Zeitschrift fur Gastroenterologie最新文献

Malnutrition affects up to 50% of all hospitalized patients and is associated with increased mortality and morbidity. Nutritional therapy is important for the early detection and treatment of malnutrition.The aim of this survey was to determine the personnel and structural nutritional medicine resources in gastroenterological clinics and to identify possible obstacles.In October 2023, an anonymous survey was conducted among gastroenterological chief physicians being member of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) on the structural and personnel resources of nutritional care.Of the 78 participants, 57.7% worked at a basic and standard care hospital, 16.7% at a maximum care hospital and 10.3% at a university hospital. There are nutritional medicine structures in 83.3% of the hospitals, 61.5% of which have a doctor with the additional qualification in nutritional medicine. The acquisition of the additional designation was subsidised in 53.8% of cases. The lack of remuneration for nutritional medicine treatments and the resulting lack of personnel resources appear to be problematic for the expansion of clinical nutritional medicine.Even though gastroenterological chief physicians ascribe great importance to nutritional medicine, it currently plays a subordinate role in clinical work, training and further education as well as in research. An improvement in budgetary remuneration appears necessary in order to strengthen nutritional medicine in everyday inpatient care.

Despite efforts toward gender equality, disparities persist in medical careers and leadership. This study examines gender representation in gastroenterology at the German Visceral Medicine Congress from 2013 to 2024, focusing on changes over time.Programs from 1,333 sessions were analyzed for gender ratios of speakers and chairs, including plenary, ab-stract, and industry sessions, plus congress presidents and awardees. Trends were assessed via linear regression and Cochran-Armitage tests.Trend analysis revealed a significant increase in female speakers (r²=0.599, p=0.005) and chairpersons (r²=0.747, p<0.001). Female speaker proportions rose significantly in plenary (r²=0.600, p=0.005), abstract (r²=0.445, p=0.025), and industry sessions (r²=0.641, p=0.003), but did not reach parity. Female chairs showed stronger upward trends: plenary (r²=0.807, p<0.001), abstract (r²=0.490, p=0.016), industry (r²=0.729, p<0.001). Congress presidencies remained all male, and 75-93% of awards went to men.Female representation, especially in chair roles, has improved since the 2019 parity resolution but remains insufficient in key areas. Ongoing gender-sensitive planning and support are needed to foster a more inclusive academic environment.

Incidental findings of the gallbladder and bile ducts are common results in routine ultrasound examinations. This highlights the importance of accurate diagnostics and risk stratification to guide clinical decision-making appropriately. This case report discusses the diagnostic and therapeutic challenges posed by incidental gallbladder polyps (GBPs) through the case of a young man in his late twenties, in whom multiple polyps in the gallbladder were discovered during an abdominal ultrasound. Following current clinical guidelines, he underwent an elective cholecystectomy. The histopathological examination showed no signs of malignancy, emphasizing the ongoing challenge of correctly identifying suspicious lesions while avoiding unnecessary procedures or overtreatment. The case illustrates the limitations of imaging techniques, particularly in assessing the malignancy risk of polyps. It also highlights the variability in size measurements and the need for a nuanced, interdisciplinary decision-making process. Finally, the case raises important questions about patient-centered care, as individual perspectives often differ from standardized recommendations.

To assess the effectiveness and safety of EUS-BD in patients with jaundice due to malignant biliary obstruction and post-surgically altered anatomy of the upper GI tract who failed prior ERC.Over a defined study period, all consecutive patients, who had undergone EUS-BD, were analyzed retrospectively using a computer-based registry.Overall, 118 patients were registered (mean age, 69 [range, 38-88] years; sex ratio [f:m], 71:47) from 2005-2020. Technical and clinical success rates were 92.4 % and 93.6 %, respectively. 103 self-expandable metallic stents (SEMS), 2 lumen-apposing metal stents (LAMS), and 22 plastic stents were used.The successful access routes to the bile duct system were trans-gastric (n=69), trans-jejunal (n=39), and trans-esophageal (n=2).Adverse events (AE) occurred in 19.5 % and re-interventions were necessary in 27.9 % of cases. The median post-interventional survival time was 85 (95% CI: 45-256) days. The following parameters were associated with a significantly shorter survival time: CRP > 50 mg/L, bilirubin serum level > 200 µmol/L, high tumor burden, Karnofsky index < 80, and manifest malnutrition status.EUS-BD in malignant biliary obstruction is a safe and effective method, even with surgically altered anatomy of the upper GI tract, in experienced hands of interventional EUS.

