Leber, Magen, Darm最新文献

The aim in treatment of reflux oesophagitis is to relieve symptoms as well as to prevent complications and recurrence of the disease. The obvious preventive measures as abstinence from alcohol and nicotine and to sleep in a raised bed are useful for the health of the patient in general, but application on a whole is not possible and their efficiency in therapy of reflux oesophagitis is questionable. As to pharmaceutical treatment, proton pump inhibitors are the first line therapy. Such treatment enables the raising of pH levels over 4 to enable efficient acid blocking. It works directly on the key enzyme without being influenced by other environmental factors. Proton pump inhibitors have few side effects and they are suitable for long term treatment. In comparison to other medications proton pump inhibitors have proved to be significantly better in reducing symptoms of reflux oesophagitis in a shorter time. They also reduce healing time of peptic lesions and have proved to be efficient in higher stages of reflux oesophagitis and even in cases resistant to H2-inhibitors. H2-inhibitors have lost their place in the treatment of reflux oesophagitis with the arrival of proton pump inhibitors, because they are less effective, have a comparable number of side effects and are not prophylactic against relapse. Only patients complaining of reflux symptoms without provable morphological changes in the oesophago-gastral region are suitable for treatment with antacida or H2-inhibitors. There is a strict indication for long term treatment in stages with severe morphological changes (stage III or IV according to Savary and Miller) and in prevention of symptomatical relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

Neoplasms of the esophagus normally appear either as a exophytic-polypoid form, or as an infiltrating carcinoma or as an ulcerating tumor. We report on a 86 year old man suffering from the rare case of a pedicle polypoid tumor of the esophagus histologically diagnosed as a carcinosarcoma. We discuss the histological problems and our diagnostic and therapeutic proceeding.

Successful use of laparoscopic cholecystectomy requires good cooperation between surgeon and gastroenterologist. Standard preoperative workup includes detailed history of the patient, blood chemistry of serum bilirubin and liver enzymes as well as sonography for the detection of common bile duct stones. Intravenous cholangiography can be performed to diagnose anatomic variations of the bile ducts. In case of common bile duct stones "therapeutic splitting" by endoscopic retrograde cholangiography with sphincterotomy and gallstone extraction preoperatively may help to avoid unnecessary conventional open cholecystectomy.

At the present, Helicobacter-associated gastritis is not considered to be an important cause of dyspeptic symptoms. Therefore, patients with dyspeptic symptoms and proven Helicobacter-gastritis are diagnosed as having functional dyspepsia, provided that Helicobacter-associated lesions like ulcers or malignancies are absent. It is controversial whether or not to treat a patient with functional dyspepsia with Helicobacter gastritis. Conclusive controlled clinical trials are lacking. If it is assumed in a given patient, that Helicobacter could be responsible for the complaints (an assumption which can never be proven and only suspected when the patient remains asymptomatic during longterm follow-up after cure of the infection) and if the patient has not responded to a standard treatment (antisecretory or prokinetic agents), we recommend Helicobacter therapy. Presently, in spring 1995, the following treatment is, in our view, the best choice during seven (to ten) days: The patient takes 20 mg omeprazol in the morning, 250 mg clarithromycin in the morning and in the evening and 500 mg metronidazole in the morning and in the evening.

In a prospective study, thirty consecutive patients presenting with either H.pylori positive (histology and/or culture) ulcer disease (n = 17; acute ulcer: n = 11) or functional dyspepsia (n = 13) were treated over one week with pantoprazole 40 mg bd, clarithromycin 250 mg bd and metronidazole 400 mg bd. Four weeks after discontinuation of the study medication H.pylori eradication was assessed by means of an urease test, culture and histology. One patient had to be withdrawn from the study after one day because of a concomitant infectious disease requiring long-term antibiotic treatment. Another patient refused the final follow-up endoscopy. 28 patients completed the study without contravening the protocol. H.pylori infection was eradicated in 24 out of 28 patients (eradication rate: 86%; 95%-confidence interval: 57%-96%). Cure of bacterial infection was more frequently obtained in ulcer patients as compared to patients suffering from functional dyspepsia (94% vs 75%; p = 0.28). In 2 patients, treatment failure was associated with pretherapeutic resistance of H. pylori to either clarithromycin or metronidazole. Without antiulcer treatment beyond eradication therapy, ulcer healing was endoscopically confirmed after 5 weeks in 9 out of 10 patients available for follow-up (healing rate: 90%; 95%-confidence interval: 56%-100%). Seven patients reported mild adverse events that did not lead to discontinuation of the study medication (rate: 23%; 95%-confidence interval: 10%-42%). After cure of the infection, histology demonstrated a statistically highly significant improvement (p < 0.001) of both grade and activity of antrum and body gastritis.(ABSTRACT TRUNCATED AT 250 WORDS)

We report of a case of spontaneous rupture of the Oesophagus (Boerhaave's-Syndrome) from a 56 year old female alcoholic, who was soon operatively treated. First the patient was explored by a left thoracotomy, the rupture was sutured from abdominal and butressed with the gastric fundus and a feeding jejunostomy was established. Because of postoperatively complications the patient was treated with haemofiltration. The way was prolongated because of severe obstructive airway disease, the patient left intensive care after 22 days.