Dear Madam,

As a sufferer of Crohn’s disease, I read with great interest the excellent review of Dr. Wasim Jafri: “Manage­ment of Inflammatory Bowel Disease”, J.EM.A. 1990,40: 162. As a biochemist and one who is dedicated to creating as much unemployment as possible among surgeons, perhaps my own experience maybe of interest. After years of periodic hell culminating in a stoppage of the bowel, I underwent emergency surgeryfor removal of the terminal ileum and ascending colon in July 1983. Recovery was painful but otherwise uneventful but consid­erable discomfort persisted. As a biochemist, I became aware of the theory of Dr.A. Burton Of University of British Columbia, Canada, in which it is supposed that the cause (or one of the causes) of Crohn’s disease is an enzyme block at the N-acetylglucosámine (NAG) stage of mucopolysac­charide biosynthesis in the gut. He is carrying out trials involving the oral administration of small doses of NAG (Sigma, U.K.) dissolved in water, with considerable suc­cess. A team in Birmingham, U.K. is now doing likewise. I have been taking a dose of approx. 300 mg/day since October 1983, in which time I have suffered no further discomfort apart from occasional doses of College Canteen Syndrome. I can eat anything Pakistani as well, as any Pakistani, with no exceptional diarrhoea. Biochemical parameters: all always normal except for one slight dip in serum vit. 1112 last December cured by one injection. Lactose tolerance has never been investigated but! can and often do gobble down 1/2 liter of ice cream quite happily. Perhaps temporary zinc deficiency from time to time. What are the chances of carcinoma developing? I cannot say and do not wish to know! Agreed, that n = 1 has no statistical weighting but could not an NAG - trial be conducted in Pakistan under the guidance of one such as Dr. Jafri. Incidentally, What is the incidence of Crohn\'s disease in Pakistan?

Sincerely Yours,
W.W.T. Manser Deptt. of Biochemistry, Baqai Medical College, P.O. Box 2407, Karachi-18.