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Secretion rates of immunoglobulins and other proteins were assessed by luminal perfusion of jejunum and distal ileum, and the jejunal histology was evaluated in eight Danish chronic Salmonella typhi and paratyphi carriers compared to nine healthy controls who previously had suffered from typhoid or paratyphoid fever not followed by a carrier state. The median secretion rates for each protein investigated in the distal ileum as well as in the jejunum revealed no significant differences between the two groups. The secretion rate of secretory IgA was raised in both groups compared to previously investigated normal persons. The histological examination revealed no signs of inflammation or presence of bacteria. It was concluded that no primary humoral immune defect was revealed in the carriers.

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A controlled study was performed to evaluate the incidence of gall bladder and biliary duct disease in chronic typhoid and paratyphoid carriers. Eight chronic carriers were compared with a comparable group of control persons who had previously had acute typhoid or paratyphoid fever without developing a chronic carrier state. By combined surgical and radiological evaluation biliary calculi were detected in 88% of the carrier group and in 11% in the control group. This difference is statistically significant (p less than 0.02). No difference in biliary function was found between the two groups.

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The humoral and cellular immunity of 8 Salmonella carriers and 9 non-carriers was investigated and compared to findings in normal persons. The antibody response in serum and intestinal secretions was investigated by means of crossed immunoelectrophoresis, and blood lymphocytes were investigated by in vitro stimulation. Both carriers and non-carriers showed increased levels of precipitating antibodies as well as lymphocyte responses, when compared to normal persons. No differences in the antibody responses either qualitatively or quantitatively were found between carriers and non-carriers. Only few precipitins could be detected in intestinal secretions. Lymphocyte responses to S. typhi and S. paratyphi were significantly higher in carriers and non-carriers than in the controls. No significant difference in lymphocyte response to S. typhi, S. paratyphi and mitogens was obtained between carriers and non-carriers. Thus, the carrier state seems not due to detectable major immunodeficiency.

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A controlled clinical study on disodium cromoglycate (DSCG) at a dose of 800 mg per day versus placebo was carried out in 141 patients with ulcerative colitis and 25 patients with Crohn's disease. Those of the ulcerative colitis patients who had been on sulphasalazine treatment continued that treatment during the trial (101 patients). Forty patients were intolerant of sulphasalazine. No patient received steroids during the last month before the study. Patients with Crohn's disease had their possible sulphasalazine treatment stopped before the trial. No beneficial effect of DSCG as compared with placebo was found, as the DSCG and the placebo group showed the same number of relapses in patients with a clinically inactive ulcerative colitis at the start of the trial and the same number of patients improving, deteriorating, and maintaining steady state in patients with clinically active ulcerative colitis at the start of the trial. There was no difference between relapse rate in DSCG and placebo groups in patients with Crohn's disease. No correlation between the eosinophil count in rectal mucosa and the outcome of the attack of ulcerative colitis could be demonstrated.

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This double-blind controlled trial compares the relapse rate in 19 duodenal ulcer patients who received cimetidine for eight weeks with that in 19 patients who received cimetidine for four weeks and inactive tablets for four weeks. Only patients who became symptom-free during the initial four weeks' treatment with cimetidine were included. The median period of remission after withdrawal of cimetidine was 50 days in patients treated with cimetidine for eight weeks and 76 days in patients treated with cimetidine for four weeks (P greater than 0.10). Six months after withdrawal of cimetidine 15 relapses had occurred in both groups. It is concluded that patients who become symptom-free during four weeks' cimetidine treatment do not benefit by continuation of treatment for another four weeks.

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In 1976 we reviewed a randomly selected cohort of 227 patients with duodenal ulcer first diagnosed in 1963. The cohort comprised cases diagnosed in both hospitals and general practice. Fifty patients had died, 12 had emigrated, and 154 (93%) of the remaining patients were interviewed. Fifty-seven medically treated patients had no symptoms, 44 had mild symptoms, and 19 had more severe symptoms. The remaining 34 patients had been treated surgically. Cases diagnosed in hospital had a more severe prognosis than those diagnosed in general practice. A random sample of 65 general practitioners and 78 medical and surgical gastroenterologists tried to predict the results of this study. The range of the predictions was very wide showing that individual prognostic estimates were highly unreliable. The mean prediction by all doctors differed little from the actual result, suggesting that the collective experience of the medical profession is more reliable. The predictions of general practitioners, physicians, and surgeons showed small systematic differences, presumably reflecting the different types of patients they treat.

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