Zeitschrift für Gastroenterologie (Z GASTROENTEROL )

Publisher: Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten; Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten. Sektion Gastroenterologische Endoskopie; Österreichische Gesellschaft für Gastroenterologie und Hepatologie; Ungarische Gesellschaft für Gastroenterologie und Hepatologie; Thieme-connect (Online service), Thieme Publishing


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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Hemosuccus pancreaticus is defined as upper gastrointestinal hemorrhage from the ampulla of Vater via the pancreatic duct. It is a rare disease, with non-specific presentation, challenging to diagnose and difficult to treat, with high mortality rates in untreated patients with massive bleeding. Given the intermittent nature of the bleeding, delays in diagnosis frequently occur. Timely diagnosis and treatment seem to result in markedly reduced mortality, therefore we emphasize the diagnostic contribution of imaging techniques by presenting the case of a patient with chronic pancreatitis in whom computed tomography established the diagnosis of blood in the Wirsung duct and contrast-enhanced ultrasound brought its added value by excluding the active bleeding.
    Zeitschrift für Gastroenterologie 11/2014; 52(11):1263-1267.
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    ABSTRACT: Ultrasound is often the first imaging procedure performed in the evaluation of individuals with suspected or known liver disease. Despite technical advances in ultrasound techniques, sonographic detection and evaluation of diffuse liver disease still remains difficult. This is due to the fact that diffuse liver disease does not always cause distortion of the liver parenchymal texture, internal liver architecture, or shape of the liver. On the other hand, the size of the liver, the echo pattern of the hepatic parenchyma, the analysis of intrahepatic vessels and alterations in perihepatic structures and lymph nodes can be helpful sonographic parameters of diffuse liver disease. Until now, the sonographic appearance of some rare diffuse liver diseases is not well known. However, there are some typical sonomorphological signs that, once identified, can facilitate the differentiation between various diseases. The aim of this paper is to highlight some typical ultrasound findings of liver parenchyma and perihepatic lymph node structures in rare diffuse liver diseases based on a review of published data.
    Zeitschrift für Gastroenterologie 11/2014; 52(11):1247-1256.
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    ABSTRACT: Einleitung: Adenokarzinome des Dünndarms sind eine sehr seltene Entität maligner gastrointestinaler Tumore. Das Auftreten in einer Jejunumschlinge nach einer Frey-Operation ist bisher in der Literatur nicht beschrieben. Ziele und Methodik: Es wird die Diagnostik und Therapie anhand eines Falles dargestellt sowie entsprechend der verfügbaren Literatur diskutiert. Ergebnis: Bei einer 53 jährigen Patientin, welche 6 Jahre zuvor eine Frey-Operation aufgrund einer chronischen Pankreatitis erhalten hatte, war im Rahmen einer ERCP-Kontrolle zunächst eine polypöse Veränderung im Bereich der Major-Papille aufgefallen. Nach dem Versuch der kompletten Abtragung ergaben sich Anteile eines invasiven Adenokarzinoms, so dass nach unauffälligem Staging, unter dem Verdacht eines Papillenkarzinoms die operative Exploration der Patientin erfolgte. Hierbei stellte sich überraschenderweise ein Tumor von der an das Pankreas anastomosierten Jejunumschlinge ausgehend und in den Pankreaskopf infiltrierend dar. Es wurde eine R0 Resektion mittels pyloruserhaltender Pankreaskopfresektion und Resektion der Freyschlinge durchgeführt. Insgesamt ergab sich ein muzinöses Adenokarzinom des Dünndarms (TNM-Klassifikation: pT4, pN0 (0/27), V0, L0, R0, G2). Im Anschluß erfolgte eine durch unsere Tumorkonferenz indizierte adjuvante Chemotherapie mit zwölf Zyklen FOLFOX. Aktuell besteht in den bis dato durchgeführten Staginguntersuchungen 6 Monate nach Operation kein Hinweis auf ein Rezidiv oder Metastasen. Schlussfolgerung: Bei Patienten nach Drainage-Operation des Pankreas ist auch die seltene Entität des Dünndarmkarzinoms im Bereich der anastomosierten Jejunalschlinge in Betracht zu ziehen und in die therapeutischen Überlegung mit einzubinden.
