SUMMARYBackground: Azathioprine therapy is discontinued in one-third of patients with inflammatory bowel disease because of toxicity or a lack of clinical response. Patients with thiopurine methyltransferase (TPMT) deficiency are intolerant to azathioprine, whilst carriers are at increased risk of side-effects. Aim: To evaluate the importance of TPMT activity in the management of azathioprine therapy in inflammatory bowel disease. Methods: Clinical response, adverse effects and haematological parameters were determined and correlated with TPMT enzyme activity and genotype in 106 patients with inflammatory bowel disease. Results: Ninety-six patients had high TPMT activity, and 10 had intermediate activity. Nineteen patients (18%)

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(Gut 1997; 40: 241-246)

INTRODUCTIONIron de®ciency anaemia is a common haematological problem but current treatment remains unsatisfactory. Intravenous iron supplementation has been withdrawn and intramuscular iron has signi®cant side-effects. Oral iron supplementation, typically with ferrous sulphate, is associated with a high incidence of gastrointestinal sideeffects, 1 and so compliance with treatment is often poor and treatment is ineffective. Although different ferrous preparations are available, there is no signi®cant difference in their side-effects or ef®cacy. 1±3 Ferrous iron preparations have more side-effects than ferric preparations, probably due to the initiation and propagation of potentially damaging hydroxyl free radicals 4, 5 at the gastrointestinal mucosa:However, iron is poorly absorbed from ferric preparations, because ferric salts are rapidly converted to poorly absorbed iron hydroxide polymers when passing from the acidic environment of the stomach to the more neutral pH of the duodenum. These polymers have high af®nity for intestinal mucus 6 and so absorption of the metal is further limited. Inhibition of this hydroxide polymer formation and a more rapid transit through the mucus layer and mucosa would facilitate ferric iron absorption.Maltol (3-hydroxy-2-methyl-4-pyrone) is a naturally occurring sugar derivative formed during caramelization SUMMARY Background: Oral iron supplements, which are usually in the form of ferrous (Fe 2+ ) salts, are toxic to the gastrointestinal mucosa, and so intolerance is common, resulting in poor compliance and failure of treatment. The sugar derivative maltol strongly chelates iron, rendering it available for absorption and stabilized in the less toxic ferric (Fe 3+ ) form. Aim: To test whether ferric trimaltol could correct iron de®ciency anaemia in patients intolerant of ferrous sulphate. Methods: Twenty-three patients were recruited from gastroenterology clinics, of whom 15 had in¯ammatory

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