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3.
Z Gastroenterol ; 54(1): 19-25, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26751113

ABSTRACT

The various efficient methods available for bowel preparation prior to colonoscopy differ in patient acceptance. Combining the laxative sodium picosulfate with hyperosmotic magnesium citrate, used in this study in the formulation CitraFleet(®), allows the uptake of the purgative substances as a solution of low volume. This observational study with 737 patients evaluated efficacy of bowel preparation, potential side or adverse effects and patient acceptance of this medicinal product when used by resident physicians in Germany.Colon cleansing with CitraFleet(®) was considered very good to sufficient in 95.2 % of the patients and inadequate in only 4.8 %. In 75 % of the colonoscopies, bowel preparation was rated very good or good. Compared to the standard regimen of two portions taken the day before endoscopy, cleaning efficacy was better when patients received one of the doses on the morning of the day of colonoscopy. The quality of bowel preparation was rated lower by gastroenterologists without any prior experience with sodium picosulfate/magnesium citrate. The overall assessment of the colon cleansing procedure by the 76 participating physicians was very positive and patient acceptance was also very high which can be considered a clear advantage over alternative methods. Efficacy of colon cleansing with CitraFleet(®) was not substantially affected by typical deviations from the recommended standard procedure, emphasizing the robustness of the method. Only one of the patients reported a mild adverse effect potentially caused by the cleansing agents.


Subject(s)
Attitude of Health Personnel , Citrates/administration & dosage , Citric Acid/administration & dosage , Colonoscopy/statistics & numerical data , Gastrointestinal Diseases/epidemiology , Organometallic Compounds/administration & dosage , Patient Acceptance of Health Care/statistics & numerical data , Picolines/administration & dosage , Adult , Aged , Cathartics/administration & dosage , Cathartics/adverse effects , Citrates/adverse effects , Citric Acid/adverse effects , Drug Combinations , Female , Gastrointestinal Diseases/chemically induced , Germany/epidemiology , Humans , Male , Middle Aged , Organometallic Compounds/adverse effects , Picolines/adverse effects , Premedication/statistics & numerical data , Prevalence , Treatment Outcome
4.
Z Gastroenterol ; 53(12): 1447-95, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26666283

ABSTRACT

Chronic pancreatitis is a disease of the pancreas in which recurrent inflammatory episodes result in replacement of pancreatic parenchyma by fibrous connective tissue. This fibrotic reorganization of the pancreas leads to a progressive exocrine and endocrine pancreatic insufficiency. In addition, characteristic complications arise, such as pseudocysts, pancreatic duct obstructions, duodenal obstruction, vascular complications, obstruction of the bile ducts, malnutrition and pain syndrome. Pain presents as the main symptom of patients with chronic pancreatitis. Chronic pancreatitis is a risk factor for pancreatic carcinoma. Chronic pancreatitis significantly reduces the quality of life and the life expectancy of affected patients. These guidelines were researched and compiled by 74 representatives from 11 learned societies and their intention is to serve evidence-based professional training as well as continuing education. On this basis they shall improve the medical care of affected patients in both the inpatient and outpatient sector. Chronic pancreatitis requires an adequate diagnostic workup and systematic management, given its severity, frequency, chronicity, and negative impact on the quality of life and life expectancy.


Subject(s)
Endoscopy, Gastrointestinal/standards , Pancreatectomy/standards , Pancreatic Function Tests/standards , Pancreatitis/diagnosis , Pancreatitis/therapy , Practice Guidelines as Topic , Chronic Disease , Germany , Humans , United States
6.
Z Gastroenterol ; 53(2): 120-4, 2015 Feb.
Article in German | MEDLINE | ID: mdl-25668714

ABSTRACT

Non cardiac chest pain (NCCP) are recurrent angina pectoris like pain without evidence of coronary heart disease in conventional diagnostic evaluation. The prevalence of NCCP is up to 70 % and may be detected in this order at all levels of the medical health care system (general practitioner, emergency department, chest pain unit, coronary care). Reduction of quality of life in NCCP is comparable, partially even higher compared to cardiac chest pain. Reasons for psychological strain are symptom recurrence in app. 50 %, nonspecific diagnosis with resulting uncertainty and insufficient integration of other medical disciplines in diagnostic work-up. Managing of patients with NCCP has to be interdisciplinary because non cardiac causes of chest pain may be found frequently. Especially gastroenterological expertise is required because in 50 - 60 % of cases gastroesophageal reflux disease (GERD), in 15 - 18 % hypercontractile esophageal motility disorders with nutcracker, jackhammer esophagus or distal esophageal spasmus or achalasia and in 32 - 35 % other esophageal alterations (e. g. infectious esophageal inflammation, drug-induced ulcer, rings, webs, eosinophilic esophagitis) as cause of chest pain may be detected. This implicates that regular interdisciplinary round wards and management of chest pain units are mandatory.


