Innere Medizin (Heidelberg, Germany)最新文献

Background: The pathophysiology of inflammatory bowel diseases is not fully understood. In a staged model by the European Crohn's and Colitis Organization (ECCO) regarding disease development, it is assumed that there is a population at risk for manifestation of disease following subtle changes over time.

Objective: This work aims to summarize the current state of knowledge regarding the pathophysiology, prediction and prevention of chronic inflammatory bowel diseases.

Materials and methods: Selective literature research via PubMed.

Results: Several genetic, biochemical, and microbiome scores have the potential to identify individuals at increased risk of developing inflammatory bowel disease, possibly up to a decade before onset.

Discussion: The growing knowledge regarding the pathogenesis of inflammatory bowel diseases makes prediction before disease onset a possible future diagnostic goal. Hypothetically, early changes before the disease manifests could be reversible and may be amenable to prevention programs.

There are national and international guidelines and developments for the surgery of chronic inflammatory bowel disease (IBD) that contribute to better patient care. Important recommendations include increasingly individualized and minimally invasive approaches with the integration of new technologies. The indication for abdominal surgery remains tied to specialization, not least in order to continue to be able to assess the importance of sequential treatment and multimodality in improving surgical results and minimizing risks. This paper aims to briefly present key surgical aspects and classify them according to the current state of knowledge.

Chronic back pain is a global health problem with significant impacts on physical and mental health, work ability, and quality of life. Back pain has an increased risk of becoming chronic, especially in patients with other chronic conditions. Treatment primarily focuses on nonpharmacological approaches. Regular exercise is strongly recommended for pain relief and improved function. Physical therapy can provide guidance and education on appropriate exercises. Acupuncture may offer some pain relief, but the evidence is inconclusive. Pharmacological treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and opioids. While NSAIDs can provide short-term relief, long-term use is associated with side effects. Muscle relaxants are not recommended for chronic pain. Opioids can be effective for severe pain but carry a risk of addiction and should be used with caution. Facet joint injections can provide temporary relief for some patients. Surgery may be considered when there is a clear correlation between structural abnormalities and symptoms. However, the relationship between degenerative changes and pain is complex and not fully understood. The management of chronic back pain often requires a multidisciplinary approach. Nonpharmacological interventions should be the first line of treatment. Pharmacological agents can provide temporary relief. Regular follow-up by healthcare professionals is crucial for optimal management.

Infection with Echinococcus multilocularis leads to the clinical manifestation of alveolar echinococcosis. This is characterized by the formation of alveolar liver tumours, which usually disintegrate necrotically in the course of the disease. Pseudocysts are formed. Especially in the early stages, curative resection followed by long-term treatment with albendazole is recommended. However, the majority of patients are not amenable to curative surgery. In these cases, albendazole therapy is the first-choice treatment. We present a rare case of albendazole-associated hepatitis in a patient with inoperable Echinococcus multilocularis infection, with a favourable outcome following a change in treatment to mebendazole.

Bacterial meningitis is a rare but severe disease with a high mortality. The most frequent pathogens in adults are pneumococcus, meningococcus and Listeria. The most important key symptoms are headache, meningism and fever; however, the absence of individual cardinal symptoms does not exclude the diagnosis. The empirical treatment consists of ceftriaxone and ampicillin, supplemented with dexamethasone as needed. It should be initiated without delay if bacterial meningitis is suspected. Before this, two pairs of blood cultures should be obtained followed by a lumbar puncture. An elevated intracranial pressure must be excluded via cerebral computed tomography before performing a lumbar puncture only in patients with confirmation of impaired consciousness, focal neurological deficits or epileptic seizures. In such cases treatment is initiated immediately after obtaining blood cultures but before the lumbar puncture. The identification and management of a focus are essential and should be conducted on the day of admission.

The case of a 22-year-old male patient who presented with acute on chronic hyperglycemia in known MODY ("maturity onset diabetes of the young") 12 (ABCC8 gene) after 11 months of treatment cessation is reported. To emphasize the importance of the awareness of this therapeutically important entity of diabetes, the essential facts of this inherited disease are summarized.

Celiac disease is one of the most common lifelong autoimmune disorders and is currently understood as a genetically determined immune intolerance to gluten. In genetically predisposed individuals, the consumption of gluten, along with additional environmental factors, triggers an immunological reaction in the small intestinal epithelium, leading to the destruction of the mucosal architecture with villous atrophy. This can be asymptomatic, but may also cause a wide range of symptoms and lead to systemic complications, such as osteoporosis or infertility. The only treatment is a lifelong, strictly gluten-free diet. Despite advances in diagnostics, many cases remain unrecognized. Diagnosis is based on the serological detection of autoantibodies against tissue transglutaminase 2 (tTG-IgA) and, if necessary, a small intestinal biopsy. Population-wide screening during childhood or adolescence, as legally introduced in Italy in September 2023, could promote early detection and prevent long-term complications. For the monitoring of diagnosed patients, regular clinical check-ups and serological testing are standard practice. In cases of persistent symptoms or risk factors for ongoing villous atrophy, a follow-up duodenal histology examination is recommended. Persistent symptoms despite adherence to a gluten-free diet are often due to continued gluten exposure; however, alternative causes must also be ruled out. In cases of severe malabsorptive symptoms, the rare condition of refractory celiac disease should be considered, with management carried out in specialized centers.