    Viszeralmedizin 2014, Leipzig, Germany; 09/2014
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    ABSTRACT: Co-regulated genes are not identified in traditional microarray analyses, but may theoretically be closely functionally linked (guilt by association, guilt by profiling). Thus, bioinformatics procedures for guilt by profiling/association analysis have yet to be applied to large-scale cancer biology. We analyzed 2158 full cancer transcriptomes from 163 diverse cancer entities in regard of their similarity of gene expression, using Pearson's correlation coefficient (CC). Subsequently, 428 highly co-regulated genes (|CC|>= 0.8) were clustered unsupervised in order to obtain small co-regulated networks. A major subnetwork containing 61 closely co-regulated genes showed highly significant enrichment of cancer biofunctions. All genes except KIF18B and CDCA3 were of confirmed relevance for tumor biology. Therefore, we independently analyzed their differential regulation in multiple tumors and found severe deregulation in liver, breast, lung, ovarian and kidney cancers, thus proving our guilt-by-association hypothesis. Overexpression of KIF18B and CDCA3 in hepatoma cells and subsequent microarray analysis revealed significant deregulation of central cell cycle regulatory genes. Consistently, RT-PCR and proliferation assay confirmed the role of both genes in cell cycle progression. Finally, the prognostic significance of the identified KIF18B- and CDCA3-dependent predictors (p = 0.01, p=0.04) was demonstrated in three independent HCC cohorts and several other tumors. In summary, we proved the efficacy of large-scale guilt by profiling/association strategies in oncology. We identified two novel oncogenes and functionally characterized them. The strong prognostic importance of downstream predictors for HCC and many other tumors indicates the clinical relevance of our findings.
    Zeitschrift für Gastroenterologie 09/2014;
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    ABSTRACT: Purpose: This investigation focuses on the physiological characteristics of gene transcription of intestinal tissue following anastomosis formation. Methods: In eight rats, end-to-end ileo-ileal anastomoses were performed (n = 2/group). The healthy intestinal tissue resected for this operation was used as a control. On days 0, 2, 4 and 8, 10-mm perianastomotic segments were resected. Control and perianastomotic segments were examined with an Affymetrix microarray chip to assess changes in gene regulation. Microarray findings were validated using real-time PCR for selected genes. In addition to screening global gene expression, we identified genes intensely regulated during healing and also subjected our data sets to an overrepresentation analysis using the Gene Ontology (GO) and Kyoto Encyclopedia for Genes and Genomes (KEGG). Results: Compared to the control group, we observed that the number of differentially regulated genes peaked on day 2 with a total of 2,238 genes, decreasing by day 4 to 1,687 genes and to 1,407 genes by day 8. PCR validation for matrix metalloproteinases-3 and -13 showed not only identical transcription patterns but also analogous regulation intensity. When setting the cutoff of upregulation at 10-fold to identify genes likely to be relevant, the total gene count was significantly lower with 55, 45 and 37 genes on days 2, 4 and 8, respectively. A total of 947 GO subcategories were significantly overrepresented during anastomotic healing. Furthermore, 23 overrepresented KEGG pathways were identified. Conclusion: This study is the first of its kind that focuses explicitly on gene transcription during intestinal anastomotic healing under standardized conditions. Our work sets a foundation for further studies toward a more profound understanding of the physiology of anastomotic healing. © 2014 S. Karger AG, Basel.
    Zeitschrift für Gastroenterologie 08/2014; 53(1-4):73-85.
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    ABSTRACT: Aims In autoimmune hepatitis (AIH), relapse rates as high as 90% have been reported after treatment withdrawal. We therefore investigated, whether longer duration of treatment and proper patient selection could increase the long-term success rates of treatment withdrawal. Methods Following our previously published experience, treatment withdrawal was considered when biochemical remission was maintained under immunosuppressive monotherapy for at least 2 years. Remission was defined as repeatedly normal serum aminotransferase levels as well as normal IgG levels. Results Out of 288 patients with well-defined AIH, 28 patients were included. Median duration of treatment was 48.5 months (range 35-179) and a sustained remission was observed for 45 months (range 24-111). All patients were in remission on immunosuppressive monotherapy for a minimum of 2 years before treatment was withdrawn. Using this strict approach, 15 patients (54%) remained in long-term remission after a median of 28 months follow-up (range 17-57) and 13 patients (46%) required reinstitution of treatment. Higher ALT and IgG levels - although within the normal range in all patients - were associated with the time to relapse. All patients who remained in remission had ALT levels less than half the ULN and IgG levels not higher than 12g/l at the time of treatment withdrawal. Conclusion Proper patient selection including a sustained complete biochemical remission on immunosuppressive monotherapy for a minimum of 2 years can markedly improve the success rates of treatment withdrawal. The interpretation of aminotransferase and IgG levels within the normal range could aid in predicting the risk of relapse.
