Eosinophile Ösophagitis: Die Sicht des Gastroenterologen

Zusammenfassung: Die eosinophile Ösophagitis ist charakterisiert durch Symptome ösophagealer Dysfunktion (meist Dysphagie) und eosinophile Entzündungsinfiltrate im Ösophagus. Diese kommen in anderen Abschnitten des Gastrointestinaltrakts nicht vor. Differenzialdiagnosen, die mit ösophagealer Eosinophilie einhergehen, müssen vor der Diagnose einer eosinophilen Ösophagitis ausgeschlossen werden. Der typische Patient mit eosinophiler Ösophagitis ist männlich und hat atopische Begleiterkrankungen. Zu den Behandlungsoptionen gehören medikamentöse Therapie, Eliminationsdiät sowie ösophageale Dilatatio

Therapie der CED bei Steroidversagen: Immunsuppressiva oder Biologika?

Zusammenfassung: Trotz oftmals erfolgreichem Einsatz von systemischen Steroiden in der Behandlung von Patienten mit aktiver chronisch-entzündlicher Darmerkrankung (CED) sind Limitationen vorhanden aufgrund von primärem Nichtansprechen, Steroidabhängigkeit sowie Steroidresistenz. Eine Langzeittherapie mit Steroiden ist im Hinblick auf die bekannten Nebenwirkungen zu vermeiden. Dieser Artikel erläutert Indikationen für den Einsatz von Immunmodulatoren (Azathioprin, 6-Mercaptopurin, Methotrexat), Medikamenten gegen Tumornekrosefaktor (Anti-TNF-Therapie) sowie Calcineurininhibitoren (Ciclosporin, Tacrolimus) bei Steroidresisten

Prevalence and risk factors for thromboembolic complications in IBD patients

Background: Inflammatory bowel disease (IBD) patients have an increased risk of venous thromboembolic complications (VTEC) such as deep vein thrombosis (DVT) and pulmonary embolism when compared to the non-IBD population. However, studies assessing VTEC prevalence in IBD as well as analyses of VTEC associated risk factors are scarce. We aimed to assess VTEC prevalence in IBD patients and to identify associated risk factors. Methods: Data from patients enrolled in the Swiss IBD Cohort Study (SIBDCS) were analyzed. Since 2006 the SIBDCS collects data on a large sample of IBD patients from hospitals and private practices across Switzerland. Results: A  total of 90/2284 (3.94%) IBD patients suffered from VTEC. Of these, 45/1324 (3.4% overall; 2.42% with DVT, 1.51% with PE) had CD, and 45/960 (4.7% overall; 3.23% with DVT, 2.40% with PE) presented with UC

Intermittent euxinia in the high-latitude James Ross Basin during the latest Cretaceous and earliest Paleocene

Seymour Island, in the James Ross Basin, Antarctica, contains a continuous succession of latest Cretaceous sediments deposited in a shallow marine environment at high latitude, making it an ideal place to study environmental changes prior to the K–Pg mass extinction. We measured major and trace elements and conducted petrographic analysis of two sections from the Maastrichtian–Danian López de Bertodano Formation of Seymour Island. Several lines of evidence point to intermittently anoxic to euxinic conditions during deposition, including the presence of pyrite framboids with a size distribution suggesting syngenetic formation in the water column, and enrichments in several trace elements, including molybdenum, arsenic, copper, zinc, and chromium. Molybdenum enrichments are clearly associated with enrichments in manganese and authigenic iron, suggesting “shuttling” of redox sensitive trace elements across a chemocline that fluctuated across the sediment-water interface. Comparisons with modern systems suggest relatively high frequency redox variability, possibly over approximately annual timescales, which may be related to the annual cycle of polar sunlight and associated seasonal changes in primary productivity. Glauconitic horizons are associated with more reducing conditions, including at the K–Pg boundary, though this does not appear to be a uniquely euxinic interval; similar degrees of trace element enrichment are seen in other highly glauconitic intervals. While euxinia may have contributed to low diversity in the lowermost ‘Rotularia Units’, redox conditions do not seem to have been the primary control on the transition to a mollusc dominated fauna in the latest Maastrichtian. Redox conditions show little to no response to the eruption of the Deccan Traps or Maastrichtian climatic changes. Instead, intermittent euxinia appears to have been a characteristic feature of this high-latitude environment during the Cretaceous–Paleogene transition

