Viszeralmedizin最新文献

{"title":"Inflammatory Bowel Diseases: Current Medical and Surgical Therapy","authors":"G. Lamprecht, R. Atreya, M. Kreis, B. Siegmund, A. Stallmach","doi":"10.1159/000438767","DOIUrl":"https://doi.org/10.1159/000438767","url":null,"abstract":"a Division of Gastroenterology and Endocrinology, University Medical Center Rostock, Rostock, Germany, b Medical Clinic 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany, c Department of General, Visceraland Vascular Surgery, Charite – University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany, d Medical Department (Gastroenterology, Infectious Diseases, Rheumatology), Charite – University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany, e Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"287 - 289"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000438767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64897226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Principles in the Treatment of Ulcerative Colitis","authors":"Florian Kühn, E. Klar","doi":"10.1159/000438894","DOIUrl":"https://doi.org/10.1159/000438894","url":null,"abstract":"Background: The primary treatment of ulcerative colitis (UC) is conservative; surgical intervention is carried out in the case of therapy-refractory situation, imminent or malignant transformation, or complications. Surgery for UC should be indicated by interdisciplinary means. Despite the development of drug therapy - in particular the introduction of biologics -, a surgical intervention becomes necessary in a relevant proportion of patients with UC throughout lifetime. Methods: A selective literature search was conducted, taking into account the current studies, reviews, meta-analyses, and guidelines. PubMed served as a database. The present work gives an overview of the surgical options, outcome as well as peri- and postoperative management for patients with UC. Results: Approximately 20% of patients with UC will require surgery during the course of their disease. The rate of colectomy after a disease duration of 10 years is at approximately 16%. Unlike Crohn's disease, UC is principally surgically curable since it is naturally limited to the colon and rectum. Restorative proctocolectomy with an ileal pouch-anal anastomosis represents the surgical treatment of choice. Large studies show a postoperative complication rate of around 30% and a low mortality of 0.1% for this procedure. Chronic pouchitis is one of the main factors limiting the surgical success of curing UC. Despite a high postoperative complication rate, there is a long-term pouch success rate of >90% after 10 and 20 years of follow-up. Conclusion: A close cooperation between the various disciplines in the pre- and postoperative setting is essential for an optimal outcome of patients with UC. Despite a 30% rate of early postoperative complications, normal quality of life can ultimately be reached in more than 90% of patients in experienced centers.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"246 - 250"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000438894","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64899066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Therapy in Inflammatory Bowel Diseases","authors":"H. Neumann, M. Neurath, R. Atreya","doi":"10.1159/000435851","DOIUrl":"https://doi.org/10.1159/000435851","url":null,"abstract":"Background: Endoscopy is an essential diagnostic and therapeutic modality in the clinical care of inflammatory bowel disease (IBD) patients. Endoscopic therapy can be used for treatment of disease-related strictures, surveillance and resection of intraepithelial neoplasia, and treatment of fistulas or disease-related complications, and is currently being evaluated regarding its capacity in in vivo molecular imaging procedures. Methods: A literature search using Medline and Science Citation Index was performed in March 2015. All studies on endoscopic therapy in IBD published from 1980 to 2015 (March) were reviewed. Potential studies were initially screened by title and abstract. The terms ‘endoscopy IBD', ‘endoscopy therapy IBD', ‘dilatation IBD', ‘strictureplasty Crohn's disease', ‘endoscopy therapy fistula', ‘endoscopy toxic megacolon', ‘endoscopy dysplasia IBD', ‘endoscopy complications IBD', and ‘molecular imaging IBD' were used in the search. A total of 115 articles were studied to construct this review. Results: Dilatation is most useful in short anastomotic strictures, but can be also undertaken in colonic strictures. Strictures in ulcerative colitis are always suspicious for neoplasia and should be evaluated carefully. Lesions with intraepithelial neoplasia can be resected when complete removal can be assured. The finding of carcinoma or high-grade dysplasia in a random biopsy is an indication for colectomy. If intraepithelial neoplasia is present in random biopsy specimens, colectomy should similarly be recommended. Endoscopic therapy of Crohn's fistulas is a possible emerging technology. In vivo molecular imaging is currently being studied in IBD patients and offers promising therapeutic opportunities. Conclusion: Therapeutic endoscopy is indispensable in the management of IBD. It has to be carefully evaluated against alternative surgical options but often offers an effective therapeutic approach.