, cimetidine, on faecal losses of fluid, electrolytes and fat was examined in 10 patients with Crohn's disease, who had diarrhoeas after extensive small bowel resection. A randomized, doubleblind and crass-over design was applied, and patients were hospitalized and on a defined diet during the study. Cimetidine, 4x400 mg, significantly reduced diarrhoeal volumes by an average of 22% @<0.05) and faecal sodium by 27% @<0.05). Patients with severe diarrhoeas responded better to treatment. No sideeffects were recorded. The reported data suggest that cimetidine may be useful in symptomatic treatment of patients with severe diarrhoeas after extensive ileal resection. Due to deficient drug absorption, higher doses may be needed for optimal effect.