Zeitschrift fur Gastroenterologie最新文献

Nutritional medicine is an important area of gastroenterology. It requires trained medical personnel who have qualified through additional training in nutritional medicine.In fall 2023, a survey was conducted among young gastroenterologists (JUGA) of the DGVS. Demographic data, the institutional and personal importance of nutritional medicine, and additional training were surveyed using Likert scales (rating scale 1 to 10), single-choice, and multiple-choice questions. The influence of gender, age, position, and institution was also examined.The personal importance of nutritional medicine among the 225 participants was 8 (7-10) on average, while its importance in the institution where they worked was 5 (3-7). This was rated significantly (p=0.012) higher in university hospitals than in non-university institutions. Obstacles cited include an unclear process for additional training, availability of case seminars and courses, and a lack of support at the management level.The importance of nutritional medicine at clinical institutions is lower than the personal interest in nutritional medicine and additional training, but this is currently associated with significant obstacles. Structural improvements and greater recognition are needed to keep additional training attractive and to meet the growing demand gap.

Achalasia, a rare esophageal motility disorder, is managed with medications, botulinum toxin, pneumatic dilation (PD), or surgery. In resource-limited settings like Pakistan, PD is preferred first-line non-surgical treatment due to its accessibility and cost-effectiveness so we aim to assess remission rates and clinical outcomes of PD.Between 2015 and 2024, 213 achalasia patients were diagnosed via HRM at Center for Liver & Digestive Diseases, Holy Family Hospital, Rawalpindi. 191 patients opted for PD and completed follow-up interviews using Eckardt score and ASQ questionnaire. Data analysis was performed using SPSS.Among 191 patients (107 males, 84 females), 53% underwent one, 30% two, and 17% three PD session. Success rates were 58% for one, 78% for two, and 87.5% for three sessions, with no severe complications. The cumulative re-dilation rate was 20%, with a 76% success rate for repeat dilations. Multiple PDs significantly outperformed single PDs(p=0.01), reducing mean Eckardt score from 6.7 to 1.9. QoL improved with successful dilations but not in failed cases.PD provides sustained symptom relief for up to five years, with repeat sessions enhancing long-term success, reinforcing PD as an effective, durable, and accessible treatment option for achalasia in low-resource settings for evidence-based clinical decision-making.

Results on exposure-efficacy relationships for vedolizumab in patients with Crohn's disease are contentious. Our study aimed at exploring the relationship between vedolizumab serum concentrations measured during induction and maintenance and treatment outcomes in Crohn's disease patients in a real-world setting.Crohn's disease patients treated with vedolizumab between January 2014 and July 2022 at our tertiary care centre were included. Serum vedolizumab concentrations were measured on at least one of the following time points: week 2, 6, 12, 26, and/or 52. Treatment efficacy was evaluated at weeks 12, 26 and 52 as clinical remission based on patients reported outcomes, faecal calprotectin and C-reactive protein remission.In total, 58 patients (55.2% females) were included. At baseline, active disease, defined either by increased faecal calprotectin, C-reactive protein or patients reported outcomes, was observed in 53 patients (91.4%). Week 12 vedolizumab serum levels were higher in clinical remitters versus non-remitters at weeks 12 and 52 (p <0.05). However, in adjusted multivariate analyses no association between vedolizumab levels and therapy outcomes was observed.In our retrospective study, vedolizumab serum concentrations measured during induction treatment were not associated with clinical and feacal calprotecin remission at weeks 12, 26 and 52.

Intraepithelial lymphocytosis is a hallmark of microscopic colitis commonly presenting with debilitating chronic watery diarrhea. The exact pathophysiology remains unclear but is believed to involve an abnormal immune response to the luminal microenvironment in genetically predisposed individuals. Medications like nonsteroidal anti-inflammatory drugs, proton pump inhibitors, and antidepressants, as well as alcohol consumption and smoking have been regarded as risk factors for microscopic colitis. Lymphocytic colitis often responds well to anti-inflammatory treatment, with budesonide being a first line therapy. Relapse is common after discontinuing budesonide, often necessitating low-dose maintenance therapy. Advanced therapies including anti-TNF-alpha (e.g. infliximab) or anti-integrin (e.g. vedolizumab) agents as well as JAK inhibitors (e.g. upadacitinib) may be considered in refractory cases. However, confirmation of the diagnosis and ruling out other etiologies are necessary before intensifying treatment. Here, we present the case of a 78-year-old female patient with a twenty month history of chronic refractory diarrhea, repeatedly diagnosed as microscopic lymphocytic colitis. Following further deterioration and the development of hepatosplenomegaly with atypical liver lesions, a review of colonic biopsies and additional work-up led to the correct diagnosis.

