Carsten Schmidt

Universitätsklinikum Jena, Jena, Thuringia, Germany

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Publications (39)253.07 Total impact

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB152. DOI:10.1016/j.gie.2015.03.1245 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2015; 81(5):AB537. DOI:10.1016/j.gie.2015.03.1084 · 4.90 Impact Factor
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    ABSTRACT: Background and Aims: Inflammatory bowel diseases (IBD) are gaining increasing medical as well as economic significance. Improving medical treatment options can have a positive effect on number of hospitalized patients, necessary operations, or the inability to work. Methods: To understand patient-relevant endpoints in IBD, the 2000 to 2012 data published by the Federal Statistical Office and the 2012 data according to Article 21 of the Hospital Reimbursement Act were assessed. In addition, data records on the medication of IBD patients of a public health insurance company were evaluated. Results: During 2000-2012, the number of hospitalized IBD-patients (ICD 10 K50, K51) rose from 38,533 to 43,452 (+12.7%). The necessity of surgical intervention increased during the period under review. The number of people unable to work developed differently for Crohn's disease (CD) and ulcerative colitis (UC). CD shows an increase of 2.1%, and UC shows a decrease in inability-to-work cases of 9.5%. Entry of persons into the statutory pension insurance system did not decline from 2000 to 2012. The number of potential years of life lost (PYLL) in patients that suffer from IBD also remained constant during the period under review (2000-2002: 2017 PYLL vs. 2011 PYLL (2010-2012)). From 2009 to 2013 the percentage of patients treated with an anti-TNF-antibodies rose (2009: CD: 4.3%; UC: 1.4%; 2013: CD: 8.4%; UC: 3.2%). Discussion: A positive development for the patient-relevant endpoints was not observed between 2000 and 2012 in patients that suffer from IBD in Germany. Improvements can only be achieved through structured and overlapping treatment concepts involving all health care providers. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
    Journal of Crohn s and Colitis 03/2015; 9(5). DOI:10.1093/ecco-jcc/jjv041 · 3.56 Impact Factor
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    ABSTRACT: Intestinal perforation or leakage increases morbidity and mortality of surgical and endoscopic interventions. We identified criteria for use of full-covered, extractable self-expanding metal stents (cSEMS) vs. 'Over the scope'-clips (OTSC) for leak closure. Patients who underwent endoscopic treatment for postoperative leakage, endoscopic perforation, or spontaneous rupture of the upper gastrointestinal tract between 2006 and 2013 were identified at four tertiary endoscopic centers. Technical success, outcome (e.g. duration of hospitalization, in-hospital mortality), and complications were assessed and analyzed with respect to etiology, size and location of leakage. Of 106 patients (male: 75 (71%), female: 31 (29%); age (mean ± SD): 62.5 ± 1.3 years, 72 (69%) were treated by cSEMS and 34 (31%) by OTSC. For cSEMS vs. OTSC, mean treatment duration was 41.1 vs. 25 days, p<0.001, leakage size 10 (1-50) vs. 5 (1-30) mm (median (range)), and complications were observed in 68% vs. 8.8%, p<0.001, respectively. Clinical success for primary interventional treatment was observed in 29/72 (40%) vs. 24/34 (70%, p = 0.006), and clinical success at the end of follow-up was 46/72 (64%) vs. 29/34 (85%) for patients treated by cSEMS vs. OTSC; p = 0.04. OTSC is preferred in small-sized lesions and in perforation caused by endoscopic interventions, cSEMS in patients with concomitant local infection or abscess. cSEMS is associated with a higher frequency of complications. Therefore, OTSC might be preferred if technically feasible. Indication criteria for cSEMS vs. OTSC vary and might impede design of randomized studies.
    PLoS ONE 01/2015; 10(1):e0117483. DOI:10.1371/journal.pone.0117483 · 3.53 Impact Factor
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    ABSTRACT: To detect high risk patients with a progressive disease course of ulcerative colitis (UC) requiring immunosuppressive therapy (IT).
    World Journal of Gastroenterology 09/2014; 20(35):12574-80. DOI:10.3748/wjg.v20.i35.12574 · 2.43 Impact Factor
  • Gastroenterology 05/2014; 146(5):S-490-S-491. DOI:10.1016/S0016-5085(14)61763-7 · 13.93 Impact Factor
  • Gastrointestinal Endoscopy 05/2014; 79(5):AB335. DOI:10.1016/j.gie.2014.02.344 · 4.90 Impact Factor
  • Gastroenterology 05/2014; 146(5):S-453. DOI:10.1016/S0016-5085(14)61625-5 · 13.93 Impact Factor
  • Gastrointestinal Endoscopy 05/2014; 79(5):AB463. DOI:10.1016/j.gie.2014.02.685 · 4.90 Impact Factor
