Efficacy of a fixed peppermint oil/caraway oil combination in non-ulcer dyspepsia.

The efficacy and safety of the standardized herbal combination preparation of Enteroplant, consisting of peppermint oil (90 mg) and caraway (50 mg) in an enteric coated capsule, have been studied in a double-blind, placebo-controlled multicentre trial in patients with non-ulcer dyspepsia. A total of 45 patients were included in the trial after thorough physical and gastro-enterological examination. The primary outcome variables were the change in the intensity of pain and the global clinical impression (Clinical Global Impression [CGI], Item 2), which were evaluated for 39 patients (test preparation: 19, placebo: 20). After four weeks of treatment both target parameters were significantly improved for the group of patients treated with the peppermint oil/caraway oil combination compared to the placebo group (p = 0.015 and 0.008, respectively). Before the start of treatment all patients in the test preparation group reported moderate to severe pain, while by the end of the study 63.2% of these patients were free of pain. The pain symptoms had improved in a total of 89.5% of the patients in the active treatment group. After 4 weeks the Clinical Global Impressions were improved for 94.5% of the patients treated with the peppermint oil/caraway oil combination. The trial medication was also superior to placebo with respect to pain frequency, medical prognosis, the severity of the disorder and the efficacy index (CGI, Items 1 and 3), which were adopted as secondary end-points for evaluation of efficacy. There were similarly favourable findings for the herbal combination, compared with placebo, with respect to the reduction of other gastrointestinal symptoms. The combination preparation was found to be excellently tolerated. There was a total of 7 adverse events (test preparation: 4, placebo: 3), with a causal association with the treatment being ascribed in one case for the test preparation group and one case for the placebo group.

[Serum cholinesterases as activity parameters in chronic inflammatory bowel diseases]. / Die Serumcholinesterase als Aktivitätsparameter bei chronisch entzündlichen Darmerkrankungen.

Significantly decreased levels of serumcholinesterase (CHE) were found in acute Crohn's disease (= CD) (3.2 +/- 1.0 KU/L) and acute ulcerative colitis (= UC) (3.54 +/- 1.6 KU/L) as compared to patients with mild or quiescient disease (CD: 5.5 +/- 1.1 KU/L; UC: 5.59 +/- 0.94 KU/L) and healthy controls (5.69 +/- 1.3 KU/L). Suppression of CHE was most evident in Crohn's colitis (2.98 +/- 1.0 KU/L) and extensive UC (2.96 +/- 1.28 KU/L). Intraindividual comparison showed an increase of CHE-levels during treatment with steroids and salicylates. There was no significant correlation to the reduced bodyweight-levels in severe IBD. Best correlations were seen between CHE/albumin (CD: r = +0.61; UC: r = +0.73) and CHE/hematocrit (CD: r = +0.50; UC: r = +0.61) in severe inflammatory bowel disease. The results of a discriminant analysis showed that CHE-levels can predict the degree of activity correctly in the majority of patients with CD and UC. It is suggested that the decrease of serumcholinesterase reflects an inhibition of liver synthesis as an acute phase response-induced by endotoxins and cytokines.

[Hyperamylasemia, hyperlipasemia and acute pancreatitis in chronic inflammatory bowel diseases]. / Hyperamylasämie, Hyperlipasämie und akute Pankreatitiden bei chronisch entzündlichen Darmerkrankungen.

