John F. Mayberry

Time Relationships between Cessation of Smoking and Onset of Ulcerative Colitis

From 5 centres 154 patients with ulcerative colitis and a history of smoking completed a questionnaire about the temporal relationship between diagnosis of colitis and cessation of smoking. One hundred and thirty-eight of these were ex-smokers and 107 (69.5%) had stopped smoking before the diagnosis of colitis was made. Fifty-six patients (52%) developed colitis within 3 years of stopping smoking. The findings suggest that smoking exerts protective effect against the development of ulcerative colitis.

Crohn’s Disease in Jewish People – An Epidemiological Study in South-East Wales

The prevalence of Crohns disease in the Jewish population of south-east Wales was established by a postal survey, review of case notes and a survey of Jewish congregations in the three synagogues of the area. The prevalence of Crohns disease had been established in various earlier studies at 52/10(5). Seven Jewish patients were identified amongst a population of between 1,750 and 2,500. The prevalence ranged from 280 to 400/10(5) (95% confidence interval 120-862/10(5]. There was no significant difference in prevalence between orthodox and reformed Jews. Jewish people are at a relative risk of developing Crohns disease of 5.4-7.7 (95% confidence interval 2.3-17.2, p less than 0.001), but the role of diet is yet to be established.

Information assessment by patients of a booklet on Crohn's disease.

Abstract Three-hundred-and-fifty patients with Crohns disease were offered an information booklet entitled “Living with Crohns Disease”, Two-hundred-and-thirty-two requested a copy and 175 of these completed a questionnaire assessing its value. In addition 93 nurses with Crohns disease were given a copy of the booklet and questionnaires were received from 82. The majority of both groups (85% and 88% respectively) found the leaflet informative but required more information on long term prognosis, cancer risk and inheritance of the disease. The patients who were not nurses wanted to know more about complications of the disease. Although patients often felt that such leaflets should be freely available in outpatient departments, less than 15% of both groups became members of lay-patient organizations.

Inflammatory bowel disease: one condition or two?

Demographic data obtained from epidemiological studies of Crohns disease and ulcerative proctocolitis in Regio Leiden (Leiden health care region) were compared. Ulcerative colitis (6.8 cases/10(5) population/year) had an incidence almost twice that of Crohns disease (3.9/10(5)/year; p less than 0.001). Each disease occurred with equal frequency in both sexes and diagnosis of the diseases occurred at similar ages (Spearmans correlation coefficient = 0.84; p less than 0.01). Where ulcerative colitis was common in the various municipalities so was Crohns disease (Spearmans correlation coefficient = 0.88; p less than 0.001). No cases of Crohns disease were identified amongst migrants, but 6 cases of ulcerative colitis (prevalence = 85/10(5); 95% confidence interval = 35-195) were found. This difference was significance (p less than 0.05). It seems likely that the two diseases may simply represent the opposite ends of a continuous spectrum of inflammatory bowel disease.

Achalasia and pregnancy

Summary. Forty‐one women with achalasia diagnosed between the ages of 18 and 45 years were interviewed and 37 of them who had been married at some time were asked to provide details of their fertility and reproductive histories. Thirty‐six agreed to do so and were compared with 36 healthy age‐matched women. The mean age at the time of study was 44 and the women had been married, on average, for 21 years. The disease developed at a mean age of 27 years and was diagnosed and treated at a mean age of 32 years. For a mean period of 5 years the disease was untreated. There were no significant differences in the number of conceptions or live births before or after the onset of symptoms or during the period when the disease was untreated. In only three of the 20 women who became pregnant after the onset of disease did symptoms become worse. Achalasia during pregnancy is probably best managed by endoscopic dilatation and there is no reason to consider termination.

Information booklets for patients with inflammatory bowel disease

Patients with inflammatory bowel disease wish to know more about their disease. Booklets must deal with such problems as prognosis and cancer risk. Although this information may depress up to 13% of patients who accept such booklets, between 30% and 39% become less anxious. Patients are highly motivated and can deal with quite difficult text, although illustrations can be helpful. Up to 34% of patients offered such booklets refused them. Nevertheless such booklets reach many people who are not members of self-help groups, and can be used by the doctor in counselling sessions with his or her patient, and in many cases produce reassurance and even lead to fewer consultations.

Information assessment by patients of a booklet on achalasia and its effect on anxiety levels

One hundred and forty of 169 patients accepted a booklet entitled ‘Living with Achalasia’. One hundred and twenty-eight completed a questionnaire about the booklet; 87% found it helpful and 93% felt that a similar booklet should be made available to all patients with the disease. Such booklets often lead to a reduction in anxiety on the part of the patient, although they want to know more about complications of the disease and long term prognosis.

Patients' perceptions of self-help groups in achalasia

The possible role of a self-help group was investigated among 126 patients with achalasia. Forty-one patients initially expressed an interest, but only 19 were willing to complete a questionnaire about their role in such a group. Only 14 patients were willing to be identified by other sufferers, and only 8 were ready to take an active part in organising meetings. Although patients with achalasia want more information about their disease, few wish to join a self-help group.