Long-Term Antibiotic Treatment for Crohn's Disease: Systematic Review and Meta-Analysis of Placebo-Controlled Trials

Background. We investigated the effectiveness of long-term antibiotic treatment in patients with Crohn's disease. Methods. We performed a systematic review and meta-analysis of randomized clinical trials. Data sources were Medline (from 1966 through June 2009), EMBASE (from 1980 through June 2009), Cochrane Central Register of Controlled Trials (issue 3, 2009), and references from relevant publications. Trials that compared antibiotic therapy during at least 3 months with placebo were included. Outcomes were remission in patients with active disease and relapse in patients with inactive disease. Results from intention-to-treat analyses were combined in a random-effects meta-analysis, stratified by class of drug. Odds ratios (ORs) >1 indicate superiority of antibacterial treatment over placebo. Numbers needed to treat for 1 year to keep 1 additional patient in remission were calculated. Results. Sixteen trials that examined 13 treatment regimens in 865 patients were included in the meta-analysis. The median duration of treatment was 6 months (range, 3-24 months). Three trials of nitroimidazoles showed benefit, with a combined OR of 3.54 (95% confidence interval [CI], 1.94-6.47). Similarly, the combined OR from 4 trials of clofazimine was 2.86 (95% CI, 1.67-4.88). For patients with active disease, the number needed to treat was 3.4 (95% CI, 2.3-7.0) for nitroimidazoles and 4.2 (95% CI, 2.7-9.3) for clofazimine. The corresponding numbers needed to treat for inactive disease were 6.1 (95% CI, 5.0-9.7) and 6.9 (95% CI, 5.4-12.0). No benefit was evident for classic drugs against tuberculosis (3 trials; OR, 0.58; 95% CI, 0.29-1.18). Results for clarithromycin were heterogeneous (I2=77%; P=.005) and not combined in the meta-analysis. Conclusions. Long-term treatment with nitroimidazoles or clofazimine appears to be effective in patients with Crohn's diseas

Assessment of Circulating MicroRNAs for the Diagnosis and Disease Activity Evaluation in Patients with Ulcerative Colitis by Using the Nanostring Technology

Background: Clinical decision and patient care management in inflammatory bowel diseases is largely based on the assessment of clinical symptoms, while the biomarkers currently in use poorly reflect the actual disease activity. Therefore, the identification of novel biomarkers will serve an unmet clinical need for IBD screening and patient management. We examined the utility of circulating microRNAs for diagnosis and disease activity monitoring in ulcerative colitis (UC) patients. Methods: Blood serum microRNAs were isolated from UC patients with active and inactive disease and healthy donors. High-throughput microRNA profiling was performed using the Nanostring technology platform. Clinical disease activity was captured by calculating the partial Mayo score. C-reactive protein (CRP) was measured in UC patients as part of their clinical monitoring. The profiles of circulating microRNAs and CRP were correlated with clinical disease indices. Results: We have identified a signature of 12 circulating microRNAs that differentiate UC patients from control subjects. Moreover, six of these microRNAs significantly correlated with UC disease activity. Importantly, a set of four microRNAs (hsa-miR-4454, hsa-miR-223-3p, hsa-miR-23a-3p, and hsa-miR-320e) which correlated with UC disease activity, were found to have higher sensitivity and specificity values than CRP. Conclusions: Circulating microRNAs provide a novel diagnostic and prognostic marker for UC patients. The use of an FDA approved platform could accelerate the application of microRNA screening in a GI clinical setting. When used in combination with current diagnostic and disease activity assessment modalities, microRNAs could improve both IBD screening and care management

Diagnosis and Management of the Symptomatic Duodenal Diverticulum: a Case Series and a Short Review of the Literature

