Zeitschrift fur Gastroenterologie最新文献

Evidence-based guidelines are an important basis for medical action. The methodological effort to develop guidelines is high. Nevertheless, a high methodological effort in the development of guidelines does not automatically guarantee the success of a guideline, but it must be ensured that guidelines are also accepted and thus applied. Currently (as of October 2024), 28 guidelines are available, which were created under the leadership of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS). How these guidelines are perceived and used in everyday clinical practice and what obstacles exist in their implementation has been little researched so far.This study examines the acceptance and use of the DGVS guidelines with the aim of optimizing the guideline process and implementation.A questionnaire with 32 questions was designed, which included closed questions, Likert scales and free-text answers. The questionnaire was sent by e-mail to 7015 DGVS members. Answering the questionnaire was anonymous and voluntary. In subgroup analyses, physicians in outpatient care, hospitals and university hospitals, as well as physicians with or without experience in guideline development were compared.604 responses were evaluated (response rate 8.6%). The DGVS guidelines are ubiquitously well known and are considered extremely useful by 66% of respondents. They are the main source of information in everyday clinical practice, but their structure is considered to need improvement. Users trust the quality of guidelines regardless of the guideline classification. There are subgroup differences regarding the extent of use or the various reasons for the use of guidelines. In outpatient care, guidelines are more often used to protect oneself against causing a medical error compared to university hospitals, and the avoidance of overtreatment generally seems to be more important at non-university hospitals.Overall, the DGVS guidelines are rated positively. In different areas of medical practice there are different wishes and requirements for guidelines. Improving the topicality of the guidelines is the priority for most respondents. Further starting points for improvement are the structure of the guidelines and focusing on relevant content for everyday cliclinical practice, especially in outpatient care.

Bouveret syndrome is a rare complication of gallstone disease. We present a 76-year old male patient in whom the diagnosis was complicated by the reporting of coffee-ground emesis suggesting upper gastrointestinal bleeding. Considering the diagnosis of Bouveret syndrome is commonly made through cross-sectional imaging, these patients rarely undergo diagnostic endoscopy. However, this case presented with typical findings during emergency esophagogastroduodenoscopy (EGD) underscoring its educational value for gastroenterologists and endoscopists.

The current goal of adapting care structures in the German healthcare system is to increase the provision of interventional treatments in outpatient settings. Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures were traditionally performed in an inpatient setting until 2022. However, with the introduction of a new Ambulatory Surgery Contract (according to Section 115b, Paragraph 1 of the Social Code, Book V) on January 1, 2023, these procedures are now intended to be carried out more strictly on an outpatient basis, meaning that hospitalization will no longer be reimbursed in most cases.Between June 1, 2023, and December 31, 2023 all ERCP procedures performed in an outpatient setting were included in this study. This cohort had standard ERCP indications and a low comorbidity burden according to the §115b specifications. Using propensity score matching (nearest-neighbor), these cases were matched with patients who underwent ERCP procedures in an inpatient setting between June 1, 2022, and December 31, 2022.Propensity-score matching identified a cohort of 166 patients (83 outpatients and 83 inpatients) with similar baseline characteristics. The most common indications for ERCP were choledocholithiasis and biliary strictures. Reported complications comprised pancreatitis, bleeding and cholangitis and were rare in both groups, occurring in 7% of inpatient procedures and in 6% of outpatient procedures. The latter cases required inpatient admission after self-presenting to the emergency department. No serious adverse events were reported.Outpatient ERCP is a safe procedure for selected patients with a low risk profile. Complications occurred rarely and could be adequately managed.

Cryptosporidium (or cryptosporidiosis caused by them) is one of the most relevant infections of the intestinal tract. The unicellular parasites infect the intestinal cells and cause cramps, weight loss and diarrhea. Cryptosporidia play a special role in AIDS patients. Here they are counted among the diseases that define the acquired immunodeficiency syndrome. Because of this relevance, the search for vaccines is a relevant goal of gastroenterological research. But how realistic are such vaccines? This article describes the disease cryptosporidiosis and reviews current therapeutics and hypothetical vaccine candidates.

Gastritis cystica profunda (GCP) is a rare disease that is often observed at the stoma site of patients undergoing gastric surgery. Specific symptoms are often lacking, making it difficult to diagnose. GCP may develop into cancer. Endoscopic resection is a good method to reduce surgical injury, and the therapeutic effect depends on the status of the primary disease.The patient was a 77-year-old male who was admitted to the hospital for repeated epigastric distention. The man had never undergone gastric surgery and did not have Helicobacter pylori infection. Physical and laboratory tests showed no abnormality. Computed tomography showed no significant abnormality. Endoscopy revealed multiple ulcers on the posterior wall of the gastric body, but biopsy showed no evidence of malignancy. The patient subsequently underwent ESD surgery with a lesion of 1.5 cm×2.3 cm. Pathological results showed the cystic dilatation of gastric glands in the submucosa, with some well-differentiated adenocarcinoma. The final diagnosis was GCP with well-differentiated gastric adenocarcinoma.Herein, we describe a case of ESD therapy for GCP with well-differentiated gastric adenocarcinoma. When gastric mucosal lesions are difficult to diagnose, further treatment and diagnosis with EMR or ESD can be considered. For patients with early gastric cancer, long-term postoperative monitoring should be carried out.