The integration of sonography into medical studies offers a wide range of opportunities, but also presents teachers with complex challenges. Teaching theoretical and practical sonographic skills requires not only technical expertise, but also sound didactic and communication skills on the part of the teachers. The aim of this study is to provide sonography teachers with sound recommendations for effective teaching based on current evidence.National and international studies on sonography training and didactics were evaluated as part of a systematic literature review. The findings were grouped by topic, structured using a consensus process, and presented in the form of practical guidelines. The analysis was based on the PRISMA criteria and supplemented by a narrative synthesis.Eleven didactically sound recommendations for sonography teaching were formulated, including: optimal group sizes, establishment of peer teaching, early curricular integration, use of modern technologies (e.g., AI, VR), use of appropriate teaching and learning materials and didactic methods, targeted teaching of psychomotor skills, and the inclusion of ethical aspects. All of the recommendations mentioned have been proven to be relevant, practicable, and didactically effective in the literature and were classified and explained in terms of content.The results show that high-quality sonography training is more than just technical training: it requires educational planning and didactic sensitivity. The tips presented here offer guidance and inspiration for reflective, evidence-based, and learner-centered teaching practices. They not only promote the acquisition of skills by students, but also the further development of the teachers themselves-towards sustainable, interprofessionally compatible sonography training.

Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) has become an established interventional procedure for treating decompensated liver cirrhosis and its complications, such as portal hypertension. Current research focuses on optimizing patient selection and timing to enhance outcomes further. TIPS effectively reduces portal vein pressure, mitigating bacterial translocation and systemic inflammation associated with cirrhosis. This reduction in inflammation has been shown to decrease decompensation events and improve survival rates. However, challenges remain regarding the precise adjustment of the portosystemic gradient (PSG) to balance symptom control with minimizing risks such as hepatic encephalopathy or cardiac complications. The main indications for TIPS include variceal bleeding (especially high-risk patients requiring preemptive TIPS within 72 hours), recurrent ascites, and Budd-Chiari syndrome. Strict patient selection is crucial to maximize benefits while minimizing risks. Emerging evidence highlights the importance of addressing both portal hypertension and inflammation to improve clinical outcomes. In summary, TIPS represents an effective approach to managing complications of liver cirrhosis that improves survival and quality of life for affected patients.

Primary sclerosing cholangitis (PSC) is an immune-mediated disease of the biliary tract for which no prognosis-improving therapies are yet available. PSC is characterized by genetic risk factors, alterations in the microbiome and pathological immune activation leading to the development of biliary fibrosis. Cholangiocytes play an active role in the inflammatory processes, as they interact directly with the microbiome and immune cells. The concomitant chronic inflammatory bowel disease has a distinct phenotype and causes a reciprocal modulation of intestinal and hepatic disease activity via changes in the intestinal barrier and the enterohepatic circulation of bile acids. While the currently available drugs and endoscopic treatment options are only symptomatically effective, new pharmacologic therapies are under clinical evaluation. In this review, we aim to provide an insight into the current understanding of the pathogenesis of PSC and new therapeutic developments.

The job profile of the clinician scientist has established itself as a central pillar of university medicine in recent years. In view of increasing demands in clinical practice and research, targeted programs are necessary to offer physicians with an interest in science a protected working environment. Structured clinician scientist models enable a systematic connection and, in some phases, separation of clinical work and research, thus forming the basis for sustainable scientific careers - even beyond specialist training. This article highlights the structure, challenges, and future outlook of these specific programs using the discipline of gastroenterology as an example.

Hepatocellular Carcinoma (HCC) is an entity characterized by a highly heterogenous tumor immune microenvironment. The introduction of immune checkpoint inhibitor (ICI) therapy as standard of care in advanced disease stages and with promising results in earlier stages has highlighted the need for a better understanding of the underlying immunobiology. In this review, we provide a summary about the immune landscape in HCC and discuss novel potential therapeutic targets as well as how spatial immune profiling may help identify optimal candidates for ICI therapy.