    Zeitschrift für Gastroenterologie 08/2014;
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    ABSTRACT: Background: Malignant biliary obstruction is often inoperable at presentation and has a poor prognosis. Percutaneous Transhepatic Biliary stenting with endoprothesis (plastic or self expanding metat stent) is a palliative procedure to relieve malignant biliary obstruction , when endoscopic technique was not possible or had failed. This study reports our experience of percutaneous transhepatic biliary stenting in malignant biliary obstruction. Methods: The authors present retrospective analysis of 46 patients who had percutaneous transhepatic biliary stenting in malignant biliary obstruction, between Jan 2011 and Mar 2014 at Békés County Hospital/Gyula. The etiology included 18(40%) cases of pancreatic cancer, 8 (17%) cases of cholangiocarcinoma, 4(8%) cases gallblader cancer, 4 (8%) cases of ampullary carcinoma and 12 (27%) cases of other metastatic liver diseases. Results: 46 patients (23 women, 23 men, mean age: 65 years , range: 41-90 years) underwent percutaneous transhepatic biliary stenting after failed endoscopic procedures. The succes rate was 93% with placement of single plastic stents in 30 patients, duoble stents in 9 patients and self expanding metal stents in 4 patients (one with rendezvous technique).Mean survival time was 65 days with range of 1- 262 days in 46 patients. The survival time was higher in younger patients with no other co-morbidity. The overall complication rate was 39% (n:18), and the commonest complication was cholangitis 13% (n:6) and stent occlusion 10%(n:5). We lost two patients in the first 24 hours because of severe sepsis. Conclusion: Our results suggest that percutaneous transhepatic biliary stenting in malignant biliary obstruction is effectively in patients who had failed endoscopic stenting, although the complication rate is high, but the survival time was longer and the patients quality of life was better.
    Zeitschrift für Gastroenterologie 05/2014; 52:469.
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    ABSTRACT: Background: Hypoxia has been shown to have a role in the pathogenesis of several forms of liver disease. The Hypoxia Inducible Factors (HIFs) are a family of evolutionarily conserved transcriptional regulators that affect a homeostatic response to low oxygen tension and have been identified as key mediators of angiogenesis, inflammation, and metabolism. HIF-1α and HIF-2α can activate simultaneously distinct target genes with different functions regarding the regulation of hypoxia-related genes. Methods: Male Wistar rats were administrated thioacetamide (TAA) in drinking water up to 20 weeks and sacrificed at different time points (4, 8, 12, 16, 20 weeks). Expression of HIF-1α and HIF-2α was evaluated during liver damage and cholangiocarcinoma development after TAA administration. Expression of HIF-1α and HIF-2α was measured by RT-PCR and Western blot. HIF-1α, HIF-2α, α-SMA, CK-19, ED1 and ED2 were localized by immunofluorescence staining. Results: The immunofluorescence staining with anti-HIF-1α identified a co-localization with α-SMA, a hepatic stellate cells marker, during 8 and 16 weeks of hepatic damage after TAA administration. However HIF-2α appeared in α-SMA positive cells during late time point of the study (16 weeks). HIF-2α was localized mainly in proximity with the sinusoidal spaces and in the endothelial cells, showed positivity in ED1 cells during early time of study (8w) while HIF-1α positivity in ED1 cells was detected during late time points (16w). Immunofluorescence analysis of liver from TAA administrated rat revealed HIF-2α strong positivity in ED2 cells while ED2 cells were negative for HIF-1α. RT-PCR and Western Blot data confirmed the immunohistochemical analysis as they showed a sharp up-regulation of HIF-1α reaching the highest level 8 weeks after beginning the experiment whereas HIF-2α showed a maximum increase of gene expression at 16 weeks. Conclusion: HIF-1α expression in the hypoxic liver area during early time point after TAA-administration and its reduction during the late time point clearly describes its role as damage-associated molecule during hepatic repair and fibrogenesis. The detection of HIF-2α at a late time point (16w) reveals that under hypoxic conditions a decline of HIF-1α in favor of HIF-2α-dependent gene regulation takes place and indicates a role of HIF-2α during the recovery phase of a chronic liver damage. HIF-2α localization in endothelial cells during hepatic damage confirms its involvement in angiogensis and vascularization. As HIF-2α seems to have a crucial role in the induction of the hepatic erythropoietin (EPO), its co-localization in ED2+ cells opens a new scenario in the role of the macrophage compartment in the process of erythropoiesis.
