Pehl C.,Medizinische Klinik
Gastroenterologe | Year: 2017
Diagnosis of functional abdominal complaints in the upper (functional dyspepsia) and lower (irritable bowel syndrome) gastrointestinal (GI) tract, requires the differential diagnostic exclusion of organic diseases. Particularly in the case of existing alarm symptoms, an initial test therapy should not be attempted in cases of dyspeptic symptoms and/or defecation problems. Each diagnostic evaluation starts with the medical history and physical examinations including rectal digitation, laboratory testing, abdominal ultrasound and gynecological investigations for women. Upper GI endoscopy or at least noninvasive testing for Helicobacter pylori should be performed in patients with dyspeptic symptoms. If defecation is dominated by diarrhea patients have to undergo thorough testing in order not to overlook specific treatable causes. This includes breath testing for food intolerance, transglutaminase antibodies for coeliac disease, fecal testing (microbiology and inflammation markers) and colonoscopy with biopsies from ileum and colon. Further investigations are recommended for patients with refractory symptoms or suspected severe motility disturbances, such as gastroparesis, chronic intestinal pseudo-obstruction (CIPO) or slow transit constipation. © 2017 Springer Medizin Verlag Berlin
Layer P.,Medizinische Klinik |
Stanghellini V.,University of Bologna
Alimentary Pharmacology and Therapeutics | Year: 2014
Background: Irritable bowel syndrome with constipation (IBS-C) represents a significant burden to patients and healthcare systems due to its prevalence and lack of successful symptomatic resolution with established treatment options. Linaclotide 290 μg has recently been approved by the European Medicines Agency (EMA) for moderate-to-severe IBS-C and by the US Food and Drug Administration for IBS-C (290 μg dose) and for chronic constipation (145 μg dose). Aim: To summarise data leading to the approval of linaclotide for IBS-C, with focus on EMA-pre-specified outcome measures. Methods: Literature search of a peer-review database (PubMed) and review of congress abstracts on linaclotide preclinical and clinical trial data in IBS-C. Results: Preclinical studies suggest that the guanylate cyclase C agonist (GCCA) linaclotide acts through elevation of cyclic guanosine monophosphate (cGMP) levels, leading to accelerated gastrointestinal (GI) transit through increased fluid secretion and reduced visceral hypersensitivity. Clinical trial data demonstrate that linaclotide improves abdominal symptoms (pain, bloating) and bowel symptoms (constipation) compared with placebo in patients with IBS-C. The most frequent side effect, diarrhoea, results from the therapeutic action of linaclotide. Linaclotide acts locally in the GI tract with minimal systemic exposure, resulting in low oral bioavailability and thus a low risk of relevant systemic adverse effects. Conclusion: Linaclotide, a first-in-class GCCA, is a promising new drug with a novel, dual mechanism of action that, unlike more well-established agents, can relieve the abdominal pain, bloating and constipation associated with IBS-C and has a low propensity for systemic side effects. © 2014 John Wiley & Sons Ltd.
Loser Chr.,Medizinische Klinik
Gastroenterologe | Year: 2012
Malnutrition is a frequent and highly relevant independent risk factor in elderly people with significant clinical consequences. Individual adequate nutritional intervention is based on the established step-wise treatment algorithm where artificial nutrition via percutaneous endoscopic gastrostomy (PEG) tubes stands at the end of the therapeutic options. Placement of PEG tubes requires a clear medical indication as well as ethical justification within a critical, individual decision-making process. To our present knowledge, nutrition via PEG is from its character supportive, early, preventive and mainly transient but should not be placed in very old, multimorbid and demented patients. Artificial nutrition with a PEG tube is not a terminal or even a symbolic treatment at the end of human life or in patients with progressive stages of incurable diseases. © Springer-Verlag 2012.
Loser C.,Medizinische Klinik
Aktuelle Ernahrungsmedizin | Year: 2012
Within the 32 years of its existence our attitude towards artificial enteral nutrition via PEG-tubes has changed in a fundamental way: in our modern understanding nutrition via PEG is supportive, early, preventive, and in many cases temporary. PEG-feeding is not an alternative but a possible supplement to normal oral food intake and requires an individual medical indication as well as an ethical justification. This does not follow standardised algorithmic thinking but is decided on an individual base taking personal wishes, resources, and needs of the individual patient into account. Nutrition via PEG-tube is not a terminal basic or even symbolic treatment at the end of life. The present dilemma of the PEG is that the public discussion primarily focus one-sided on the problems of PEG-placement in multimorbid, elderly, and/or demented patients or patients in end-stage tumour diseases where indeed PEG-placement is neither medically nor ethically justified - we still place PEG-tubes to often in the wrong patients! On the other hand we still consider supportive and in many cases temporary nutrition via PEG too rare and even too late in those patients which clearly could benefit from an early, supportive, and preventive PEG-treatment on the base of our present evidence-based scientific knowledge - we still consider PEG-treatment not adequately and in most cases too late in the right patients! Placing a PEG-tube is not the second last step before death and physicians have to accept the ethically given limits of medical treatment by realizing our modern understanding of the benefits and limits of supportive artificial nutrition via PEG. © Georg Thieme Verlag KG Stuttgart . New York.