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    ABSTRACT: Inflammatory bowel disease (IBD) is a frequently occurring disease in young people, which is characterized by a chronic inflammation of the gastrointestinal tract. The therapy of IBD is dominated by the administration of anti-inflammatory and immunosuppressive drugs, which suppress the intestinal inflammatory burden and improve the disease-related symptoms. Established treatment strategies are characterized by a limited therapeutical efficacy and the occurrence of adverse drug reactions. Thus, the development of novel disease-targeted drug delivery strategies is intended for a more effective therapy and demonstrates the potential to address unmet medical needs. This review gives an overview about the established as well as future-oriented drug targeting strategies, including intestine targeting by conventional drug delivery systems (DDS), disease targeted drug delivery by synthetic DDS and disease targeted drug delivery by biological DDS. Furthermore, this review analyzes the targeting mechanisms of the respective DDS and discusses the possible field of utilization in IBD.
    Advanced drug delivery reviews 10/2013; 71. DOI:10.1016/j.addr.2013.10.001 · 12.71 Impact Factor
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    ABSTRACT: The systemic therapy of inflammatory bowel diseases (IBD) by oral administration of anti-inflammatory and immunosuppressive agents is characterized by an increased probability of adverse drug reactions. A successful treatment with a simultaneous reduction of adverse events may be achieved by the administration of micro- and nanosized targeted drug delivery systems, which accumulate selectively in inflamed mucosal areas without systemic absorption. We described in a first in vivo study in IBD patients a significantly enhanced, but minor accumulation of non-functionalized poly(lactic-co-glycolic acid) (PLGA) microparticles in ulcerous lesions very recently. The aim of this study was therefore the assessment of an increased targeting potential of different non-, chitosan- and polyethylene glycol (PEG)-functionalized PLGA micro- and nanoparticles to inflamed intestinal mucosa compared to healthy mucosa. For the quantification of nano- and microparticles, fluoresceinamine-labeled-PLGA was synthesized by carbodiimide reaction. Fluorescent chitosan-, PEG-, and non-functionalized PLGA micro- and nanoparticles with mean hydrodynamic diameters of 3000 nm and 300 nm were prepared by solvent evaporation technique. The targeting efficiencies in terms of particle translocation and deposition were investigated in Ussing chamber experiments. Healthy and inflamed macrobiopsies were received from routine endoscopic examinations of patients with IBD as well as control patients. 101 Ussing chamber experiments of patients with IBD (Crohńs disease: n = 7 and ulcerative colitis: n = 9) as well as healthy control patients (n=5) were performed. Histomorphological and electrophysiological investigations of inflamed mucosal tissues confirmed a significant alteration of mucosal barrier integrity in IBD patients (TER: healthy: 34.1 Ω x cm(2); inflamed: 21.6 Ω x cm(2); p=0.034). In summary, nanoparticles showed an increased translocation and deposition compared to microparticles in healthy and in inflamed mucosa. Chitosan-functionalized particles adhered onto the tissue surface and thus showed the lowest particle translocation and deposition in healthy and inflamed tissues. PEG-functionalized nanoparticles showed the highest translocation through healthy (2.31%) and inflamed mucosa (5.27%). Moreover, PEG-functionalized microparticles showed a significantly increased translocation through inflamed mucosa (3.33%) compared to healthy mucosa (0.55%; p=0.045). Notably, the particle deposition of PEG-functionalized microparticles was significantly increased in inflamed mucosa (10.8%) compared to healthy mucosa (4.1%; p=0.041). Based on the targeted translocation and deposition to inflamed intestinal mucosa, PEG-functionalized PLGA microparticles were qualified as an innovative drug delivery system. These particles may serve as a selective treatment strategy to inflamed mucosal areas in IBD with the potential to improve therapeutic efficacy and to reduce adverse events.
    European journal of pharmaceutics and biopharmaceutics: official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V 09/2013; DOI:10.1016/j.ejpb.2013.09.016 · 4.25 Impact Factor
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    ABSTRACT: BACKGROUND:: The correlation between noninvasive markers with endoscopic activity according to the modified Baron Index in patients with ulcerative colitis (UC) is unknown. We aimed to evaluate the correlation between endoscopic activity and fecal calprotectin (FC), C-reactive protein (CRP), hemoglobin, platelets, blood leukocytes, and the Lichtiger Index (clinical score). METHODS:: UC patients undergoing complete colonoscopy were prospectively enrolled and scored clinically and endoscopically. Samples from feces and blood were analyzed in UC patients and controls. RESULTS:: We enrolled 228 UC patients and 52 healthy controls. Endoscopic disease activity correlated best with FC (Spearman's rank correlation coefficient r = 0.821), followed by the Lichtiger Index (r = 0.682), CRP (r = 0.556), platelets (r = 0.488), blood leukocytes (r = 0.401), and hemoglobin (r = -0.388). FC was the only marker that could discriminate between different grades of endoscopic activity (grade 0, 16 [10-30] μg/g; grade 1, 35 [25-48] μg/g; grade 2, 102 [44-159] μg/g; grade 3, 235 [176-319] μg/g; grade 4, 611 [406-868] μg/g; P < 0.001 for discriminating the different grades). FC with a cutoff of 57 μg/g had a sensitivity of 91% and a specificity of 90% to detect endoscopically active disease (modified Baron Index ≥2). CONCLUSIONS:: FC correlated better with endoscopic disease activity than clinical activity, CRP, platelets, hemoglobin, and blood leukocytes. The strong correlation with endoscopic disease activity suggests that FC represents a useful biomarker for noninvasive monitoring of disease activity in UC patients.
    Inflammatory Bowel Diseases 01/2013; DOI:10.1097/MIB.0b013e3182810066 · 5.48 Impact Factor
  • Proceedings of the 17th Annual Conference in Medical Image Understanding and Analysis (MIUA); 01/2013
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    ABSTRACT: Most of the drugs used in the treatment of inflammatory bowel disease (IBD) become systemically bioavailable and potentially bear strong adverse effects. Targeting inflamed areas of the intestine and keeping the drug localised at its site of action can reduce adverse effects. In animal studies, luminal uptake into inflamed mucosal areas has been shown to be size dependent. We investigated the potential of nano- and microparticle uptake into the rectal mucosa of human IBD patients. Fluorescently labelled placebo nanoparticles (NP) 250nm in size and microparticles (MP) 3.0μm in size were prepared. Two hours after rectal application to patients with Crohn´s disease (CD) or ulcerative colitis (UC), confocal laser endomicroscopy was performed to visualize particles in inflamed mucosal areas. In biopsies, ex vivo mucosal transport processes were investigated in miniaturised Ussing chambers. We examined 33 patients with IBD (19 patients with CD, 14 patients with UC) and 6 healthy controls. A significantly enhanced accumulation of MP in ulcerous lesions was observed (covered area=1.28% (range 0.83% - 3.45%) vs. 0% in controls; p=0.011), while NP were visible only in traces on mucosal surfaces of all patients. Ussing chamber experiments suggest persorption of particles through cellular voids; statistical significance was only reached for NP. Drug-containing particles may have great potential to more specifically target intestinal lesions to maximise therapeutic efficacy and minimise potential side effects. Nanoparticles may not be required for local drug delivery to intestinal lesions in humans, thereby minimizing the risk of unintended translocation into the blood system.
    Journal of Controlled Release 11/2012; 165(2). DOI:10.1016/j.jconrel.2012.10.019 · 7.26 Impact Factor
  • Carsten Schmidt, Iver Petersen, Andreas Stallmach
    Gastrointestinal Endoscopy 04/2012; 75(4):AB350. DOI:10.1016/j.gie.2012.03.913 · 4.90 Impact Factor
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    ABSTRACT: The clinical course of Crohn's disease (CD) is highly variable with a subgroup of patients developing a progressive disease course necessitating immunosuppressive therapy (IT). However, reliable, stable and non-invasive individual clinical parameters in order to identify patients at risk for undergoing subsequent IT have not been sufficiently established. We therefore aimed to identify such clinical parameters. A retrospective, multicenter analysis of CD patients from 6 German tertiary IBD centers was performed. Patients were classified into two groups depending on requiring IT or not. Personal data, clinical and laboratory parameters during the first 3 months after CD diagnosis and effects of initial medical therapy were compared between these two groups. In 218 (61.8%) of the 353 patients the CD course necessitated IT. Those patients were significantly younger at symptom onset and diagnosis, and required significantly more often a systemic corticosteroid therapy. Furthermore, significant differences in serological markers of inflammation were observed. Age, gender and the effect of initial steroid therapy were used to develop a prognostic model predicting the individual probability of necessitating IT. The simple clinical items age at diagnosis, gender, and need for systemic steroid therapy can predict a progressive disease course in early CD. Our model based on these parameters allows an individualized estimation of each patient's risk to develop a progressive disease course. Thereby, our model can help in deciding if patients will need immunosuppressive drugs early in the disease course or if a careful watch and wait strategy is justified.
    Journal of Crohn s and Colitis 02/2012; 6(1):21-8. DOI:10.1016/j.crohns.2011.06.006 · 3.56 Impact Factor