Subject(s)
Chest Pain/diagnosis , Chest Pain/epidemiology , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Quality of Life , Angina, Unstable/diagnosis , Angina, Unstable/epidemiology , Causality , Comorbidity , Coronary Disease/diagnosis , Coronary Disease/epidemiology , Humans , Incidence , Risk Factors
8.
Rofo ; 186(11): 1002-8, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25122174

ABSTRACT

UNLABELLED: Chronic pancreatitis shows an increasing prevalence and incidence mainly in the Western Hemisphere. Early diagnosis and therapy are frequently delayed because of non-specific symptoms as well as non-specific blood values. The German Society of Digestive and Metabolic Diseases (DGVS) organized the preparation and publication of an interdisciplinary S3 level guideline with the support of the German Radiological Society (DRG) as 1 of 11 contributing societies. In this article we present and discuss the main topics of the guideline regarding the diagnosis, differential diagnosis and therapy of complications of this complex chronic disease with a focus on clinical and scientific radiologists. KEY POINTS: • Ultarsound represents the perfect first line imaging modality • For further diagnostic werk up MRI with MRCP are recommended for the differential diagnosis of pancreatic cancer • For clinical studies the modified (CT, MRI) Cambridge classification is recommended.


Subject(s)
Cooperative Behavior , Diagnostic Imaging , Interdisciplinary Communication , Pancreatitis, Chronic/diagnosis , Pancreatitis, Chronic/therapy , Contrast Media , Delayed Diagnosis , Follow-Up Studies , Humans , Image Enhancement , Magnetic Resonance Imaging , Pancreas/pathology , Pancreatic Pseudocyst/classification , Pancreatic Pseudocyst/diagnosis , Pancreatic Pseudocyst/therapy , Pancreatitis, Chronic/classification , Pancreatitis, Chronic/complications , Prognosis , Sensitivity and Specificity , Ultrasonography
11.
Dtsch Med Wochenschr ; 139(3): 79-83, 2014 Jan.
Article in German | MEDLINE | ID: mdl-24089288

ABSTRACT

BACKGROUND: If the diagnosis is made early the cure rate of bowel cancer is more than 90 %. Occupational preventative medical care required by law and carried out by company physicians can be supplemented by a medical consultation and by simple screenings to interest employees in cancer prevention and refer them to registered general practitioners and specialist doctors for further diagnosis and treatment. SUBJECTS AND METHODS: Since 2001, BASF SE in Ludwigshafen, Germany offers its employees aged 45 and more a program to detect intestinal cancer early. The employees receive personal invitations for this program once a year. The participants answer a standard questionnaire about risk factors for bowel cancer and an endoscopic diagnosis, if this has already been carried out, and receive a FOBT. Since 2010 an immunological test system was used. We compare the results from two consecutive years with a Guajacum test system (g-FOBT) and an immunological test (i-FOBT). The German Association of Digestive and Metabolic Diseases, DGVS, recommends a colonoscopy if test results are positive or a family member has suffered from bowel cancer. RESULTS: Between 2008 and 2011, a total of 52,797 invitations were sent to employees aged 45 and over. Overall, 16,730 men (37.7 % of 46,245) and 1,585 women (24.4 % of 6,552) took part (in some cases more than once). The return rate of the FOBT increased from 66.7 % in 2008 to 79.5 % in 2011. Due to positive results and/or suspicious information in the questionnaire, 2,441 colonoscopies were recommended, 849 of them because of a positive FOBT. The medical department was informed of 224 endoscopy diagnoses. In 8 cases, manifested cancer (6 × colon, 2 × rectum) and in 57 cases adenomatous polyps were diagnosed as preliminary stages of cancer. Most of these diagnoses were made using the i-FOBT, the simultaneous increase in positive test results and therefore more frequent recommendations for a colonoscopy. CONCLUSION: The additional offer of a program for early detection of bowel cancer as part of an occupational surveillance examination helps detecting bowel cancer early in employees who show no symptoms. Since men on average fall ill earlier, it makes sense to offer these tests at the age of 45.  Personal invitations lead to consistently high participant rates and the simplicity of the i-FOBT leads to high return rates of tests. The rate of positive test results is higher compared to g-FOBT. In our follow-up, significantly more intestinal cancer and possible preliminary stages were detected through screening with the immunological test.


Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer/methods , Guaiac , Occult Blood , Occupational Health Services , Adenomatous Polyps/diagnosis , Adenomatous Polyps/pathology , Adenomatous Polyps/prevention & control , Colonoscopy , Colorectal Neoplasms/pathology , Colorectal Neoplasms/prevention & control , Early Diagnosis , Female , Follow-Up Studies , Germany , Humans , Male , Middle Aged , Neoplasm Staging , Predictive Value of Tests
14.
Radiologe ; 53(9): 775-82, 2013 Sep.
Article in German | MEDLINE | ID: mdl-23933636

ABSTRACT

Colorectal cancer (CRC) is responsible for 27,000 deaths and 65,000 new cancers in Germany each year, although this should be unnecessary as CRC is preventable because it is possible to remove the precursors, harmless polyps and adenomas. However, only 2.5 % of people in health insurance make use of screening colonoscopy annually so that it becomes necessary to check out other screening tests. The most commonly used test is the Guaiak-based test for fecal occult blood (gFOBT) which is highly specific but not very sensitive (only approximately 10 %). New immunological stool tests are more sensitive but the specificity is reduced from 90 % to approximately 80 %. Virtual colonoscopy based on computed tomography (CT) or magnetic resonance imaging (MRI) is comparable to endoscopy for diagnostics with overall accuracy rates of approximately 80-90 % for polyps larger than 5 mm but for radiation protection reasons CT is not usable in Germany and MRI is internationally not adequately established by large study trials. For the future there is much hope in molecular blood tests. It is of great importance that every physician is aware of the different tests, their strengths and weaknesses and advises all patients to use the different screening possibilities.


Subject(s)
Colonography, Computed Tomographic/statistics & numerical data , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/epidemiology , Diagnostic Errors/prevention & control , Diagnostic Errors/statistics & numerical data , Early Detection of Cancer/statistics & numerical data , Unnecessary Procedures , Colorectal Neoplasms/prevention & control , Evidence-Based Medicine , Germany/epidemiology , Humans , Primary Prevention/statistics & numerical data , Reproducibility of Results , Sensitivity and Specificity
18.
Zentralbl Chir ; 138 Suppl 2: e63-9, 2013 Dec.
Article in German | MEDLINE | ID: mdl-21544755

ABSTRACT

BACKGROUND: Diverticulitis due to diverticulosis of the colon is a common clinical problem with a high morbidity and socio-economic consequences. Frequent clinical signs are flatulence, abdominal pain, stool problems which may often be misinterpreted as the symptoms of an irritable bowel or a colitis. Accordingly, the diagnostic work-up must be adequate to allow for the stage-adapted planning and performance of the therapy. MATERIAL AND METHODS: The following questions will be addressed in this review: What do we need to clarify diagnosis? Which antibiotics should be used? What is the best conservative approach for treatment? RESULTS AND CONCLUSIONS: Basic conservative therapy consists of systemic antibiosis which can be extended by a topical antibiosis, and administration of aspirin as well as probiotics. The indications for a specific therapy is made on an individual basis according to stage (Hansen and Stock). Above all, a "team approach" and close communication between gastroenterologists and surgeons are mandatory for adequate treatment of these patients.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Aspirin/therapeutic use , Colectomy , Diverticulitis, Colonic/therapy , Life Style , Probiotics/therapeutic use , Clinical Trials as Topic , Combined Modality Therapy , Cooperative Behavior , Diagnosis, Differential , Diverticulitis, Colonic/classification , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/diagnosis , Diverticulitis, Colonic/pathology , Humans , Interdisciplinary Communication , Prognosis
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