Introduction: The incidence of duodenal diverticula (DD) found at autopsy may be as high as 22%. Perforation is the least frequent but also the most serious complication. This case series gives an overview of the management of this rare entity. Methods: This study is a case series of eight patients treated for symptomatic DD. Results: Two patients had a perforated DD. One perforation was in segments III-IV, which to our knowledge is the first published case; the other perforation was in segment II. A segmental duodenectomy was performed in the first patient and a pylorus-preserving duodeno-pancreatectomy (pp-Whipple) in the second. A third patient with chronic complaints and recurring episodes of fever required an excision of the DD. In a fourth patient with biliary and pancreatic obstruction, a pp-Whipple was carried out, and a DD was discovered as the underlying cause. Four patients (one small perforation, one hemorrhage, and two recurrent cholangitis/pancreatitis caused by a DD) were treated conservatively. Conclusions: Symptomatic DD and, in particular, perforations are rare, encompass diagnostic challenges, and may require technically demanding surgical or endoscopic interventions. The diagnostic value of forward-looking gastroduodenoscopy in this setting seems limited. If duodenoscopy is performed at all, the use of a side-viewing endoscope is mandator

Comparison of different biopsy forceps models for tissue sampling in eosinophilic esophagitis.

Background and aims: Eosinophilic esophagitis (EoE) is a mixed inflammatory and fibrostenotic disease. Unlike superficial inflammatory changes, subepithelial fibrosis is not routinely sampled in esophageal biopsies. This study aimed to evaluate the efficacy and safety of deep esophageal sampling with four different types of biopsy forceps. Patients and methods: In this cross-sectional study, esophageal biopsies were taken in 30 adult patients by one expert endoscopist. Biopsies sampled from distal esophagus using a static jaw forceps (Olympus, FB-11K-1) were compared with proximal biopsies sampled with static jaw (Olympus, FB-45Q-1), alligator jaw (Olympus, FB-210K), and large-capacity forceps (Boston Scientific, Radial Jaw 4). One pathologist calculated the surface area of epithelial and subepithelial layers in hematoxylin and eosin (H&E)-stained biopsies. Results: Subepithelial tissue was acquired in 97 % (static jaw FB-11K-1), 93 % (static jaw FB-45Q-1), 80 % (alligator jaw), and 55 % (large-capacity) of samples. Median (interquartile [IQR]) ratios of surface area of epithelial to subepithelial tissue were: static jaw FB-45Q-1, 1.07 (0.65 - 4.465); static jaw FB-11K-1, 1.184 (0.608 - 2.545); alligator jaw, 2.353 (1.312 - 4.465); and large-capacity, 2.71 (1.611 - 4.858). The static jaw models obtained a larger surface area of subepithelial tissue compared with the alligator jaw (P < 0.001 and P = 0.037, for FB-11K-1 and FB-45Q-1, respectively) and the large-capacity forceps (P < 0.001, for both static jaw models). No esophageal perforations occurred. Conclusions: The static jaw forceps models allowed sampling of subepithelial tissue in > 90 % of biopsies and appear to be superior to alligator or large-capacity forceps in sampling larger amounts of subepithelial tissue

Earth Observation-Based Dwelling Detection Approaches in a Highly Complex Refugee Camp Environment - A Comparative Study

For effective management of refugee camps or camps for internally displaced persons (IDPs) relief organizations need up-to-date information on the camp situation, that can be provided by Earth observation (EO). In this study, different approaches were tested using the example of a highly complex camp site in Somalia.Si loogu sameeyo maareen rasmi ah xereyinka qaxootiga iyo barakacayaasha gudaha dalka, ururada samafalku waxay u baahanyihiin xog ama warar cusub oo ku saabsan xaaladaha xerooyinka. Haddaba daraasaadkan wuxuu si gaar ah u baarayaa xero ku taalla Soomaaliya.Per una gestione efficace dei campi profughi o campi per sfollati interni (IDPs), le organizzazioni umanitarie hanno bisogno di informazioni aggiornate sulla situazione del campo, che possono essere fornite con osservazioni della Terra dallo spazio (EO). In questo studio, diversi approcci sono stati testati partendo dal caso di un campo molto complesso in Somalia