145 clinical observations of 114 patients with Crohn's disease and 65 observations of 47 patients with ulcerative colitis were analyzed prospectively concerning the prevalence of pathologically elevated levels of serumamylase or -lipase and acute pancreatitis. Painless hyperamylasemia or hyperlipasemia were found in 18 of 114 patients with Crohn's disease (15.8%) and in 10 of 47 patients with ulcerative colitis (21.3%) without morphological abnormalities on ultrasound. Range of elevated serumamylase levels differs from 35 to 68 U/L (Ref.-value less than 34 U/L), range of serumlipase levels varies from 199 to 858 U/L (Ref.-value less than 190 U/L). Pathologically elevated levels of serumamylase and -lipase persisted for 17.7 +/- 9.0 (5-28) days in Crohn's disease and 22.8 +/- 9.8 (7-33) days in ulcerative colitis. No relation to the activity or the duration of the disease, drug treatment or the weight loss of the patients could be shown. Acute pancreatitis was found in 4 of 114 patients (3.5%) with Crohn's disease, whereas in ulcerative colitis acute pancreatitis was diagnosed in 1 of 47 patients (2.1%). Regarding the promoting factors, drugs (azathioprine and salazosulfapyridine) and mechanical alterations of the bile duct (primary sclerosing cholangitis) or the pancreas (pancreas divisum) were found in 4 of the 5 patients. However the case of a 23 year old woman suffering from Crohn's ileocolitis who died of an idiopathic pancreatitis remains obscure.

[Crohn disease-associated pancreatitis: is there a new extra-intestinal manifestation of the disease?]. / Morbus-Crohn-assoziierte Pankreatitis: Gibt es eine neue extraintestinale Manifestation der Erkrankung?

We report the case of a 23-year old woman suffering from Crohn's ileocolitis for 14 years who died of a prolonged shock followed by hyperglycaemia. The post-mortem examination showed an acute pancreatitis. There was no hint for Crohn's disease of the duodenum or primary sclerosing cholangitis (PSC). Unexplained Pancreatitis coincident with Crohn's disease might be a possible extraintestinal manifestation of the disease. However such association remains speculative at the moment. Further studies based on morphological, functional, immunological and epidemiological data are required. Review of the literature and our own data show the necessity to look attentive for other causes of acute pancreatitis associated with Crohn's disease (PSC, pancreas divisum, drug induced-pancreatitis).

Pneumatosis cystoides intestinalis: case reports and review of the literature.

Pneumatosis cystoides intestinalis is an uncommon condition in which submucosal or subserosal gas cysts are found in the wall of the small or large bowel. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical and bacterial causes. Approximately 85% of cases are thought to be secondary to coexisting disorders of the gastrointestinal tract or the respiratory system. Since 1986 we have observed 4 cases of pneumatosis cystoides intestinalis. A review of the literature is presented with emphasis on the etiology, diagnosis, differential diagnosis, and therapy of pneumatosis cystoides intestinalis. Symptoms of pneumatosis cystoides intestinalis include diarrhea, constipation, rectal bleeding, passage of mucus per rectum, vague abdominal discomfort, abdominal pain, urgency, malabsorption, weight loss, and excessive flatus. Depending on the location of the gas filled cysts the range of symptoms in each patient may vary enormously.

[Infectious enterocolitis. Clinical and endoscopic diagnosis]. / Infektiöse Enterokolitiden. Klinische und endoskopische Diagnostik.

Among inflammatory bowel diseases, intestinal infections imitating Crohn's disease or ulcerative colitis comprise about 15 to 20%. For prognostic and therapeutic reasons, diagnostic procedures have to cover not only clinical and endoscopic investigations, but also detailed microbiological methods (stool cultures, serology, biopsy cultures).

[Effect of chronic alcohol drinking and liver cirrhosis on oro-cecal transit time (H2 breath test)]. / Einfluss von chronischem Alkoholkonsum und Leberzirrhose auf die oro-zökale Transitzeit (H2-Atemtest).

In a clinical study (1.1.1986-28.2.1988) the oro-cecal transit time of lactulose was studied in 45 patients with liver cirrhosis of different etiologies by hydrogen breath test. The results were compared to the transit time of 16 healthy volunteers. The oro-cecal transit time of patients with alcoholic cirrhosis (means = 154 +/- 29 min.) was significantly increased (P less than or equal to 0.001) while non alcoholic cirrhosis (means = 99 +/- 34 min.) did not differ from the control group (means = 98 +/- 16 min.) As an explanation of the increased oro-cecal transit time an alcoholic autonomic neuropathy (- greater than n. vagus) is discussed.

[Liver function of patients with arterial hypoxemia in chronic obstructive respiratory tract disease and the effect of nasal oxygen insufflation]. / Leberfunktion von Patienten mit arterieller Hypoxämie bei chronisch obstruktiver Atemwegserkrankung und der Einfluss der nasalen Sauerstoffinsufflation.

