BMJ  2004;329:880 (16 October), doi:10.1136/bmj.329.7471.880

BMJ family highlights

What's new this month in BMJ Journals

IgG guided food elimination can relieve irritable bowel

Patients with irritable bowel syndrome were tested for immunoglobulin G (IgG) antibodies to 29 food antigens and then randomly assigned to a test or sham diet. Investigators and patients were blinded; symptoms were reassessed after 12 weeks. Participants who excluded foods identified by the ELISA test for IgG were more likely to improve—the number needed to treat was 2.5. A previous study had found a number needed to treat of 17 for three months' treatment with tegaserod.

Gut 2004;53: 1459-64[Abstract/Free Full Text]

Sulphur may exacerbate ulcerative colitis

A high intake of sulphur and sulphate was associated with relapse in 183 patients with ulcerative colitis who were followed prospectively for 12 months. Comparison of the diets of the 96 who relapsed and the 87 who did not showed that the former were more likely to have a high intake of red meat, processed meat, and alcohol. Contrary to commonly held belief, dairy products were not associated with relapse nor dietary fibre with its avoidance. The common factor in these foods is sulphur content, but the authors advocate caution with this interpretation and call for an intervention study.

Gut 2004;53; 1479-84[Abstract/Free Full Text]

Parents' pain does not cause children's pain

Successive questionnaires to children and their parents have failed to show a link between their experiences of pain. Many previous reports had suggested that children who report pain are more likely to have parents who do the same. The investigators questioned 1326 children aged 12-15 and obtained data from 1003 parents. Although more than half reported at least one day of pain in the month preceding the questionnaire, no consistent association could be found. In common with many previous studies, the major determinants of childhood complaints of pain were psychosocial difficulties and adverse behaviour, rather than a learnt response from parents.

Ann Rheum Dis 2004;63: 1152-4[Abstract/Free Full Text]

Advice on pathology report increased GPs' referrals for possible coeliac disease

Clinical biochemists in Portsmouth, England, provoked a major rise in guideline adherence for investigating coeliac disease by adding a note to their pathology reports. A previous study had shown that 70% of patients reported as having gut related antibodies were not referred for investigation, as recommended by the guidelines of the British Society for Gastroenterology (BSG). The investigators added a comment to positive reports of antibodies to transglutaminase or endomysium, saying that the BSG recommended referral. The referral rate increased to nearly 80%, all of whom received a jejunal biopsy. This left 18 non-referred patients, of whom four had been placed on a diet without biopsy; five were lost to follow up and nine were neither referred nor treated by their GP. The authors suggest that all laboratories should add explicit advice on following BSG guidelines.

J Clin Path 2004;57: 943-5[Abstract/Free Full Text]

Smoking bans really work Between 1992 and 1999, US workplace smoking bans became more common, people became more proscriptive about smoking in their homes, and total smoking rates fell. It seems that introducing workplace bans influences what people do at home, and tobacco control policies not only reduce the number of smokers but also exposure to tobacco smoke generally. Tobacco Control 2004;13: 258-63[Abstract/Free Full Text] Credit: BILDERBERG/PHOTONICA

Octopus pots, stress, and heart attacks Acute myocardial infarction occurred in three patients aged under 60 shortly after acutely stressful events—a heated meeting involving a sexual harassment case, an argument leading to permanent family break up, and a road crash. On angiography, none had serious coronary artery disease but all showed temporary left ventricular wall motion abnormalities. The particular ventriculogram pattern is known as tako-tsubo, after a fancied resemblance to a Japanese vessel used for trapping octopus. Heart 2004;90: e52[Abstract/Free Full Text]

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