[Fiber, food intolerances, FODMAPs, gluten and functional gastrointestinal disorders--update 2014]. / Fiber, food intolerances, FODMAPs, gluten und funktionelle darmerkrankungen--update 2014.

The controversial effects of dietary fiber on symptoms in functional gastrointestinal disorders are summarized. Studies concerning adverse reaction to foods are mentioned and the possible role of food allergy and food intolerances, especially pseudoallergic reactions to biogenes amines, in symptom provocation is discussed. The known effects of lactose deficiency and fructose malabsorption are reviewed. The FODMAP concept (fermentable oligo-, di-, monosaccharides and polyols) is presented in more detail and recent studies on pathophysiological effects of FODMAP constituents and of therapeutic effects of a low FODMAP diet on symptoms in patients with irritable bowel syndrome are discussed. Finally, studies on the new disorder non-celiac gluten sensitivity (NCGS) are summarized and the state of the discussion whether wheat intolerance is due to gluten or the grains is given.

[Effect of quality assessment assurance in 2002 (before starting the German colorectal cancer screening programme by colonoscopy) on the quality of reprocessing of flexible endoscopes--a nationwide analysis]. / Effekt der Qualitätssicherungsvereinbarung von 2002 (bei Einführung der Vorsorgekoloskopie) auf die Qualität der Aufbereitung flexibler Koloskope - eine bundesweite Analyse.

BACKGROUND: International studies in the 1990 s and the HYGEA study from Germany in 2002 revealed prevalences of around 50 % of microbiological contaminations in reprocessed flexible endoscopes. Before introducing the colorectal cancer screening programme by colonoscopy in Germany in 2002, the Kassenärztliche Bundesvereinigung (KBV) and the key stakeholders of the public health insurance system agreed on a quality assessment assurance for reprocessing endoscopes where the qualification for refund for colonoscopies from the public health system was made conditional on adequate qualifications of the gastroenterologist; on a minimum number of performed procedures per year; and on adequate endoscope reprocessing documented by negative surveillance cultures two times per year. This study is an implementation and outcome evaluation of the quality assessment assurance in colonoscopy in Germany. METHODS: The following data - per year and per Kassenärztliche Vereinigung (KV) - were obtained from the KBV: the number of endoscopic units performing therapeutic and/or screening colonoscopies within each KV; the results of all microbiological surveillance tests of reprocessing quality (two per year per unit); the number of failed surveillance tests and re-tests; and the number of qualifications for refund from the public health system cancelled due to repeated failure of microbiological surveillance tests. RESULTS: The percentages of actually performed hygiene control tests (out of those prescribed by the assurance system) reached 95 % already in 2004 and remained above or close to this level thereafter. After the introduction of the quality assessment assurance, the percentage of failed microbiological surveillance tests dropped significantly and steadily from close to 17 % in 2003 to below 4 % in 2007. CONCLUSIONS: This study evidences 1. the successful implementation of the quality assessment assurance in Germany and 2. a substantial improvement in the quality of reprocessing flexible endoscopes achieved by these measures with a drop from 50 % of failed tests observed before the introduction in 2000 - 2001 to below 4 % in 2007.

[Five years of the Robert Koch Institute guidelines for reprocessing of flexible endoscopes. A look back and a look forward]. / Fünf Jahre Empfehlungen der Kommission für Krankenhaushygiene zur Aufbereitung flexibler Endoskope. Blick zurück und Blick nach vorn.

In a short review the national and international reception of the German guidelines for reprocessing flexible endoscopes is presented. The recommendations of the guidelines are discussed in view of recent knowledge on old problems such as prion inactivation and new infectious diseases and new microorganisms such as SARS, avian influenza and C. difficile. New disinfectants and new methods for endoscope disinfection are mentioned, the importance of careful cleaning is underlined. The German guidelines of the Robert Koch Institute and the US Multi-Society guidelines, published in 2003, are compared. The discrepancies concerning recommendations for water quality for final rinsing and need of microbiological controls of endoscope reprocessing are stressed. Aspects not mentioned in the German guidelines, e.g. duration of storage after reprocessing and risk of infection transmission by the endo-washer, are discussed.

[Reprocessing rigid and flexible cystoscopes in urology: recommendations for ambulant practices]. / Sachgerechte Aufbereitung starrer und flexibler Zystoskope : Hinweise für die Praxis.

Infection control visits of the public health department in the city of Frankfurt a.M., Germany, revealed the need for easily understandable and practicable information and recommendations for the reprocessing of rigid and flexible cystoscopes. Based on the German Guidelines for reprocessing medical devices and cystoscopes practical information and examples of specific reprocessing schedules are given in this article in order to enable the personnel in the practices to comply with the guidelines and to prevent nosocomial infections.

[Vienna classification of Crohn's disease: helpful or dispensable? A critical view]. / Wien-Klassifikation des Morbus Crohn: hilfreich oder verzichtbar? Eine kritische Standortbestimmung.