Patients suffering from chronic obstructive airway disease often have arterial hypoxemia, which is more or less severe. If hypoxemia deteriorates the function of the liver is still unknown. The aim of this study was to determine, if a mostly oxygen dependent process of liver metabolism (galactose elimination capacity) is disturbed and if it can be increased by oxygen insufflation. Under the same conditions an oxygen independent process (indocyaninegreen clearance) should not be influenced. Our results show, that galactose elimination capacity under room air was pathologic and can be increased significantly by oxygen breathing. No change of indocyaninegreen clearance was seen under the same conditions. After termination of oxygen therapy the galactose elimination capacity was as bad as before oxygen breathing. Dysfunctions of the liver, which are caused by hypoxemia, can be positively influenced by oxygen, but only for the duration of oxygen insufflation.

[Orthograde intestinal irrigation with a mannitol solution in reducing hepatic encephalopathy in patients with liver cirrhosis and gastrointestinal hemorrhage]. / Orthograde Darmspülung mit einer Mannitlösung zur Reduktion der hepatischen Enzephalopathie bei Leberzirrhotikern mit gastrointestinaler Blutung.

The development of hepatic encephalopathy and coma hepaticum in patients with acute gastrointestinal bleeding and hepatic cirrhosis is a serious problem. Since 1983 we perform a whole gut irrigation with mannite for cleansing the bowel via naso-gastric tube. The aim of this therapy is to reduce the severity of hepatic encephalopathy. The first 20 patients with the new therapeutic concept were compared with the last 20 patients with the prevailing therapy. We studied the effect of the new therapeutic concept as to reduction of hepatic encephalopathy and possible electrolyte loss. None of the patients in the mannite group had hepatic encephalopathy stage III or IV, whereas 75% of the patients without mannite showed clinical signs of stage III or IV. Serum potassium, sodium and chloride were not significantly different between both groups. In the group with mannite application no change in serum creatinine was observed, whereas in the other group a minute increase of serum creatinine was seen.

Hepatic drug disposition in multiple organ failure.

In 15 patients with multiple organ failure of septic etiology, some principal partial hepatic functions of drug disposition were measured by the test substances galactose, indocyanine green, theophylline and 4-methylumbelliferon. Glucuronidation was not impaired in any case, whereas flow-limited and capacity-limited drug elimination can be influenced. Drug monitoring and intense clinical observation seem necessary to improve drug therapy and the outcome of patients with multiple organ failure.

[The liver and aging. The effect of age on liver function and drug metabolism]. / Leber und Alter. Einfluss des Lebensalters auf Leberfunktion und Arzneimittelmetabolismus.

Theophylline (oxidative phase I metabolism) is biotransformed by the liver at an increasingly delayed rate with advancing age. Hymecromone (phase II metabolism) does not display any dependence of glucuronidisation on age. The indocyanine green half-life and the galactose elimination capacity show a highly significant dependence on age. Drugs with flow-limited elimination or mainly oxidative phase I biotransformation should be administered with reduced dosage level while monitoring the serum concentration levels. Drugs that are transformed via phase II reactions usually do not require dosage adjustment.

[Endoscopic palliative therapy of malignant esophageal and cardia stenoses. Results--complications--follow-up]. / Endoskopische Palliativtherapie maligner Osophagus-und Kardiastenosen. Ergebnisse--Komplikationen--Katamnesen.

60% of oesophageal and cardiac carcinomas are curatively inoperable at the time of diagnosis. Non-surgical, especially endoscopic palliative procedures gained enormously in topicality. Since 1984 we treated 96 patients with malignant stenoses of the upper gastrointestinal tract by different endoscopic therapies: bougienage, laser coagulation, ballon dilatation, implantation of bridging tubes. Complication rate and lethality of all procedures were low. By none of the endoscopic measures was a prolongation of survival time achieved. Bougienage in combination with laser coagulation as well as tube implantation improved the patients' life quality.