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ObjectiveAlcoholic fatty liver (AFLD) and non-alcoholic fatty liver (NAFLD) are two common conditions. However, if they can increase the risk of death is poorly explored. We therefore aimed to investigate the potential association between the presence and severity of liver steatosis and mortality in a large sample of older people.DesignProspective.SettingCommunity.ParticipantsWomen and men randomly sampled from the electoral rolls of the population of Castellana Grotte, a town in Southern Italy (Apulia region) between 2005 and 2006. Among 1942 initially contacted, 1708 (=87.9%) participated to the baseline survey (Multicentrica Colelitiasi III (MICOL III)). This specific study included 1445 older participants (mean age=65.2 years, females=44.2%).ExposureNAFLD or AFLD.Primary and secondary outcomesMortality (all-cause and specific-cause).ResultsAfter a median of 12 years, 312 participants (=21.6%) died. After adjusting for nine potential confounders, the presence of steatosis was not associated with any increased risk of death in both NAFLD and AFLD. The severity of liver steatosis was not associated with any increased risk of mortality in NAFLD, while in AFLD, the presence of moderate steatosis significantly increased the risk of overall (HR=2.16; 95% CI 1.19 to 3.91) and cancer-specific (HR=3.54; 95% CI 1.16 to 10.87) death.ConclusionsLiver steatosis is not associated with any increased risk of death in NAFLD, while moderate steatosis could be a risk factor for mortality (particularly due to cancer) in people affected by AFLD.

BACKGROUND Intrasphincteric injection of botulinum toxin (Botx) has been proposed as treatment for oesophageal achalasia. However, the predictors of response and optimal dose remain unclear. AIMS To compare the effect of different doses of Botx and to identify predictors of response. PATIENTS/METHODS A total of 118 achalasic patients were randomised to receive one of three doses of Botx in a single injection: 50 U (n=40), 100 U (n=38), and 200 U (n=40). Of those who received 100 U, responsive patients were reinjected with an identical dose after 30 days. Clinical and manometric assessments were performed at baseline, 30 days after the initial injection of botulinum toxin, and at the end of follow up (mean 12 months; range 7–24 months). RESULTS Thirty days after the initial injection, 82% of patients were considered responders without a clear dose related effect. At the end of follow up however, relapse of symptoms was evident in 19% of patients who received two injections of 100 U compared with 47% and 43% in the 50 U and 200 U groups, respectively. Using Kaplan-Meier analysis, patients in the 100×2 U group were more likely to remain in remission at any time (p CONCLUSIONS Two injections of 100 U of Botx 30 days apart appeared to be the most effective therapeutic schedule. The presence of vigorous achalasia was the principal determinant of the response to Botx.

Introduction Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. Objectives To estimate NAFLD prevalence and transition probability through different severity stages in a population older than 18 years of age. Methods The survey was conducted from July 2005 to January 2007 in Putignano, Bari. A systematic random sample of 2301 subjects from the list of records maintained by general practitioners was drawn. Subjects were asked to complete a questionnaire regarding sociodemographic characteristics and life styles, underwent anthropometric measures and liver echography. A sequential logit model was used to estimate the effect of the explanatory variables on the odds and probabilities of passing a set of transitions. Results Overall prevalence of NAFLD was 24.3% (male 36.7%, female 14.2%); NAFLD steady raised with age. BMI and its interaction with age resulted significantly associated with the odds of transition from less to more severe NAFLD, especially in early stages. At 40 years old the transition probability to pass from no NAFLD to any form of NAFLD reached 35% and 8% among men and women respectively. The effect of BMI on the most severe stage of NAFLD is almost entirely the result of transition between absence to light NAFLD for subjects in the range 18–30 years old. A small effect of BMI was also seen in post-menopause women. Conclusions The implications of this alarming and silent prevalence of NAFLD derived from the fact that this liver condition may progress to more severe liver disease.

Introduction Obesity has become a threat to public health, as the epidemic is not confined to developed countries but is affecting many developing ones. Objectives To estimate overweight and obesity prevalence and their association with some social characteristics in a population older than 18 years of age. Methods The survey was conducted from July 2005 to January 2007 in Putignano, Bari, Apulia. A systematic random sample of 2301 subjects from the list of records maintained by general practitioners was drawn. Subjects were asked to complete a questionnaire regarding sociodemographic characteristics and life styles, underwent anthropometric measures and liver echography. A fasting blood sample was drawn. A quantile regression model was fitted to the data (conditional quantiles: 0.47 overweight and 0.83 obesity) with 500 bootstrapped replications. Results Overall prevalence of overweight was 50.1% (male 59.5%, females 14.6%) whereas obesity prevalence was 16.1% (male 18.0%, females 14.6%). Overweight and obesity steady raised with age. Overweight was associated positively with age at enrolment, being a male, number of household members, daily alcohol intake, married status and high socio-economic status. Obesity was associated positively with age at enrolment, being a male and daily alcohol intake. Conclusion There is little doubt that socio-cultural and life-style factors operate to influence overweight and obesity but it is important to investigate the factors and their interaction on obesity as well as the pathway linking them. This approach may support the development and implementation of effective public health strategies.

Editor,—The British Society of Gastroenterology should be congratulated for commissioning the guidelines on the management of acute pancreatitis ( Gut 1998; 42 (suppl 2):S1–13). However, in this document the clinically relevant issue of drug treatment of acute pancreatitis has not been reviewed in depth. Although we agree that current treatment of severe necrotising pancreatitis is unsatisfactory, we do not share the opinion that beyond resuscitation and support there is no agreed specific treatment. We would like remind members of the …