Diet and irritable bowel syndrome: an update from a UK consensus meeting.

There has been a renewed interest in the role of dietary therapies to manage irritable bowel syndrome (IBS), with diet high on the agenda for patients. Currently, interest has focussed on the use of traditional dietary advice (TDA), a gluten-free diet (GFD) and the low FODMAP diet (LFD). A consensus meeting was held to assess the role of these dietary therapies in IBS, in Sheffield, United Kingdom.Evidence for TDA is from case control studies and clinical experience. Randomised controlled trials (RCT) have demonstrated the benefit of soluble fibre in IBS. No studies have assessed TDA in comparison to a habitual or sham diet. There have been a number of RCTs demonstrating the efficacy of a GFD at short-term follow-up, with a lack of long-term outcomes. Whilst gluten may lead to symptom generation in IBS, other components of wheat may also play an important role, with recent interest in the role of fructans, wheat germ agglutinins, as well as alpha amylase trypsin inhibitors. There is good evidence for the use of a LFD at short-term follow-up, with emerging evidence demonstrating its efficacy at long-term follow-up. There is overlap between the LFD and GFD with IBS patients self-initiating gluten or wheat reduction as part of their LFD. Currently, there is a lack of evidence to suggest superiority of one diet over another, although TDA is more acceptable to patients.In view of this evidence, our consensus group recommends that dietary therapies for IBS should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Given the lack of dietetic services, novel approaches such as employing group clinics and online webinars may maximise capacity and accessibility for patients. Further research is also required to assess the comparative efficacy of dietary therapies to other management strategies available to manage IBS.

Long-term care for patients with coeliac disease in the UK: a review of the literature and future directions.

Coeliac disease is a common digestive disorder that affects 1% of adults. It is characterised by mucosal damage of the small intestine caused by dietary gluten. The main treatment for coeliac disease is a lifelong gluten-free diet, which can reduce morbidity and mortality and also improve quality of life. Despite the benefits, adhering to this diet is often challenging, with patients often struggling to sustain dietary restriction. Structured follow-up for coeliac disease is recommended in international guidelines for improving adherence and for detecting complications;however, uncertainty exists concerning exactly who should be administering this follow-up care. Here, we undertake a review of the current approaches described in the literature to follow-up patients with coeliac disease, and assess the efficacy of these differing models. We also explore future directions for the care of these patients in the context of the UK National Health Service (a publicly funded healthcare system). Although the focus of this review pertains to follow-up within the UK healthcare system, these problems are recognised to be international, and so the findings of our review are likely to be of interest to all healthcare professionals seeing and managing patients with coeliac disease.

Radiology, physical science, and the emergence of medical physics.

The early development of medical physics as a separate discipline and profession is briefly reviewed. Although both x rays and radioactivity were discovered by physicists, at first the physical investigations of these phenomena, and their medical applications, proceeded along parallel but independent lines. Radiological journals were founded in Britain, Germany, and the U.S. as early as 1896-1897 but it was not until ten years later that papers on radiation physics began to appear regularly. In 1913 the first full-time physicists were appointed to posts in medical schools and hospitals: William Duane in the U.S. and Sydney Russ in Britain. Thereafter the number of physicists engaged in medical applications increased slowly but steadily, and in the 1920s they began to apply the new science of radiation dosimetry to both x ray and radium therapy. The "Hospital Physicists' Association" was founded in Britain in 1943 with 53 members and the "American Association of Physicists in Medicine" followed in 1958 with 127 charter members.

The application of a digital whole body scanner to the dosimetry of intralymphatic 32P/131I Lipiodol.

A quantitative, digital-output, whole-body scanner in a low background area has been used in the dosimetry of 32P/131I Lipiodol for intralymphatic radiotherapy. Five patients with malignant melanoma received intralymphatic administrations of Lipiodol labelled with 6 mCi 32P and 1.5 mCi 131I. The 131I is used primarily as a tracer for external measurements and the 32P as the chief therapeutic agent. Whole body scans were made at intervals for up to 15 days using the digital scanner, with the spectrometer set over the 364 keV photopeak of 131I. On the same occasions complete gamma-spectra were obtained for these patients using a 2 m arc, single detector whole body counter. The method used in estimating the activity at various sites in the body from the digital whole body scans is described and problems that arise in using 131I as a tracer for 32P Lipiodol in this work are discussed. For the administered activities mentioned above, maximum absorbed doses to the lymph nodes were found to range from 30-96 krad with a mean value of 51 krad. Uptake of radioactivity was also found in the lungs, resulting in absorbed doses of 350-960 rad with a mean value of 540 rad.

The limitations of the dual radionuclide subtraction technique for the external detection of tumours by radioiodine-labelled antibodies.

A dual radionuclide subtraction technique for external detection of tumours has been evaluated to determine the viability of the method for use with radioisotope labelled antibodies. A number of external scintigraphic investigations have been carried out with 131I-labelled antibodies to carcinoembryonic antigen (CEA). The investigations were performed on patients with metastatic disease known to produce CEA. The dual radionuclide subtraction technique was used to account for the blood and tissue background. The 131I-labelled antibodies were found to localise in the metastatic lesions, but the subtraction technique using 99Tcm-labelled HSA and pertechnetate gave ambiguous results, which included the production of artefacts. The ambiguities noted in the clinical results were substantiated by experimental data, which highlight the unreliability of this technique.

Blood cell labelling. Theory and methods: radiation hazards.

The chief physical properties of the radionuclide In111 are outlined, and compared with those of three other radionuclides, Tc99m, I131 and Cr51 which have similar applications. It is pointed out that the gamma-rays of In111 are appreciably more penetrating in lead than those of Tc99m and the significance of this, both in the use of shielding on syringes and in the effectiveness of lead glass screens is discussed. Examples are given of the dosimetry for In111 labelled cells in humans and it is noted that the absorbed dose in the spleen per mCi (37 MBq) injected may be some 10 rad (0.1 Gy). The problems that have been noted of damage to cells arising from oxine labelling and now considered to be due to radiation damage are briefly reviewed.