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"280 - 286"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000435851","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64881312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications and Specific Surgical Techniques in Crohn's Disease","authors":"C. Seifarth, M. Kreis, J. Gröne","doi":"10.1159/000438955","DOIUrl":"https://doi.org/10.1159/000438955","url":null,"abstract":"Background: Crohn's disease (CD) as one of the major entities of chronic inflammatory bowel diseases can affect all segments of the gastrointestinal tract but occurs most often in the small bowel, the terminal ileum, the colon, and the rectum. Typical symptoms include tiredness, lower abdominal pain, fever, and diarrhea, which are initially treated by conservative measures. Most patients will eventually develop complications such as fistulas, abscesses, or strictures. Surgery is often unavoidable in these cases. Methods: This review considers studies on the treatment of CD, published from 1979 up to now. The literature regarding the course, complications, and surgical therapy of CD was reviewed. Searches were performed in PubMed, using the following key words: CD, surgery, immunosuppression, guidelines, malnutrition as well as appropriate sub-items. In most cases the literature is limited to detailed information on specific therapeutic or diagnostic topics. Moreover, many studies are designed retrospectively and with a small number of patients. Additionally, our long-standing experience with patients suffering from CD is taken into consideration in this review. Results: There is a wide variety of indications for surgery in CD which includes complications like strictures, fistulas and abscess formation, neoplasia, or refractoriness to medical therapy. The risk of developing complications is about 33% after 5 years, and 50% after 20 years. Furthermore, one-third of CD patients need surgical therapy within the first 5 years of diagnosis. The treatment requires close cooperation between gastroenterologists and surgeons. When indicated, surgery should be performed in a ‘conservative' fashion, i.e. as limited as possible, in order to achieve the required result and to avoid small bowel syndrome. Conclusion: This article provides a complete overview of indications and specific surgical treatment in patients with CD. Surgery is typically indicated when complications of CD occur. An interdisciplinary collaboration is necessary in order to ensure optimal indications and timing of surgery. This is of paramount importance to achieve the ultimate goal, i.e. a good quality of life of the patients.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"273 - 279"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000438955","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64900661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Therapy of Active Ulcerative Colitis","authors":"M. Bürger, C. Schmidt, N. Teich, A. Stallmach","doi":"10.1159/000436959","DOIUrl":"https://doi.org/10.1159/000436959","url":null,"abstract":"Background: Medical therapy of mild and moderate ulcerative colitis (UC) of any extent is evidence-based and standardized by national and international guidelines. However, patients with steroid-refractory UC still represent a challenge. Methods: A literature search using PubMed (search terms: ulcerative colitis, therapy, new, 1-2008-2015) resulted in 821 publications. For the current article, 88 citations were extracted including 36 randomized controlled studies, 18 reviews, and 8 meta-analyses. Results: In steroid-refractory UC, early intensive therapy using anti-tumor necrosis factor (TNF) antibodies or the calcineurin inhibitors cyclosporine and tacrolimus is indicated in any case to prevent progression to a toxic megacolon and/or to avoid proctocolectomy. In patients with chronic disease activity, treatment with anti-TNF antibodies has a higher level of evidence than azathioprine therapy and should therefore be preferred. However, there is a subgroup of UC patients who may achieve prolonged steroid-free remission on azathioprine monotherapy. The importance of vedolizumab, a newly registered inhibiting antibody against integrin, has not yet been fully clarified since direct comparison studies are lacking, in particular in relation to anti-TNF antibodies. Conclusion: There is a great need for additional innovative therapies, especially in cases of primary non-response or secondary loss of response to anti-TNF antibodies. New small molecules (Janus kinase inhibitors) are promising with an acceptable safety profile and efficacy in UC. Further, strategies that target the intestinal microbiome are currently considered for patients with active or relapsing UC, and may in the future open up new therapeutic options.