Background-One of the major pathophysiological abnormalities in patients with gastro-oesophageal reflux disease is thought to involve transient lower oesophageal sphincter (LOS) relaxations.

Background-The response of the oesophagus to refluxed gastric contents is likely to depend on intact neural mechanisms in the oesophageal mucosa. The epithelial innervation has not been systematically evaluated in health or reflux disease. Aims-To study oesophageal epithelial innervation in controls, and also inflamed and non-inflamed mucosa in patients with reflux oesophagitis and healed oesophagitis. Patients-Ten controls, nine patients with reflux oesophagitis, and five patients with healed oesophagitis. Methods-Oesophageal epithelial biopsy specimens were obtained at endoscopy. The distribution of the neuronal marker protein gene product 9.5 (PGP), and the neuropeptides calcitonin gene related peptide (CGRP), neuropeptide Y (NPY), substance P (SP), and vasoactive intestinal peptide (VIP) were investigated by immunohistochemistry. Density of innervation was assessed by the proportion of papillae in each oesophageal epithelial biopsy specimen containing immunoreactive fibres (found in the subepithelium and epithelial papillae, but not penetrating the epithelium). Results-The proportion of papillae positive for PGP immunoreactive nerve fibres was significantly increased in inflamed tissue when compared with controls, and non-inflamed and healed tissue. There was also a significant increase in VIP immunoreactive fibres within epithelial papillae. Other neuropeptides showed no proportional changes in inflammation. Conclusions-Epithelial biopsy specimens can be used to assess innervation in the oesophagus. The innervation of the oesophageal mucosa is not altered in non-inflamed tissue of patients with oesophagitis but alters in response to inflammation, where there is a selective increase (about three-to fourfold) in VIP containing nerves. (Gut 1999;44:317-322)

Benign intracranial hypertension (BIH, pseudotumour cerebri) is a rare condition with unknown aetiology although hormonal influences have been implicated. It occurs spontaneously, particularly in young obese women, and is associated with several drug treatments including corticosteroids. Two young adult women are described in whom headache and papilloedema in association with raised intracranial pressure occurred during prednisolone treatment for inflammatory bowel disease. This provides further evidence of the risk of BIH during corticosteroid treatment and has not been described before in adults with this condition. Advice is given to gastroenterologists to use corticosteroids with caution in adults, particularly young, fertile female patients. The treatment of a severe relapse of colitis in a patient who has had one episode of steroid related BIH remains a dilemma.

Esophagitis is a common endoscopic finding, although its prevalence and contribution to morbidity and mortality in hospital inpatients has not been systematically evaluated. This study aimed to determine the prevalence of esophagitis among hospital inpatients referred for upper gastrointestinal endoscopy, to assess factors associated with the presence of esophagitis, and to determine the mortality of patients with esophagitis. All inpatients referred for upper gastrointestinal endoscopy in a district general hospital were assessed prospectively for one year. The reason for referral, endoscopy findings, and one-month mortality were determined together with a history of nasogastric intubation, periods spent supine, and drug use. Of 595 inpatients who underwent gastroscopy, 58% were referred for investigation of acute upper gastrointestinal bleeding. Esophagitis was found in 196 (33%). Esophagitis was significantly associated with wide-bore nasogastric intubation (p = 0.021; relative risk, 2.61; 95% CI, 0.64-6.06) but not with fine-bore nasogastric intubation. Esophagitis was also significantly associated with being nursed supine (p = 0.015; relative risk, 1.41; 95% CI, -1.75-6.72). There was no association between esophagitis and specific drug therapy. Mortality among patients with esophagitis was higher than those without esophagitis (p = 0.04; relative risk, 1.38; 95% CI, 0.34-3.22). Reflux esophagitis is common in hospital inpatients who are endoscoped. Although the underlying diseases are likely to account for the high mortality, the associations of wide-bore nasogastric intubation and being nursed supine should alert caregivers to an increased risk. If nasogastric intubation is required for feeding only, fine-bore tubes should be considered.