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    ABSTRACT: Recent studies demonstrated that depression was associated with mucosal inflammation in patients with ulcerative colitis (UC). This association had not been studied in patients with UC with ileal pouch-anal anastomosis (IPAA) after restorative proctocolectomy. We hypothesized that depression and mucosal proinflammatory cytokines in UC-patients with pouchitis were associated. We assessed 18 IPAA-UC-patients with pouchitis and 19 IPAA-UC-patients without pouchitis. Mucosal biopsies were taken from the areas with maximal inflammation in the pouch or from the posterior wall of the pouch if the pouch had a normal endoscopic appearance. Disease activity was assessed by the Pouch Disease Activity Index. The expression of mucosal proinflammatory gene transcripts (interleukin-8 [IL-8] and interleukin-1ß [IL-1b]) was quantified by real-time polymerase chain reaction. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS). Pearson correlations between depression and cytokine transcripts were calculated. The correlation of HADS depression scores of patients with pouchitis with IL-8 was r=0.51 (p=0.03) and with IL-1ß was r=0.47 (p=0.04). The correlation between the HADS depression scores of patients without pouchitis with IL-8 was r=-0.19; (p=0.21) and with IL-1ß was r=-0.12 (p=0.30). Depression is associated with mucosal proinflammatory cytokines in patients with pouchitis after restorative proctocolectomy in patients with UC.
    Journal of Crohn s and Colitis 09/2011; 5(4):350-3. DOI:10.1016/j.crohns.2011.03.001 · 3.56 Impact Factor
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    ABSTRACT: Gastrointestinal cancer is a major public health problem worldwide. Detection of early neoplastic lesions in gastrointestinal tract is essential for cure, because prognosis and survival are related to the size and stage of malignant lesions. Endoscopic screening and treatment of polyps could prevent approximately 80% of colorectal cancer (CRC). However, white-light endoscopy is an imperfect technology since miss rates of up to 25% have been reported and polyps without malignant potential were treated without benefit but with additional costs and risks to the patient. There are several known "human" predictors of an inadequate colonoscopy. These include patient characteristics such as poor bowel preparation, female gender, or inpatient status. Skills of the endoscopists are also an important issue. Therefore, a variety of advanced technologies has been attempted to overcome these issues. These new endoscopic imaging techniques allow a more precise classification of mucosal alterations with selection of patients for invasive therapy or surveillance. Further, molecular and functional imaging techniques could identify novel targets for therapies and new prospects to access response to therapies. However, at the "end of the day" a better endoscopic approach for CRC screening and surveillance depends on a good bowel preparation, a trained endoscopist spending sufficient time on a detailed examination together with an advanced endoscope.
    Journal of Biophotonics 08/2011; 4(7-8):482-9. DOI:10.1002/jbio.201100027 · 3.86 Impact Factor
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    ABSTRACT: Population ageing is a global phenomenon. People aged 65 years and older comprise approximately 16% of the population of Europe. The medical management of elderly patients with inflammatory bowel disease (IBD) is challenging with respect to diagnosis, pharmaceutical and surgical treatment, and complications. IBD has a late onset in 10%-15% of patients, with the first flare occurring at 60 to 70 years of age; others suffer from the disease for several decades. Even though the natural course of the disease in geriatric populations and the diagnostic options may not differ much from those in younger patients, distinct problems exist in the choice of medical therapy. Recommended clinical practise has been rapidly evolving towards an intensified initial treatment in IBD. However, in patients older than 65 years, a gentler approach should be used, and a combination of immunosuppressive agents should be avoided because of increased risk of infectious and neoplastic complications. Furthermore, elderly patients with severe IBD show prolonged, complicated post-operative clinical courses with worse hospital outcomes, so early surgical intervention for elderly patients is recommended. This article provides an overview of elderly IBD patient care, including medical and surgical therapeutic considerations and emphasises the necessity of close collaborations between gastroenterologists and surgeons.
    Journal of Crohn s and Colitis 06/2011; 5(3):177-88. DOI:10.1016/j.crohns.2011.02.001 · 3.56 Impact Factor

Publication Stats

615 Citations
253.07 Total Impact Points

Institutions

  • 2012–2015
    • Universitätsklinikum Jena
      • Klinik für Innere Medizin II
      Jena, Thuringia, Germany
  • 2007–2011
    • Friedrich-Schiller-University Jena
      • Clinic of Internal Medicine II
      Jena, Thuringia, Germany
  • 2002–2005
    • Universität des Saarlandes
      Saarbrücken, Saarland, Germany