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"236 - 245"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000436959","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64882527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occult and Manifest Colorectal Carcinoma in Ulcerative Colitis: How Does It Influence Surgical Decision Making?","authors":"J. Hardt, P. Kienle","doi":"10.1159/000438811","DOIUrl":"https://doi.org/10.1159/000438811","url":null,"abstract":"Background: The incidence of colorectal cancer (CRC) among patients with ulcerative colitis (UC) is increased compared to the general population. The diagnosis of CRC potentially influences surgical decision making in patients with UC. Methods: This review considers clinical studies, systematic reviews, and guidelines on the surgical therapy of CRC in UC. We searched the bibliographic databases The Cochrane Library and Medline (applying MeSH terms such as ‘Colitis, Ulcerative/surgery', ‘Colorectal Neoplasms', and ‘Proctocolectomy, Restorative') with no restriction on language, date, or country. Search results as well as references of relevant publications were independently screened by both authors of this review. Results: The surgical gold standard for proven CRC in UC is oncological proctocolectomy, if possible preferably as a restorative procedure with formation of an ileal pouch-anal anastomosis. Mucosectomy and hand-sewn anastomosis is the preferred option for fashioning the anastomosis in these patients, especially in case of dysplasia or cancer in the rectum, although the available data is not conclusive. In highly selected cases of patients with histologically confirmed sporadic CRC without dysplasia in multiple random biopsies and without relevant inflammation, a conventional limited oncological resection is adequate. If UC patients with rectal cancer require radiotherapy, it should be performed in a neoadjuvant setting because of the high risk of radiation-induced pouch failure. Conclusion: Although restorative proctocolectomy is clearly the gold standard therapy for patients with CRC in UC, surgical decision making has to take into account the various settings and patient factors.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"1 1","pages":"252 - 257"},"PeriodicalIF":0.0,"publicationDate":"2015-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000438811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64897669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Therapy of Perianal Crohn's Disease","authors":"T. Klag, M. Goetz, E. Stange, J. Wehkamp","doi":"10.1159/000434664","DOIUrl":"https://doi.org/10.1159/000434664","url":null,"abstract":"Background: Development of perianal fistulas are a common feature of Crohn's disease (CD). Consequences are severe impairment of quality of life as well as potentially life-threatening complications like abscess formation or bacterial sepsis. Therefore, appropriate treatment is an important task in the management of CD. Methods: This review describes the epidemiology, pathogenesis, diagnosis, and conservative medical treatment of perianal CD with regard to the available literature. In February 2015, a PubMed search was performed with the following terms (combined and separate): ‘Crohn's disease management', ‘Crohn's disease complications', ‘perianal Crohn's disease', ‘fistulizing Crohn's disease', ‘perianal fistulas', ‘fistula healing', ‘fistula closure'. From the search results, 36 articles were chosen as core elements of this review. Results: Pelvic magnetic resonance imaging and rectal endosonography are established diagnostic approaches to evaluate perianal fistulas in conjunction with endoscopy. Antibiotics, thiopurines, and calcineurin inhibitors are useful agents in the management of perianal CD. The availability of anti-TNF-alpha therapies has substantially changed the prospects and goals of medical treatment, and fistula healing seems to be possible in a substantial proportion of patients. Conclusion: Antibiotics and several immunosuppressive drugs have improved the treatment of fistulizing CD and should be combined with surgical measures.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"265 - 272"},"PeriodicalIF":0.0,"publicationDate":"2015-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000434664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64880539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Imaging Techniques in the Diagnosis of Inflammatory Bowel Diseases","authors":"Yan Li, K. Hauenstein","doi":"10.1159/000435864","DOIUrl":"https://doi.org/10.1159/000435864","url":null,"abstract":"Background: Cross-sectional imaging modalities are fundamental in the management of patients with inflammatory bowel disease (IBD) from the first diagnosis and throughout the entire course of the disease. Over the past few years, the use of magnetic resonance (MR) imaging (MRI) has considerably increased, and no other imaging modality has experienced as advanced a development as MRI. Methods: A comprehensive literature search (PubMed/Medline) using keywords such as ‘MR enterography', ‘imaging modalities', ‘IBD', and ‘Crohn's disease' was performed. 