Thirty two patients with active Crohn's disease were included in a controlled randomised trial to determine the efficacy and safety of polymeric enteral nutrition compared with steroids, to achieve and maintain clinical remission. The polymeric diet was administered through a fine bore nasogastric tube by continuous, pump assisted infusion (2800 (SEM 120) kcal/day). The steroid group received 1 mg/kg/day ofprednisone. Both treatments were effective in inducing clinical remission: 15 of the 17 patients given steroids and 12 ofthe 15 patients assigned to the polymeric diet went into clinical remission (defined by a Van Hees index <120) within four weeks of treatment. The percentage reduction of the Van Hees index was 34*8 (4.9)% for steroids and 32 3 (5)% for enteral nutrition (mean difference 2-5%; 95% CI -11-8% to +16-8%). Mean time elapsed to achieve remission was similar in both groups (2.0 (1) v 2-4 (1.2) weeks). Tolerance of the enteral diet was excellent. Four patients in the steroid group had mild complications attributable to this treatment. Ten patients (66.6%) in the steroid group and five (41.6%) in the enteral nutrition group relapsed within a year of discharge, but no differences were found in the cumulative probability of relapse during the follow up period. These results suggest that polymeric enteral nutrition is as safe and effective as steroids in inducing short term remission in active Crohn's disease.

IBS clinical subtypes distribution differs depending on the population evaluated, the geographical location, and the criteria employed to define IBS and bowel habit subtypes. In most cases, clinical course is characterized by the presence of mild-to-moderate symptoms appearing sequentially. Prospective studies, using clear and stable diagnostic criteria and subtype definitions, and based on daily data collection should further characterize IBS clinical course.

In patients with chronic hepatitis C, the influence of the genetic heterogeneity of the hepatitis C virus (HCV) on the progression of liver disease and on the responsiveness to interferon therapy is a matter of controversy. In this study we evaluated the genetic complexity of HCV by singlestrand conformation polymorphism (SSCP) analysis of amplicons from the hypervariable region 1 (HVR1) in 168 patients with chronic genotype 1b HCV infection, of whom 122 received a single course of interferon therapy (3 MU, three times weekly for 6 months). No correlation was observed between the degree of genetic complexity of HCV (indicated by the number of bands in the SSCP assay) and patient age, serum alanine aminotransferase activity, or serum HCV-RNA concentration, measured by competitive polymerase chain reaction. HCV genomic complexity was not related to gender nor to the presumed source of infection. The number of SSCP bands detected in serum samples from patients with chronic hepatitis, either mild (8.1 ؎ 3.9), moderate (8.0 ؎ 3.3), or severe (9.2 ؎ 3.3), and in patients with liver cirrhosis, either compensated (8.0 ؎ 2.9), decompensated (6.3 ؎ 2.9), or with superimposed hepatocellular carcinoma (9.5 ؎ 2.9), was similar. The number of SSCP bands detected in patients with sustained response (7.5 ؎ 3.9), transient response (8.3 ؎ 2.9), or no response (8.2 ؎ 3.6) to interferon administration was similar as well. These observations suggest that the genetic complexity of hypervariable region (HVR1) of HCV, as estimated by SSCP analysis, is not related to the severity of liver injury nor to the type of response to interferon therapy. The hepatitis C virus (HCV) is an RNA virus that replicates with a high rate of mutation, 1 which is particularly evident in the hypervariable region 1 (HVR1) of the N-amino terminal region of the second envelope domain of the viral genome. 2,3 Under the influence of environmental factors, continuous viral mutation gives raise to a mixed and changing population of mutants, which is known as quasispecies. 4 As in infections with other RNA viruses, the quasispecies nature of HCV 5 may have important biological implications concerning viral persistence, pathogenicity, and resistance to antiviral agents. However, attempts aimed to define the relationship between clinical aspects of chronic HCV infection and the genetic heterogeneity of the infecting virus have provided conflicting results.By sequence analysis of HVR1, greater nucleotide sequence diversity between HCV variants was shown in isolates from patients with more advanced liver disease, 6 but this finding has not been confirmed by others. 7 Studies based on singlestrand conformational polymorphism (SSCP) analysis of HVR1 derived amplicons have also provided controversial data. In 1995, Koizumi et al. 8 found that the viral populations were more heterogeneous in patients with hepatic cirrhosis or hepatocellular carcinoma than in those with chronic hepatitis, but other studies did not disclose a clear association between the degree of HCV qu...