The psychosocial effects of eating and drinking - summarized as food-related quality of life (FR-QoL) - are underexplored in inflammatory bowel disease (IBD). Currently, there is no German instrument to assess FR-QoL in IBD patients. This study aimed to translate the validated English FR-QoL-29 questionnaire into German and evaluate its validity and reliability.A monocentric, cross-sectional study was conducted at a tertiary referral center with IBD patients and healthy controls. Participants completed questionnaires on sociodemographics, disease history, the Malnutrition Universal Screening Tool (MUST), the German Short Health Scale (SHS), and the FR-QoL-29-German. The FR-QoL-29 was translated into German using a forward-backward method. Its reliability and validity was assessed using Pearson correlation coefficients, intraclass correlation coefficients, and Cronbach's α.N=200 IBD patients (Crohn's disease: 61.8%; women: 50.8%; remission: 56.2%) and n=10 healthy controls completed the questionnaires. Overall, 113 IBD patients repeated the questionnaires after an average of six weeks. Significant differences in FR-QoL-29-German sum scores were found between all levels of IBD disease activity, except for remission - mild disease (p = 0.423) and moderate - severe disease (p = 0.999). FR-QoL-29-German scores significantly correlated with age (p = 0.041), disease activity (p < 0.001), MUST (p = 0.015), fecal Calprotectin (p = 0.011) and SHS (p < 0.001). Overall, the FR-QoL-29-German showed excellent internal consistency (Cronbach's α = 0.965) and good test-retest reliability (ICC = 0.85 [95% CI: 0.78-0.89]).The FR-QoL-29-German is a valid and reliable tool for assessing food-related quality of life in German-speaking individuals with IBD.

Direct-acting antiviral (DAA) regimens for the treatment of hepatitis C virus (HCV) infection are endowed with sustained virological response (SVR) rates >95%. However, HCV cure does not completely eliminate the risk of hepatocellular carcinoma (HCC) development and liver decompensation. The present study investigated the impact of the administered DAA regimen on clinical long-time outcomes after SVR.Matched-pair survival analyses of 5802 chronically HCV infected patients from the German Hepatitis C-Registry compared the incidence of liver-related events 2.5 years after SVR in patients receiving either sofosbuvir (SOF)-based treatment or NS3/NS4A-protease inhibitor (PI)-containing DAA regimens. Hypothesis driven logistic regression analyses were performed to identify independent predictors for the occurrence of liver-related events.Matched-pair survival analyses revealed a borderline significant difference in the incidence of liver-related endpoints (except of HCC development) in patients receiving SOF-based treatment (4.1%) compared to PI-containing DAA regimens (2.6%) 2.5 years after SVR (p=0.061). Numerically, a trend towards a benefit of PI-based DAA treatment was observed (PI 65 events vs SOF 102 events). Hypothesis driven logistic regression analyses could not confirm SOF-based treatment as an independent predictor for the occurrence of liver-related events after HCV cure (p=0.072, OR=0.670).The incidence of liver-related events 2.5 years after HCV cure did not differ significantly between SOF-based DAA treatment and PI-containing regimens. However, numerically a trend towards a benefit of PI-based DAA treatment was observed. Therefore, a minor effect of the applied DAA regimen on the long-term incidence of liver-related events cannot be excluded.

Short bowel syndrome is a rare complex disease that mainly develops due to extensive bowel resections and can lead to chronic intestinal failure. Due to the decreased intestinal surface absorption of macronutrient, micronutrient and/or fluids is reduced. Correspondingly manifold symptoms arise as diarrhoea, weight loss, vitamin deficiencies, chronic kidney disease, hepatopathy and others with great impact on quality of life of patients. Therapy is complex and needs interdisciplinary collaboration between dieticians, gastroenterologists, surgeons and also a dense monitoring of general practitioners. Commonly patients need permanent home-parenteral support. Therapies have to be decided individually and have to be reviewed regularly for effectivity and side effects. Furthermore, periodic monitoring of several clinical and laboratory tests should be performed. Morbidity and mortality of this disease complex is high and lead by appearance and management of complications. This practical guide should give an overview about the disease, diagnostics and management and should enable the best possible care of these complex patients.

Ultrasound diagnostics is a widely used, radiation-free, cost-effective, and bedside-applicable imaging technique. Given its numerous advantages and broad application, it appears reasonable to integrate practical use and theory into medical education at an early stage. Since the content of student ultrasound courses varies significantly on an international scale, the aim of this paper is to establish foundations for a more standardized approach to student's ultrasound education (SUSE) especially with focus on abdominal ultrasound. This review examines to what extent measurements can be effectively incorporated into student ultrasound training and under which conditions the teaching of pathologies should be included in these courses. Additionally, the handling of false-positive and false-negative findings in student training is discussed. Considering the growing relevance of interventional ultrasound (INVUS), the paper further explores the extent to which interventional procedures should already be taught during SUSE.