48 articles published between 1999 and 2015 were systematically reviewed. In this article, besides the current standard MRI techniques, we review novel and implementable for routine use MR techniques. The use of positron emission tomography/computed tomography (PET/CT) and hybrid imaging such as PET/MRI with enormous potential will also be briefly discussed. Results: New imaging techniques such as diffusion-weighted imaging, dynamic contrast-enhanced MR perfusion, and MR motility imaging yield advanced findings about changes in the microenvironment and alterations in motility of the affected bowel segment, and are proven to improve the diagnostic accuracy in assessing the scale, activity level, and severity of the IBD. Novel magnetization transfer imaging allows direct visualization of fibrosis in the bowel wall. Conclusion: Diffusion-weighted imaging can be easily implemented in standard MRI for routine use to further enhance the diagnostic accuracy in disease assessment. For validation of magnetization transfer imaging, larger studies are warranted.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"227 - 234"},"PeriodicalIF":0.0,"publicationDate":"2015-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000435864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64881447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Therapy of Fibrostenotic Crohn's Disease","authors":"B. Siegmund","doi":"10.1159/000435868","DOIUrl":"https://doi.org/10.1159/000435868","url":null,"abstract":"Introduction: The present review serves to provide a concise overview of the current knowledge on therapeutic strategies with regard to fibrostenotic lesions in Crohn's disease. Methods: A literature search was performed focusing on the last 5 years, and current concepts of pathophysiology, epidemiology, and treatment have been summarized. Results: Fibrostenotic lesions in Crohn's disease are currently considered to be a consequence of the chronic inflammatory nature of the disease. Hence, therapeutic strategies are limited to the concept that early treatment of the inflammatory lesions can prevent structural changes, and to various endoscopic and surgical approaches. Direct targeting of the fibrostenotic lesion itself has not been the focus until now. This review will provide an overview of the pathophysiology and epidemiology of fibrostenotic lesions including current therapeutic approaches. Since research with regard to other organ systems and fibrosis is far more advanced, current strategies from available studies in these areas will be discussed. The results and the potential impact for Crohn's disease will be considered. Conclusion: The vision of these approaches is to reverse structural changes and restore normal function.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"259 - 264"},"PeriodicalIF":0.0,"publicationDate":"2015-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000435868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64881517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Cholecystitis.","authors":"Jochen Schuld,&nbsp;Matthias Glanemann","doi":"10.1159/000431275","DOIUrl":"https://doi.org/10.1159/000431275","url":null,"abstract":"<p><strong>Background: </strong>The treatment of acute cholecystitis has been controversially discussed in the literature as there are no high-evidence-level data yet for determining the optimal point in time for surgical intervention. So far, the laparoscopic removal of the gallbladder within 72 h has been the most preferred approach in acute cholecystitis.</p><p><strong>Methods: </strong>We conducted a systematic review by including randomized trials of early laparoscopic cholecystectomy for acute cholecystitis.</p><p><strong>Results: </strong>Based on a few prospective studies and two meta-analyses, there was consent to prefer an early laparoscopic cholecystectomy for patients suffering from acute calculous cholecystitis while the term 'early' has not been consistently defined yet. So far, there is new level 1b evidence brought forth by the so-called 'ACDC' study which has convincingly shown in a prospective randomized setting that immediate laparoscopic cholecystectomy - within a time frame of 24 h after hospital admission - is the smartest approach in ASA I-III patients suffering from acute calculous cholecystitis compared to a more conservative approach with a delayed laparoscopic cholecystectomy after an initial antibiotic treatment in terms of morbidity, length of hospital stay, and overall treatment costs. Concerning critically ill patients suffering from acute calculous or acalculous cholecystitis, there is no consensus in treatment due to missing data in the literature.</p><p><strong>Conclusion: </strong>Laparoscopic cholecystectomy for acute cholecystitis within 24 h after hospital admission is a safe procedure and should be the preferred treatment for ASA I-III patients. In critically ill patients, the intervention should be determined by a narrow interdisciplinary consent based on the patient's individual comorbidities.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"163-5"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000431275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}