Zeitschrift fur Gastroenterologie最新文献

Crohn's disease (CD), also known as cicatrizing enteritis, is an inflammatory bowel disease that occurs in the distal ileum and right colon of unknown cause and is also called inflammatory bowel disease (IBD) with ulcerative colitis (UC). In recent years, intestinal biota have been confirmed to play a significant role in various gastrointestinal diseases. Studies have found that intestinal microbiota disorders are closely associated with the onset and progression of Crohn's disease. Bacteroidetes, the second largest microbiota in the intestine, are crucial for equilibrium in the microbiota and intestinal environment. Certain Bacteroides can induce the development of Crohn's disease and aggravate intestinal inflammation directly or through their metabolites. Conversely, certain Bacteroides can reduce intestinal inflammation and symptoms of Crohn's disease. This article reviews the effect of several intestinal Bacteroides in the onset and progression of Crohn's disease and their impact on its treatment.

Functional dyspepsia is common and classified as a disorder of gut-brain interaction (DGBI). The prevalence is estimated around 10 % of the population. Diagnosis is based on symptoms, which are based on the Rome IV criteria, in combination with diagnostic procedures that may include laboratory testing, Helicobacter pylori testing, upper gastrointestinal endoscopy, abdominal ultrasound, and other examinations, depending on the severity, duration and presence of alarming symptoms. Therapeutic procedures include psychoeducation, dietary counseling, mind-body procedures, psychotherapy and medication. The S1 guideline summarizes the current state of knowledge and allows a targeted approach based on the currently available medical evidence.

AL-Amyloidosis is a rare systemic disease that can occur in patients with monoclonal gammopathy or multiple myeloma. As multiple organs may be affected by deposition of amyloid fibrils, the clinical presentation varies considerably, and the diagnostic process may be challenging.We report on a 59-year-old female who suffered from gastroesophageal reflux symptoms, nausea, epigastric pain, and meteorism over several years. Repeated upper GI endoscopies including biopsies and CT scans were unremarkable except for unspecific enlargement of mesenterial lymph nodes.A few weeks after a surgical hiatal hernia repair with fundoplication, the patient developed massive distension of the stomach and the proximal duodenum resulting in gastric perforation. Histopathological staining of gastric biopsies and mesenterial lymph nodes using hematoxylin and eosin was unremarkable. Because of endoscopic findings (submucosal hematomas, and ulcerations) and the unexplained severe motility disorder, histopathological staining was performed using Congo red. Extensive amyloid deposits were seen. Further workup confirmed AL amyloidosis caused by monoclonal gammopathy. Specific oncological treatment was started.The rare differential diagnosis of amyloidosis should be taken into account in patients with unexplained motility disorders, unspecific gastrointestinal symptoms, and abdominal lymphadenopathy. In the presented case, delayed diagnosis of AL amyloidosis in the gastrointestinal tract led to severe gastroparesis resulting in gastric perforation. Specific histopathologic staining can confirm the diagnosis.

The current standard of care for the definitive surgical treatment of complicative ulcerative colitis is a continence-preserving proctocolectomy with the creation of an ileal pouch anal anastomosis. In addition to structural and functional disorders, pouchitis of the J-pouch is a common phenomenon, typically well responsive to antimicrobial therapy. However, sometimes chronic antibiotic-refractory pouchitis occurs, most often due to not completely understood multifactorial pathomechanisms. While high-quality evidence is available only for anti-integrin therapy, the role of advanced therapy, i.e., cytokine-antibodies or small molecules in the treatment of chronic antibiotic-refractory pouchitis (CARP), is emerging.This case demonstrates a successful induction treatment of CARP with the novel p19-selective IL-23-targeted antibody mirikizumab.

Clinical ultrasound (ClinUS) is the integration of ultrasound diagnostics into the clinical examination. By comparing clinical ultrasound with other models of ultrasound diagnostics, this overview presents a concept that integrates point-of-care ultrasound, comprehensive specialty-specific ultrasound examinations and specialized multiparametric ultrasound. The applications, advantages and challenges of clinical ultrasound and its special features in comparison to other cross-sectional imaging modalities are discussed using the example of gastroenterology and general medicine in particular.

We present the case of a 70-year-old patient of Caucasian origin under palliative chemotherapy for metastasized colorectal cancer, who presented with signs of complete small bowel obstruction six months after placement of a diverting ileostomy. Following previous tumor perforation, he was not considered a candidate for further surgical intervention.Thus, endoscopic ultrasound-guided enterocolostomy (i.e., ileosigmoidostomy) with a lumen-apposing metal stent was successfully performed in a coloenteric approach to restore the passage.Oral nutrition could be resumed the next day, and the patient could be discharged in substantially improved condition after three days.

Therapy for children and adolescents with chronic inflammatory bowel disease (IBD) is basically no different from that for adult patients. However, of the steadily increasing number of biologics and signalling inhibitors for adults, only two TNFα antibodies are currently approved in Germany for the treatment of IBD from the age of 6. This means that a large proportion of the drugs authorised for adults with IBD are not available for children and adolescents with moderate to severe disease. The small number of approved drugs also makes it difficult to achieve the prognostically important goal of achieving a sustained remission of IBD soon after diagnosis, which is characterised by the patient being free of symptoms and also the objectifiable goal of mucosa healing. This position paper is intended to present the current study situation on the drug treatment of children and adolescents with IBD outside the age limit and to serve as a basis for information and decision-making for the Medical Service in the assessment of individual case applications as well as for the treating physicians, the cost bearers, health policy and social court decision-makers.