Loser C.,Medizinische Klinik
Verdauungskrankheiten | Year: 2011
Malnutrition is a frequent and typical phenomenon in elderly people and due to the lack of adequate compensation in elderly malnutrition should be detected early and consequently treated on an individual basis. Malnutrition in elderly is a highly relevant clinical risk factor with concomitant severe economic consequences. Malnutrition has significant impact on all relevant clinical out-come-parameters such as rate of complication, morbidity, mortality, quality of life and health care-costs. In clinical practice detection of malnutrition is quickly and easily possible by simple well-established screening tools (NRS, SGA, MNA) which should routinely be used especially in risk patients. Individual adequate nutritional intervention is based on the established stepwise treatment algorithm which is recommended by the responsible nutritional and geriatric societies. Especially for nutritional oral supplements the high clinical efficiency is well documented and proven in a variety of actually published meta-analyses. Especially in very old, multimorbid, demented patients or cancer patients the ethically justified borders of medical treatment have to be individually considered next to a recent medical indication. Artificial nutrition is not a symbolic treatment at the end of human life or in patients with progredient stages of incurable diseases. © 2011 Dustri-Verlag Dr. Karl Feistle.
Labenz J.,Medizinische Klinik
Chirurg | Year: 2014
Background: Diverticular bleeding is the most common cause of acute severe lower gastrointestinal bleeding. Diagnostic and therapeutic approaches have not been standardized. Objective: Development of an evidence-based management algorithm. Materials and methods: A systematic search of the literature (PubMed 1998-2013) was carried out and a review with consideration of current guidelines is given. Results: The lifetime risk of clinically relevant bleeding is estimated to be 5 % in persons with colonic diverticula. Patients with clinically suspected diverticular hemorrhage should be admitted to hospital. Diverticular bleeding will cease spontaneously in around 70-90 % of the cases. In patients with severe lower gastrointestinal tract bleeding, defined as instability of the circulation, persistent bleeding after 24 h, drop of the hemoglobin level to ≥ 2 g/dl or the necessity for transfusion, endoscopy of the upper and lower gastrointestinal tract within the first 12-24 h is recommended. In patients with active diverticular bleeding or signs of recent hemorrhage (e.g. visible vessel or adherent clot) endoscopic therapy is strongly recommended because it significantly decreases the rate of early and late rebleeding. Angiography with superselective embolization is a therapeutic option in patients where endoscopy failed. Surgery should be considered in patients with ongoing bleeding and failure of interventional treatment and in patients who suffered from recurrent severe diverticular bleeding. Conclusions: Diverticulosis coli remains the most common cause of lower gastrointestinal bleeding. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed either conventionally or by interventional therapy. © 2014 Springer-Verlag Berlin Heidelberg.
Layer P.,Medizinische Klinik
Expert Review of Gastroenterology and Hepatology | Year: 2013
Irritable bowel syndrome is a heterogeneous disease with a complex underlying pathophysiology and multiple symptoms - that is, clinical manifestation patterns. As such, management of irritable bowel syndrome requires a flexible approach tailored to the individual patient. This article reviews rational, evidence-based management strategy and treatment options for this variable condition. © 2013 Informa UK Ltd.
Geisler T.,Medizinische Klinik |
Schaeffeler E.,Medizinische Klinik |
Gawaz M.,Medizinische Klinik |
Schwab M.,Medizinische Klinik
Thrombosis and Haemostasis | Year: 2013
Platelets are critically involved in atherosclerosis and acute thrombosis. The platelet phenotype shows a wide variability documented by the inherited difference of platelet reactivity, platelet volume and count and function of platelet surface receptors. Several candidate genes have been put into focus and investigated for their functional and prognostic role in healthy individuals and patients with cardiovascular (CV) disease treated with antiplatelet agents. In addition to genetic variation, other clinical, disease-related and demographic factors are important so-called non-genetic factors. Due to the small effect sizes of single nucleotide polymorphisms (SNP) in candidate genes and due to the low allele frequencies of functional relevant candidate SNPs, the identification of genetic risk factors with high predictive values generally depends on the sample size of study cohorts. In the post-genome era new array and bioinformatic technologies facilitate high throughput genome-wide association studies (GWAS) for the identification of novel candidate genes in large cardiovascular cohorts. One of the crucial aspects of platelet genomic studies is the precise definition of a specific clinical phenotype (e.g. stent thrombosis) as this will impact importantly the findings of genomic studies like GWAS. Here, we provide an update on genetic variation of platelet receptors and drug metabolising enzymes under specific consideration of data derived by GWAS. The potential impact of this information and the role in personalised therapeutic concepts will be discussed. © Schattauer 2013.
Hauber H.-P.,Medizinische Klinik
Pneumologie | Year: 2011
Paraneoplastic syndromes occur in approximately 10% of all patients with lung cancer. They can be the first manifestation of the disease or of a recurrence. Endocrine, haematological, neuromuscular, dermatological, renal, and metabolic syndromes as well as syndromes involving the connective tissue and constitutional syndromes can be distinguished based on their clinical symptoms. In this review, the epidemiology, pathogenesis, clinical signs and treatment options for the clinically important paraneoplastic syndromes in lung cancer are discussed. © Georg Thieme Verlag KG Stuttgart.
Exercise training for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD)! Already on the ICU? Rehabilitation on the hospital floor? [Training bei Patienten mit exazerbierter COPD im Akutkrankenhaus! Schon auf der Intensivstation? Reha auf dem Krankenhausflur?]
Spielmanns M.,Medizinische Klinik
Atemwegs- und Lungenkrankheiten | Year: 2014
The acute exacerbation of COPD (AECOPD) means a prognostic and critical worsening of the underlying disease for the patient. Therefore the prevention of AECOPD is a meaningful therapeutic goal probably reached by using pulmonary rehabilitation. But the question is when to begin with the PR. A very early beginning with parts of a common PR, for example during the ICU therapy, can be of advantage and should be continued during the stay on a normal ward. Nevertheless, this means not the replacement of pulmonary rehabilitation programs. Actually completing a pulmonary rehabilitation in an in- or outpatient setting is the only therapeutic option taking influence on the course and the prognostic development of patients with COPD. © 2014 Dustri-Verlag Dr. Karl Feistle