SUMMARYAim: To examine the published evidence on the association between paracetamol or non-steroidal antiinflammatory drugs and relapse in inflammatory bowel disease.

SUMMARY To determine whether the "congestive" gastropathy associated with portal hypertension showed distinctive histological features independent of inflammatory gastritis, endoscopic biopsy specimens ofgastric mucosa from 23 patients with portal hypertension and 25 patients with non-ulcer dyspepsia were examined. Active chronic gastritis associated with Campylobacterpylori was found in three patients with portal hypertension compared with 13 patients with non-ulcer dyspepsia. The changes of reflux gastritis were seen in nine patients with portal hypertension compared with three patients with non-ulcer dyspepsia. Mucosal capillary dilatation, assessed on sections stained for factor VIII related antigen, a specific marker for endothelial cells, was significantly greater in biopsy specimens from patients with portal hypertension but this difference was not apparent on sections stained conventionally. The degree of capillary dilatation was unrelated to the presence of histological gastritis.These observations support the view that portal hypertension is associated with a distinctive gastropathy characterised by prominence and dilatation of mucosal capillaries.

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SUMMARY We describe a patient with intestinal lymphangiectasia who developed hyposplenism and speculate that it resulted from chronic loss of lymphocytes into the gut.Splenic atrophy has been long recognised in association with coeliac disease' and, more recently, impaired splenic function has been described in patients with ulcerative colitis and Crohn's disease.2The aetiology of this hyposplenism is unknown, but by analogy with animal models it has been suggested that it results from lymphocyte depletion due to chronic loss into the gut.Intestinal lymphangiectasia is a disease characterised by dilated lymphatics, protein-losing enteropathy, hypoalbuminaemia and oedema, and patients with this disease lose albumin, immunoglobulins, and lymphocytes into the bowel. If the development of splenic atrophy results from prolonged lymphocyte depletion, it is likely that patients with intestinal lymphangiectasia will develop abnormalities of splenic function over a period of time, although, to our knowledge, this has not been studied.Since 1976, various tests of splenic function have been applied to one of our patients with intestinal lymphangiectasia and the results are reported below. During this time, however, the patient also developed other clinical problems.Case report A 40 year-old man presented in 1975 with a past history of vagotomy and pyloroplasty for a duodenal ulcer. He now complained of epigastric discomfort, diarrhoea, and ankle swelling. Examination confirmed pitting oedema of the ankles but there were

We have measured plasma fibronectin in 28 patients with well-compensated chronic liver disease, 4 patients with non-cirrhotic portal hypertension and 6 patients who have undergone shunt surgery for the relief of portal hypertension and splenectomy. 17 patients with portal hypertension had significantly lower levels of fibronectin (207 ± 54; mean ± SD) compared with 15 patients without portal hypertension (315 ± 75, p < 0.001) and the 6 patients who had undergone shunting and splenectomy (330 ± 66, p < 0.001). We suggest that in patients with portal hypertension and splenomegaly, low levels of fibronectin might result from increased consumption by the enlarged spleen.