SUMMARY A 39 year old man developed an itchy bullous rash in the perineum and on the extremities. Six years later, after giant intestinal villi had been noted at endoscopy, a diagnosis of the glucagonoma syndrome was made. Investigation revealed a large tumour of the pancreatic body and tail. The molecular species of glucagon secreted by the tumour were characterised using the combined purification procedures of immunoaffinity chromatography followed by gel filtration.

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The first part of the duodenum has been studied endoscopically in treated and untreated coeliac patients. Biopsies taken from the duodenal cap during endoscopic examination, show villous atrophy similar to that found in the distal duodenum and jejunum. Using the indigocarmine scattering method, severe atrophy of the mucosal surface can be demonstrated throughout the duodenal cap, in vivo, in untreated coeliac disease.

An increased association of ulcerative colitis and coeliac disease has been reported, as have the results of several small-bowel biopsy studies in ulcerative colitis. Forty-two patients from a population of 438 patients with coeliac disease had rectal biopsies. Fourteen of these showed inflammation of various degrees of severity, including three compatible with a diagnosis of ulcerative colitis. The presenting complaint in 34 of these patients was diarrhoea or steatorrhoea. Twenty-seven patients had coeliac disease diagnosed at the same time or after their rectal biopsy. The other 15 were previously diagnosed coeliacs. Twelve of the 14 patients with abnormal rectal biopsy specimens were known to have subtotal/total villous atrophy at the time of rectal biopsy. Proctitis as seen in these coeliac patients had no unique features to differentiate it from proctitis caused by other disorders. The diarrhoea/steatorrhoea stopped in all patients on commencement of a gluten-free diet, except in those with ulcerative colitis. Proctitis is common in patients with coeliac disease presenting with diarrhoea/steatorrhoea. This study supports the finding of an increased association of coeliac disease and ulcerative colitis and is, to our knowledge, the first rectal biopsy study of a coeliac population.

SUMMARY Fifty two children in whom coeliac disease was confirmed by persistent enteropathy while they were taking gluten were monitored to assess the effects of compliance with a gluten free diet (GFD). Between the ages of 17-8 and 18-5 years height (in 45 patients followed up for a mean of 14*9 years) and weight (in 43 followed up for a mean of 15-2 years) were significantly lower in those complying poorly with a GFD compared with those complying well. Of the 37 patients still attending the clinic after a mean of 25 years, having been followed up for a mean of 18-4 years, 16 who had complied well with the diet had normal or only slightly abnormal mucosal morphology whereas all 10 who had not complied had abnormal morphology. In these 10 lactase, sucrase, and alkaline phosphatase activities were significantly less than values in those who complied well. Mucosal sucrase and alkaline phosphatase activities in those who complied well were no different from those in a control population, whereas lactase activity was significantly lower. It is concluded that failure to comply with a GFD during childhood results in decreased adult stature and in persisting active enteropathy with depressed brush border enzyme activity.Sheldon reviewed 57 young adults who had been diagnosed as having coeliac disease in childhood and found that six were stunted'; there had, however, been a delay of at least seven years before diagnosis. Of the 57, 13 had had a clinical relapse, and 19 had low serum folate and 11 low serum iron concentrations. The initial diagnosis had been made without intestinal biopsy. Young and Pringle from a series of 110 children regarded as having coeliac disease, followed up 44 for between eight and 19 years2; 11 out of 20 receiving a strict gluten free diet (GFD), six out of 16 receiving a partial GFD, and only one out of eight receiving a normal diet were above the 50th height centile, and five receiving a normal diet were below the 3rd centile. No initial biopsy was done in 13 of the 110, and in the 44 followed up for some years repeat biopsies were not done, progress being assessed by anthropometric and clinical criteria.We followed up a group of 52 children for a mean of 18-4 years to see if there was an association between their growth, general health, mucosal morphology, and enzymology and their compliance with a GFD. We believe that this is the first study in which the initial diagnosis was confirmed in all cases by the finding of persisting gluten enteropathy and in which serial biopsies were performed. Patients and methodsWe studied 52 children, 47 of whom had taken part in a previous study;3 the mean age at diagnosis was 3-3 years (range 6 months to 12 years). The children comprised 32 girls and 20 boys; because there was no difference between the sexes in either compliance with diet or outcome the results were combined. In 42 children persisting gluten intolerance was confirmed by mucosal relapse on return to a normal diet; 10, whose dietary compliance was poor, were regarded as having persisting glut...