Leber, Magen, Darm最新文献

In a pilot study we investigated the effect of ursodeoxycholic acid therapy in 11 patients (mean age 45.8 +/- 13.2 years) with chronic active, ANA- and/or SMA-positive autoimmune hepatitis of moderate severity. All patients were clinical asymptomatic and no indication for immunosuppressive therapy could be established in any patient. After a washout period of at least 3 months, the treatment was administrated with 500 mg ursodeoxycholic acid twice daily. A statistically significant improvement in all important hepatic parameters was achieved within 3 months of therapy. No further improvement could be observed once 6 months had elapsed. Significant decreases of SGOT (29.9 +/- 20.2 vs 17.7 +/- 7.1 U/l, p = 0.020), SGPT (43.8 +/- 31.0 vs. 19.6 +/- 6.7 U/l, p = 0.0012), GLDH (20.1 +/- 20.9 vs. 5.2 +/- 2.6 U/l, p = 0.0001) und gamma-GT (152.0 +/- 124.8 vs. 60.6 +/- 49.2 U/l, p = 0.0064) were observed during treatment. Despite tendential improvement, serum biliruhin, levels (18.2 +/- 9.4 vs. 16.9 +/- 9.4 mumol/l, p = 0.287) did not change significantly during treatment. Ursodeoxycholic acid may be beneficial in altering the natural course of chronic active hepatitis and of value in preventing mild attacks of immune hepatitis. The simple fact that ursodeoxycholic acid administration is essentially free of side-effects can go a long way towards justifying further clinically controlled studies.

The aortoenteric fistula is one of the rare causes of gastrointestinal bleeding. A 73 year old patient presented with a secondary fistula after implantation of a synthetic graft. The diagnosis was confirmed by endoscopy. At elective laparotomy, a communication between the graft and the duodenum was discovered. Principally the combination of gastrointestinal bleeding and aortic graft is always suspicious of an aortoenteric fistula. The treatment must be surgical.

Portal hypertension, defined by a constant increase of the portal vein pressure over 5 to 10 mmHg, is usually caused by a pre-, intra- or posthepatic obstruction of the portal blood flow. Advances in ultrasound techniques like duplex or colour doppler enabled portal hypertension to be diagnosed safely in a noninvasive way. Invasive procedures for the measurement of portal pressure or blood flow are just applied for scientific and pharmacological questions. The therapy of portal hypertension concentrates on the treatment of its complications: The management of the acute variceal hemorrhage should follow a sequential regime. The treatment of the individual patient however, depends on the special experiences of the responsible doctor. In the primary and secondary prophylaxis of hemorrhage from esophageal varices the administration of portal pressure reducing agents like beta-blockers, sclerotherapy or banding of esophageal varices, represent effective strategies. Trials in the future should concentrate on the characterization of these patients, who show the best response to different prophylactic strategies. The treatment of ascites is according to a sequential procedure. Peritoneovenous shunts are usually not necessary. The transhepatic intrajugular portosystemic stent shunt offers a new therapeutic option of complications of portal hypertension. First studies show encouraging results.

The case of a patient with diffuse white furs in the whole esophagus is described. Esophagoscopy was suggestive of the presence of a wide-spread Candida esophagitis. The histologic and cultural examinations excluded Candida esophagitis and did not show unequivocal pathologic alterations. Detailed anamnestic exploration revealed a long existing distinct abuse of an antacid. After discontinuation of the antacid-intake a control gastroscopy was done 4 months later showing completely normal mucosa and disappearance of all furs. The present case demonstrates that antacidum intake must be encountered as differential diagnosis of esophageal white plaques.

Percutaneous endoscopic gastrostomy (PEG) is a simple technique for the endoscopic placement of a permanent feeding access. The procedure is relatively safe and the technique well established. PEG can, however, be associated with serious complications and death. Following the rare PEG-related complication of an abdominal dislocation we review technique, indications and complications of this sixteen year old method.