A comparative study of metronidazole and sulfasalazine in active, not severe, ulcerative colitis. An Israeli multicenter trial.

Since metronidazole (M) was found to be effective in Crohn's disease, we evaluated its efficacy in the treatment of active ulcerative colitis (UC). Forty-six outpatients with acute, nonsevere UC were studied. Forty-two concluded the trial. Twenty-three received M 1.35 g/day and 19 received sulfasalazine (S) 4.5 g/day for 28 days in a randomized double-blind study. Six of 23 receiving M improved (26%) as against 13 of 19 patients receiving S (68%) (p less than 0.01). No significant side effects were noted. We conclude that M is ineffective in the therapy of an acute attack of UC.

Gastrointestinal endoscopy in octagenarians.

Seventy-five patients, 80-90 years old, each having approximately three associated diseases, underwent a total of 104 gastrointestinal endoscopies. Of these, 73 were upper (29 emergencies) and 31 lower endoscopies (21 were rigid sigmoidoscopies). There were two very mild short-lived complications; vomiting and bleeding. We found 16 gastric ulcers, 16 duodenal or pyloric ulcers, and 11 cases of esophagitis. Bleeding duodenal (8) or gastric (4) ulcers and polyps or malignant tumors (7) were seen less often. In 34 of 68 lesions the endoscopic and x-ray findings were the same. In the other 34 there were 10 endoscopic failures to identify colonic diverticula, hiatus hernia, and gastroesophageal reflux that were seen radiologically. In 24 patients, diagnoses were not made radiologically, but were recognized at endoscopy. The safety and accuracy of endoscopy in the old and sick does not differ from that in younger patients.

Zollinger-Ellison syndrome, prolonged cimetidine administration and nasopharyngeal carcinoma:--a coincidence?

A patient with Zollinger-Ellison syndrome who developed an undifferentiated nasopharyngeal carcinoma (NPC) after 3 years of daily treatment with a least 1.0 g cimetidine is described. The question is raised whether large doses of cimetidine, administered for long periods to patients perhaps already immunologically compromised, may change T-suppressor cell functions so as to enable proliferation of oncogenic viruses (e.g. EB virus) and the appearance of tumor. We feel that when the population at risk is small, even a solitary case should alert all concerned.