This bibliometric study examines the publication activities of German university departments of gastroenterology and hepatology.First and last authorships from staff members (chief and consultants) of 39 German university departments of gastroenterology were evaluated. Gender assignment was carried out through manual verification based on information available on hospital websites. The observation period extended from 2010 to 2019, and all PubMed-listed publications were considered. The 5-year Impact factor (IF2016) was evaluated through the publishing journals' five-year IF in 2016.A total of 4,923 publications with 22,609.5 cumulative impact factors (c-IFs) were generated by 509 staff members. Publications on gastroenterology accounted for 30.3% and publications on hepatology for 26.7% of the total publications. The most common research foci were therapeutic approaches (35.0%) and diagnostics (30.2%). While women comprised 21.8% of the total staff, they accounted for only 16.9% of publishing authors. The proportion of female staff decreased with increasing professional level (Consultants 26.2%, Consultants with management functions 12.7%, Directors 10%; Doctors 29.9%, Senior lecturers 13.9%, Professors 15.4%). The c-IF were distributed as 89% male and 11% female staff, with the average IF per authorship being nearly equal for male and female authorships (men IF 4.54, women IF 4.42).This study confirms the strong male dominance in leadership positions, number of publications, and generated c-IFs in German gastroenterological university departments.

Mesalazine is the first-line treatment for mild-to-moderate ulcerative colitis (UC) of any extent, as recommended by all major international and national guidelines. Approximately 85% of UC cases are classified as mild-to-moderate, making mesalazine a cornerstone therapy for the majority of patients. It rapidly induces clinical response and clinical remission, sustains steroid-free clinical, endoscopic, and histologic remission over the long term, and has a safety profile comparable to placebo. This paper reviews the recommendations for mesalazine use in the German UC guideline and provides practical advice (including do's and don'ts) for their implementation in daily clinical practice. Examples include explaining the expected timeline and nature of the clinical response to mesalazine treatment; outlining the practical implications of the dose-dependency of the drug's therapeutic effect; and emphasizing the importance of rectal mesalazine as the first-line treatment for proctitis. Additionally, we conducted a systematic literature search to evaluate whether mesalazine should be continued after escalation to biologics or small molecules. While no clear evidence of short-term clinical benefit was found, there was also no evidence of harm. In light of the potential long-term chemoprotective effect of mesalazine, continuation may be considered on a case-by-case basis. Lastly, we provide an overview of the various mesalazine formulations available in Germany, detailing how they are not interchangeable due to differences in drug-release profiles, excipients, and dosing strengths. Understanding these differences may help clinicians personalize treatment, improving adherence and clinical outcomes.

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) represent the most prevalent primary liver cancers and pose significant challenges in oncology. While their etiology and incidence vary globally, the molecular landscape of these tumors is increasingly understood, offering new opportunities for precision medicine. In this joint multinational review, we present a comprehensive analysis of the key molecular pathways involved in the pathogenesis of HCC and CCA, highlighting actionable targets for emerging therapies. Recent advances in molecular diagnostics have significantly influenced treatment paradigms for both cancers. In HCC, while genetic alterations have not yet led to established diagnostic or therapeutic applications, targeting vascular endothelial growth factor (VEGF), immune checkpoints, and tyrosine kinase pathways has demonstrated considerable therapeutic potential. In CCA, genetic profiling has uncovered actionable alterations, such as FGFR2 fusions and IDH1 mutations, driving the development of targeted therapies. The growing complexity of precision oncology underscores the need for standardized molecular testing and streamlined diagnostic workflows to ensure timely and effective treatment. This review also emphasizes the importance of collaborative efforts between clinicians, pathologists, and oncologists to optimize outcomes. By synthesizing the latest molecular insights and treatment trends, this review provides a valuable resource to guide the personalized management of HCC and CCA.