A short review of phenotypic classification of Crohn's disease is given. Pitfalls in a clinical system of disease classification into different phenotypes and limitations of the Vienna classification of Crohn's disease are discussed. The concept of distinctive patterns of disease "behaviour" is criticized. The disease behaviour is not a persistent phenomenon and changes in the long-term follow-up significantly. Factors not addressed in the Vienna classification but, of course, influencing presentation and progression of Crohn's disease such as influences of early childhood, smoking and use of non-steroidal anti-inflammatory drugs are mentioned. The need of the classification criterion "age" is questioned. It is criticized that the Vienna classification has (at least until now) no consequences for the management of Crohn's disease. Experimental treatment approaches follow the current genetic or microbiological hypotheses and do not consider the Vienna classification system. In view of the philosophy of science the need of phenotypic classification into subgroups, clarification of mechanisms and experimentation with drug treatments in the elaboration of disease causation is stressed. In recent years much progress has been made in clarifying Kirsner's "mysterious and multiplex" nature of inflammatory bowel disease. However, as physicians we have to focus on the "menace" of a chronic disease for the patient's life and not only to treat the hole of the patient with "biologicals" but rather to treat the whole patient in a bio-psycho-social approach.

[Consultation. Considerations on the practice of medical consultation]. / Die Sprechstunde. Gedanken zur Praxis des ärztlichen Gespräches.

On the theme of Linus Geisler's nine steps for a successful consultation between doctor and patient, the ability for self-criticism, the ability to be able to listen to oneself and the value of the doctor-patient relationship in the context of medical practice will be discussed. Subsequently, the framework of the consultation, the consulting room atmosphere and the complete setting of the consultation will be dealt with. The importance of active listening and the recognition of all messages, both verbal and from body language, will be particularly emphasized. The capability for empathy is presented as the necessary bridge to recognition of the feelings and inner world of the patient. Because one only sees what one is looking for and only recognizes what one knows, the recognition of typical complaints presented by patients in a consultation represents the "something" which must be specifically elucidated. The problems and symptoms which the patient brings to the doctor are surrounded by a ring of fears and apprehensions. For this reason it is decisive to uncover the accompanying cloud of fears and apprehensions with appropriate questions, to correctly assign the unsettling symptoms of the patient and to be able to correctly interpret them. As illustrated by the language of nature - the translation of deoxyribonucleic acid (DNA) triplets into amino acids - the translation of biological, psychological and social aspects of the complaints symptomatic into the level of diagnosis and the translation of the referential, social and affective meaning of the expressions used by the patient, into the level of the significance will be discussed. The role of the doctor here is that of a producer of context and a skilled translator. In the management of functional disorders and chronic diseases the construction of a shared reality is important. The therapeutic function of consultations is due to an introduction of metaphors as bridges - bridges to an improved understanding of the body, the self and the world. The role of the physician here is that of a moderator, motivator an accompanying person. Finally, Jaspers levels of good doctoring (natural science or causal level, nursing level, communicative-existential level) are stressed and the importance of a good patient-physician relationship for a patient-centered medicine is underlined.

[Clinical management of patients with short bowel syndrome]. / Diätetische und medikamentöse Therapie des Kurzdarmsyndroms.

Diarrhoea, malabsorption and malnutrition characterise the short bowel syndrome. The underlying gastrointestinal disorders, the types of intestinal resections performed and the subsequent pathophysiological situations are reviewed. Recommended therapeutic measures in the postoperative period as well as in the rehabilitation of patients with short bowel syndrome are discussed in more detail. In the postoperative period, parenteral nutrition is essential followed by an enteral diet to stimulate bowel adaptation, reduce fluid loss and increase nutrient absorption. The final diet should be based on the anatomy of the retained bowel (presence or absence of a colon and ileum). The importance of the colon as a digestive organ in patients with short bowel and the need of a low-oxalate diet are underlined. The possible benefit of new treatment options (glutamine, growth hormone and glucagon-like peptide 2) is discussed. Both typical complications of the short bowel syndrome and management of these complications are presented.

[Reprocessing of flexible endoscopes and endoscopic accessories - an international comparison of guidelines]. / Leitlinien zur Aufbereitung flexibler Endoskope und endoskopischen Zusatzinstrumentariums im internationalen Vergleich.

Endoscopic examinations and procedures are essential for diagnosis and treatment of gastrointestinal diseases. As a result of poor reprocessing practice microorganisms can be transmitted via endoscope. The majority of infection transmissions is due to insufficient performance of cleaning and disinfection disregarding guidelines of societies of gastrointestinal endoscopy. A review of the literature and a comparison of European and American guidelines for reprocessing flexible endoscopes are given. Differences in the classification of endoscopic devices, on the possibility of prion transmission, recommendations on staff training and protection, quality assurance of reprocessing and evidence-based graduation of guidelines are stressed and discussed. With respect to the procedure of endoscope reprocessing, differences concerning the cleaning solution to choose, necessity of thoroughly manual cleaning and brushing of the accessible endoscope channels (even in the case of subsequent automatic reprocessing endoscopes in washers-disinfectors), disinfection solution, microbiological quality of water for final rinsing and rationale for alcohol flush of endoscope channels for better drying are mentioned. The need for experimental investigations of the cleaning and disinfection process is stressed. In contrast to recent guidelines of European and American societies of gastrointestinal endoscopy, the now updated recommendations of the Robert Koch-Institute for reprocessing flexible endoscopes and endoscopic accessories are evidence-based and graduated.

