Objective-To establish the frequency of permanent growth failure in juvenile onset inflammatory bowel disease.Design Main outcome measures-Height, weight, body mass index, and sexual maturity.Results-All patients were sexually mature. 67 of the 70 patients examined were of normal height, and three women with Crohn's disease were abnormally short. Weight and body mass index were normal in all patients with ulcerative colitis. Patients with Crohn's disease had significantly lower weight than those with ulcerative colitis (men 66-8 (9.5) kg v 78-4 (13-8) kg, P=0 04; women 51 5 (8.2) kg v 63-0 (12-1) kg, P<0-02) irrespective of disease activity. Body mass index was also significantly lower than the normal distribution (P<0 01). Growth retardation was not mentioned as a problem for any of the 17 patients interviewed only by telephone.Conclusions-Despite growth retardation in the teenage years most young people with inflammatory bowel disease will eventually achieve normal height.Reasons for lower weight in patients with Crohn's disease remain to be established.

Seventy young adults (50 with Crohn's disease (CD) and 20 with ulcerative colitis (UC)) (from a geographicaliy derived cohort of patients with juvenile onset inflammatory bowel disease were interviewed and examined at a mean of 14 (range 5.2-29.5) years after diagnosis. Details of education and employment were collected as part of a structured clinical interview. Although 57% had had periods of absence from school of two months or more, their school examination pass rates were similar to those of the healthy population. The achievements of CD patients were consistently better than those of the UC group. In 15 patients, relapses of inflammatory bowel disease had adversely affected examination performance or prevented them from sitting school examinations. Extra tuition in hospital had been provided for only four patients, and three others had had privately arranged tuition at home. Fifty per cent proceeded to full time higher education. At the time of review, seven patients were full time students, one was a university research fellow, 47 were in full time and three in part time employment, one was self employed, four were housewives, and only six were involuntarily unemployed. All four unemployed CD patients attributed this to inflammatory bowel disease, but other factors were relevant in the unemployed UC patients. Few had direct evidence of rejection by employers on health grounds, though some did not declare their illness to prospective employers. (Gut 1994; 35: 665-668)

In a prospective investigation of the clinical and pathological effects of pelvic radiotherapy on the rectum, nine patients (age range 58-77 years) had symptoms assessed weekly during radical treatment for bladder and prostatic tumours, and at 2, 4 and 12 weeks after treatment. Stool frequency increased in all patients from a mean of 1.7 per day before treatment to 5.0 per day at 4 weeks (P < 0.05). Seven patients developed liquid stools during treatment; 6 had pain on defaecation, 8 had urgency of defaecation, all experienced tenesmus and 3 had episodes of faecal incontinence. One patient had symptoms of such severity that treatment was interrupted. Virtually all symptoms had resolved by 12 weeks after treatment. Sigmoidoscopy with biopsy of anterior and posterior rectal walls was performed before treatment began, at 2 weeks and 4 weeks during treatment, and 4 and 12 weeks after treatment. All patients during treatment had evidence of acute inflammatory damage with hyperaemic, oedematous mucosa and failure of healing of biopsy sites. Histological examination of the rectal biopsies revealed the well described characteristic mucosal changes with crypt cell damage, inflammatory cell infiltrate and loss of crypts. In 2 of 7 cases studied, pathology was still abnormal at 3 months. Radiation injury to bowel is an underemphasised cause of morbidity and further prospective studies are required to determine methods of reducing normal tissue damage and ameliorating symptoms.