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Vanilloid receptor 1 (VR1) is expressed by sensory neurons. Once activated, these neurons evoke the sensation of burning pain and release neuropeptides that induce neurogenic inflammation. We used immunoblotting and immunostaining to estimate the density of VR1 in colonic tissues of patients with inflammatory bowel disease and of controls. Our study results indicate that VR1 immunoreactivity is greatly increased in colonic nerve fibres of patients with active inflammatory bowel disease. Thus, the discovery of new drugs that can bind the VR1 receptor, or antagonise endogenous inflammatory substances that activate this receptor, could lead to new therapies for pain and dysmotility.

1. Traditional remedies are an unusual, but recognised cause of lead poisoning. Only two cases have previously been reported in this country. 2. We report a series of five cases of lead poisoning due to traditional remedies in the West Midlands. All developed typical clinical features. 3. Blood lead and zinc protoporphyrin (ZPP) concentrations were elevated 2-10 times the upper limit of normal. The remedies contained up to 60% lead by weight. One also contained traces of mercury, another arsenic, and a third aluminium and tin. 4. Confirmation of the medicines as the cause of the poisoning was made in one patient by measurement of lead isotopic ratios. 5. The present morbidity from traditional remedies may be far greater than is realised, and will continue until such time as the supply of harmful preparations can be effectively limited. There needs to be increased awareness of their dangers amongst doctors and the communities at risk. This will best be achieved by appropriately targeted education.

We report what we believe to be the first case of Crohn's disease involving the cervical oesophagus with an oesophago-pulmonary fistula to the apex of the lung. The proximal location of the disease prevented radical therapy and the patient eventually died from chronic sepsis.

A case of actue jejuno-gastric intussusception diagnosed at gastroscopy is described. The patient had undergone a Polya gastrectomy eight years previously. Other reported cases have been discovered by radiology or at surgery. Endoscopy is the method of choice to diagnose this uncommon, but important condition.

Two patients are described who were found to have a destructive lesion of the myenteric plexus. In one the upper small intestine was involved and the clinical picture was of recurrent pseudo-obstruction; in the other the lesion was in the distal colon and resulted in intractable constipation. The lesion cannot be demonstrated by conventional histological techniques, being seen only in silver preparations cut parallel to the bowel wall, and may have been overlooked in the past. The aetiology is unknown.

Red cell indices were determined and bone marrow was examined in a selected group of 21 patients with Crohn's disease who had a routine peripheral blood picture suggestive of iron deficiency. Only nine (43%) of these patients had no stainable iron stores in the marrow fragments and could be considered as being definitely iron deficient. All indirect measurements in the diagnosis of iron deficiency, except the total iron-binding capacity (TIBC), appeared likely to result in over-diagnosis. Iron-deficient erythropoiesis, without true deficiency, may be due to the inflammatory disease process and this study indicates that the examination of bone marrow aspirate is necessary for the certain diagnosis of iron deficiency in Crohn's disease.