[HYGEA (Hygiene in gastroenterology--endoscope reprocessing): Study on quality of reprocessing flexible endoscopes in hospitals and in the practice setting]. / HYGEA (Hygiene in der Gastroenterologie - Endoskop-Aufbereitung): Studie zur Qualität der Aufbereitung von flexiblen Endoskopen in Klinik und Praxis*

The quality of reprocessing gastroscopes, colonoscopes and duodenoscopes in daily routine of 25 endoscopy departments in hospitals and 30 doctors with their own practices was evaluated by microbiological testing in the HYGEA interventional study. In 2 test periods, endoscopes ready for use in patients were found contaminated at high rates (period 1: 49 % of 152 endoscopes; period 2: 39 % of 154 endoscopes). Culture of bacterial fecal flora (E. coli, coliform enterobacteriaceae, enterococci) was interpreted indicating failure of cleaning procedure and disinfection of endoscopes. Detection of Pseudomonas spp. (especially P. aeruginosa) and other non-fermenting rods - indicating microbially insufficient final rinsing and incomplete drying of the endoscope or a contaminated flushing equipment for the air/water-channel - pointed out endoscope recontamination during reprocessing or afterwards. Cause for complaint was found in more than 50 % of endoscopy facilities tested (period 2: 5 in hospitals, 25 practices). Reprocessing endoscopes in fully automatic chemo-thermally decontaminating washer-disinfectors with disinfection of final rinsing water led to much better results than manual or semi-automatic procedures (failure rate of endoscopy facilities in period 2 : 3 of 28 with fully automatic, 8 of 12 with manual, 9 of 15 with semi-automatic reprocessing). The study results give evidence for the following recommendations: 1. Manual brushing of all accessible endoscope channels has to be performed even before further automatic reprocessing; 2. For final endoscope rinsing, water or aqua dest. should only be used disinfected or sterile-filtered; 3. Endoscopes have to be dried thoroughly using compressed air prior to storage; 4. Bottle and tube for air/water-channel flushing have to be reprocessed daily by disinfection or sterilization, and in use, the bottle have to be filled exclusively with sterile water. The HYGEA study shows that microbiological testing of endoscopes is useful for detection of insufficient reprocessing and should be performed for quality assurance in doctors' practices, too. The study put recommendations for reprocessing procedures in more concrete terms.

[Preventing transmission of infection in endoscopy: hygienic maintainance of flexible endoscopes and measures for personal protection]. / Vermeidung einer Infektionsübertragung in der Endoskopie: hygienische Aufbereitung flexibler Endoskope und Massnahmen zum Personalschutz.

For prevention of transfer of infective agents by the contaminated endoscope the importance of thorough mechanical cleaning of the endoscope and adequate disinfection is stressed. Mode of action and side effects of liquid disinfectants as well as resistance of microorganisms (spores and some mycobacteria) to germicidal chemicals are mentioned. The different steps of disinfection procedures and potential causes of failure are discussed. Automatic disinfection systems are required for a higher degree of security of both patient and staff of the endoscopic unit. A regular control of the efficacy of the disinfection process is recommended and models for implementation are discussed. For prevention of occupationally acquired infection general precaution guidelines (use of gloves, prevention of needle-stick injuries) and vaccination programs are stressed.

[Risk of infection in endoscopy]. / Infektionsrisiko in der Endoskopie.

Infection is one of the hazards of endoscopic procedures. This long known risk has received major concern because of potential HIV infection. In the individual patient, both, patient related factors (such as the compromised host) and procedure related factors (such as tissue damage) determine the risk of infection. The potential for transmission of microorganisms from patient to patient or from the endoscopic equipment to the patient is reviewed. Common sources of infection and relevant microorganisms are listed. For prevention of transfer of infective agents through the contaminated endoscope the importance of thorough mechanical cleaning of the endoscope and adequate disinfection is stressed.

[Pathogenesis of stomach carcinoma--significance of nitrates, N-nitroso compounds, nutritional factors and Helicobacter pylori-induced chronic active and chronic atrophic gastritis]. / Pathogenese des Magenkarzinoms--Bedeutung von Nitraten, N-Nitroso-Verbindungen, Nahrungsfaktoren und einer Helicobacter pylori-induzierten chronisch-aktiven und chronisch-atrophischen Gastritis.

Epidemiological data on gastric cancer, time trends and histological classification are reviewed. Known models on gastric carcinogenesis including the pathogenetic importance of nitrates and N-nitroso compounds and protective effects of dietary components are discussed and recent evidence on Helicobacter pylori (Hp) induced chronic active gastritis, its progression to chronic atrophic gastritis and its role in gastric carcinogenesis is summarized. Epidemiological, clinical and pathological support for a causal relationship of Hp and gastric carcinoma is included in a new multistep model on aetiopathogenesis of gastric cancer. The follow-up of patients at risk as well as the question of cancer prevention by Hp eradication are mentioned.