    Zeitschrift für Gastroenterologie 01/2014;
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    ABSTRACT: P-cadherin is a major contributor to cell-cell adhesion in epithelial tissues, playing pivotal roles in important morphogenetic and differentiation processes and in maintaining tissue integrity and homeostasis. Alterations of P-cadherin expression have been observed during the progression of several carcinomas where it appears to act as tumor suppressive or oncogenic in a context-dependent manner. Here, we found a significant downregulation of P-cadherin in hepatocellular carcinoma (HCC) cell lines and tissues compared to primary human hepatocytes and non-malignant liver tissues. Combined immunohistochemical analysis of a tissue microarray containing matched pairs of HCC tissue and corresponding non-tumorous liver tissue of 69 patients confirmed reduced P-cadherin expression in more than half of the cases. In 35 human HCC tissues, the P-cadherin immunosignal was completely lost which correlated with tumor staging and proliferation. Also in vitro, P-cadherin suppression in HCC cells via siRNA induced proliferation compared to cells transfected with control-siRNA. In summary, downregulation of P-cadherin expression appears to induce tumorigenicity in HCC. Therefore, P-cadherin expression may serve as a prognostic marker and therapeutic target of this highly aggressive tumor.
    Zeitschrift für Gastroenterologie 01/2014; 7(9):6125-32.
  • Zeitschrift für Gastroenterologie 12/2013;
  • Zeitschrift für Gastroenterologie 08/2013; 45:S13.
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    ABSTRACT: Abstract OBJECTIVE: The aim of this study was to develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. BACKGROUND: The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric descriptions of occurrences that are merely associated with severity. METHODS: A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensive medicine specialists, and radiologists who are currently active in clinical research on acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organised to bring contributors from different disciplines together and discuss the concept and definitions. RESULT: The new international classification is based on the actual local and systemic determinants of severity, rather than descriptions of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity - mild, moderate, severe, and critical. CONCLUSIONS: This classification is the result of a consultative process amongst pancreatologists from 49 countries spanning North America, South America, Europe, Asia, Oceania, and Africa. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout
    Zeitschrift für Gastroenterologie 06/2013; 51((6)):544-50.
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    ABSTRACT: Die primäre intestinale Lymphangiektasie (PIL) verursacht eine Störung des Lymphtransports und wird nach der Systematik der gastroenterologischen Erkrankungen den exsudativen Gastroenteropathien zugeordnet. Die Diagnose basiert auf klinischen, laborchemischen und histologischen Befunden. Konservative Therapieversuche beinhalten v. a. diätetische Maßnahmen, die den erheblichen Proteinverlust ersetzen, und die gestörte Fettverdauung verbessern sollen. Zudem besteht die Möglichkeit, das Sekretionspotenzial generell durch die Verabreichung von Antiplasmin oder Octreotid zu verringern. Wir beschreiben den Krankheitsverlauf eines 58-jährigen Patienten, bei dem wegen zunehmender Verschlechterung des Allgemeinzustands mit therapierefraktärem Chylaskos und Beinödemen nach frustranen Diätanwendungen sowie konservativer Therapie eine zunächst explorative Laparotomie vorgenommen wurde. Intraoperativ fand sich eine typische PIL des Jejunums etwa 20 cm distal des Treitz'schen Bandes. Diese konnte durch eine histologische Sicherung bestätigt werden. Ein Jahr nach Resektion des betroffenen 105 cm langen Dünndarmsegments mit anschließender End-zu-End-Enteroanastomose ist der Patient beschwerdefrei und hat an Gewicht zugenommen. Ferner hat sich der Serumseiweißstatus verbessert. Freie intraabdominelle Flüssigkeit und Beinödeme sind nicht mehr nachweisbar.
    Zeitschrift für Gastroenterologie 06/2013; 51(6):576-579.
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    ABSTRACT: Introduction: Digital health data are an integral part of high level patient safety and quality assurance. To achieve steady flow of reliable information, intelligent and adapted database management systems (DBMS) are crucial. The objective of this analysis was to investigate the impact of a proprietary DBMS on quality and safety at the surgical department of a university hospital. The practical use and technical background of ChiBase© together with the implementation of quality assurance and patient safety will be presented. Material and methods: ChiBase© is a proprietary DBMS developed by surgeons in cooperation with computer scientists using FileMaker Pro 11©.The integration in hospital information system was realized by HL7© interface. To accomplish audit criteria several security standards were included. Results: The implementation of Chibase© over a three year period has proved its worth in daily surgical routine in terms of enhancing patient safety and quality assurance. By continuous optimization of patient coordination and monitoring together with constant assessment of surgical procedures, it was possible to have an important contribution to increase patient safety. Conclusion: ChiBase© meets all standards to implement evidence based medicine in daily clinical routine with high safety standards. It provides high data quality and security, data independence and redundancy-depleting. By ensuring seamless and complete documentation our DBMS supports highest level of quality assurance for best patient safety.
    130. Kongress der Deutschen Gesellschaft für Chirurgie; 05/2013