Gastroenterologische Gemeinschaftspraxis

Herne, Germany

Gastroenterologische Gemeinschaftspraxis

Herne, Germany
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The recent increase in overweight and obesity as well as the spectrum of obesityassociated gastrointestinal disorders are reviewed. Dietary measures,the need of behavior modification and the importance of increased physical activity are mentioned. The role of gastroenterologist in the long-term management of obese patients is stressed. Endoscopic-bariatric approaches and indications to bariatric and metabolic surgery are discussed. © 2016 Dustri-Verlag Dr. Karl Feistle.


The infection risk of immunocompromised patients in gastroenterology is reviewed. Possible endogenous infection sources as well as exogenous sources of transmission of infective agents both at home in daily life and in the medical context are discussed. Measures for infection prevention by patients and relatives include hand hygiene, personal hygiene, protection from food-borne diseases as well as safe contact with animals and vaccinations. Preventive measures in the responsibility of physicians and medical personnel are discussed in more detail. The risks of certain immunosuppressive agents (e.g. azathioprine, methotrexate, cyclosporine, infliximab, adalimumab) are underlined and the importance of vaccinations is stressed.


Although transient bacteremia following endoscopic examinations is not unusual, infectious complications after endoscopic procedures are rather rare and focus on peristomalinfections after percutaneous gastrostomy(PEG) or infective complications (including sepsis) after esophageal variceal injection sclerotherapy/-ligation or endoscopic retrograde cholangio-pancreaticography (ERCP). In 2007 the American Heart Association and other societies decides against regular antibiotic prophylaxis in patients with artificial heart valves or artificial joint protheses except in patients with special indications. The recommendations of American and European gastrointestinal societies for prophylactic administration of antibiotics before endoscopic procedures are discussed in detail. © 2016 Dustri-Verlag Dr. Karl Feistle.


The decreased immunoreactivity in the elderly and the increased infection risk of patients under immunosuppressive therapy, treatment with biologicals or chemotherapy is reviewed. Possible endogenous infection sources as well as exogenous sources of transmission of infective agents both at home in the daily live and in the medical context are discussed. Measures for infection prevention by patients and relatives include hand hygiene, personal hygiene, protection from food-borne diseases, contact with animals and vaccinations. Preventive measures in the responsibility of physicians and medical personnel are discussed in more details. The possibilities of a reactivation of previous hepatitis B virus infection or tuberculosis during treatment with immunosuppressive agents are mentioned and the importance of careful surveillance is stressed. © 2016 Dustri-Verlag Dr. Karl Feistle.


Leiss O.,Gastroenterologische Gemeinschaftspraxis
Verdauungskrankheiten | Year: 2016

Measures who are both necessary for a good hygienic management of patients as well as protective for the medical staff preventing contact with infective agents are discussed. The importance of hand hygiene for prevention of infection transmission is stressed and the “when” and “how” of hand hygiene is mentioned. Furthermore, the importance of protective clothes and hygienic measures for common invasive procedures such as punctures and injections are discussed. © 2016 Dustri-Verlag Dr. Karl Feistle.


Leiss O.,Gastroenterologische Gemeinschaftspraxis
Verdauungskrankheiten | Year: 2016

The importance of vaccinations in adults and controls of vaccination status in the elderly, in patients with immunosuppression or in patients waiting for organ transplantation are stressed. The biology of the innate and the adaptive immune system and the difference between polysaccharide and conjugate vaccines are discussed. The goals of vaccination to achieve protection of an individual against infectious diseases or to achieve high vaccination rates in the population in order to avoid transmission of highly contagious infective disorders (e.g., pertussis, influenza,…) are underlined. Requirements and tools for implementation of vaccination in the physician’s office are mentioned in more detail. The influence of different immunosuppressive drugs on vaccination success and the possibility of a reactivation of latent infections during immunosuppressive therapy are discussed. © 2016 Dustri-Verlag Dr. Karl Feistle.


The present pathophysiological concept of eosinophilic esophagitis, clinical symptoms in children and adults and the significance of endoscopic findings are discussed. The differential diagnosis especially to PPIresponsive gastroesophageal reflux disease (GERD) is mentioned in detail. The therapeutic options are diet, drugs and dilatation. The results of allergy tests in children and the effects of elimination diets are discussed. The concept of the “6 food elimination diet” and recent results in adults are presented. © 2016.


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. © 2014 Georg Thieme Verlag KG Stuttgart.New York.


Leiss O.,Gastroenterologische Gemeinschaftspraxis
Verdauungskrankheiten | Year: 2016

The global epidemic of obesity and obesity-associated disorders as well as the limited success of dietary and pharmacological management of obesity lead to a dramatic increase in surgical interventions. The underlying pathophysiological mechanisms of the various bariatric operations are mentioned and the metabolic and nutritional consequences presented. The different spectrum of deficiencies of vitamins and trace elements depending on the type of bariatric surgery performed is discussed in more detail. The need of regular controls and substitutions of vitamins and trace elements is stressed. © 2016.


The recent increase in overweight and obesity as well as the spectrum of obesityassociated gastrointestinal disorders are reviewed. Dietary measures, the need of behavior modification and the importance of increased physical activity are mentioned. The role of gastroenterologist in the long-term management of obese patients is stressed. Endoscopic-bariatric approaches and indications to bariatric and metabolic surgery are discussed. © 2016.

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