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ABSTRACT: Das kolorektale Karzinom (KRK) ist eine der häufigsten Tumorerkrankungen in westlichen Ländern.Obwohl das KRK in frühen Stadien
geheilt werden kann, sind mehr als die Hälfte der Tumoren bei der Erstdiagnose nicht mehr kurativ therapierbar.Die jährliche
Durchführung eines fäkalen Okkultbluttests und eine sich ggf. anschließende Koloskopie senken die KRK-assoziierte Mortalität
um bis zu 30%.Die totale Koloskopie im Abstand von 10 Jahren vermindert die Sterblichkeit am KRK um etwa 60% und ist seit
kurzer Zeit in Deutschland als Screeningmaßnahme durch die öffentlichen Krankenkassen anerkannt. Eine hohe Beteiligung der
Bevölkerung ist jedoch unabdingbare Voraussetzung für den Erfolg (und die Kosteneffektivität) jeglicher Präventionsmaßnahmen.Die
Entwicklung nichtinvasiver Bild gebender Verfahren (MR-/CT-Kolonographie) kann möglicherweise die Patientenakzeptanz verbessern.Sensitivität
und Spezifität dieser Verfahren müssen jedoch ebenso wie die damit verbundenen Kosten weiter evaluiert werden,um langfristig
Eingang in die klinische Routine zu finden.
Colorectal cancer (CRC) is one of the most frequent tumors in western countries.More than 50% of all CRC are diagnosed at
an advanced stage which precludes curative treatment. For this reason, early detection of CRC is mandatory to improve longterm
outcome. Fecal occult blood testing (FOBT) once per year and subsequent colonoscopy (if the FOBT is positive) provides up
to 30% decrease in mortality from CRC.Due to the fact that current data indicate a 60% reduction in CRC-associated mortality,
colonoscopy has recently been approved for CRC screening by german public health insurance companies. Yet efforts in screening
largely depend on patient compliance, particularly in view of cost-effectiveness. Introduction of new imaging techniques (CT-/MRI-colonography)
may increase general acceptance, but clinical benefit and costs still remain to be determined in larger studies.
Der Radiologe 04/2012; 43(2):105-112. · 0.61 Impact Factor
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ABSTRACT: STW 5, a herbal extract, is effective for the treatment of symptoms in patients with functional dyspepsia (FD). However, its mode of action is still unclear and a modulation of gastric motility is hypothesized. This multicentre, placebo-controlled double-blind study addressed the question of whether STW 5 accelerates gastric emptying in patients with FD and gastroparesis. One-hundred and three patients diagnosed with FD were randomly assigned to a treatment with either STW 5 or a liquid placebo for 28 days. The primary end point of the study was a change of a validated gastrointestinal symptom (GIS) score under treatment. Additionally, patients underwent a (13)C octanoic acid breath test for the assessment of the gastric half-emptying time (t(1/2)). Patients with prolonged t(1/2) were diagnosed with gastroparesis and requested to repeat the test at the end of treatment. A change of t(1/2) was defined a secondary study end point. t(1/2) was prolonged in 48.6% of patients in the STW 5 group and in 43.8% of the placebo group. During treatment, t(1/2) increased non-significantly in patients treated with STW 5 (+23 +/- 109 min; P = 0.51) and slightly accelerated among patients in the placebo arm (-26 +/- 51 min; P = 0.77) (P = 0.49). The improvement of the GIS (P = 0.08) and the proportion of patients with a treatment response (P = 0.03) were more pronounced in the STW 5 group. Our findings suggest that the clinical effects of STW 5 in patients with FD and gastroparesis are not directly mediated by an acceleration of gastric emptying. A clear-cut correlation with symptom improvement is still lacking.
Neurogastroenterology and Motility 03/2009; 21(6):632-8, e25. · 3.41 Impact Factor
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ABSTRACT: The lactose[(13)C]ureide breath test ((13)C-LUBT) has been validated and established as a reliable, non-invasive test for the assessment of orocaecal transit time (OCTT). More recently, small studies have demonstrated that inulin could be an alternative substrate for H(2)-based breath testing of the small bowel transit (H(2)-INBT). We compared the performance of the H(2)-INBT with the (13)C-LUBT in an appropriate number of participants, determined by sample-size calculation.
Twenty-nine people underwent a combined (13)C-LUBT/H(2)-INBT. Five Hundred mg of lactoseureide was ingested on the day before the test to induce an adequate enzyme activity in colonic bacteria. For the test, they received 500 mg of lactose[(13)C]ureide and 5 g inulin, dissolved in 400 mL of a standard enteral liquid nutrition orally. Breath samples were collected every 30 min for 8 h and analysed for H(2)[ p.p.m.] and (13)CO(2)-enrichment [delta-(13)C]. For the (13)C-LUBT, the OCTT was defined as the interval with an increase of delta > 2.5SD above the running average of all previous points. The latter was defined as a rise of > 10ppm above baseline regarding the H(2)-INBT.
Breath tests produced evaluable data in 27/29 patients [93%]. Median OCTTs were 315 min (range 210-450 min) for the (13)C-LUBT and 300 min (180-420 min) for the H(2)-INBT (P = 0.15). The (13)C-LU-OCTT correlated well with the H(2)-IN-OCTT (r = 0.72). Bland-Altman blot showed that the mean H(2)-IN-OCTTs were approximately 30 min shorter than predicted with the (13)C-LUBT.
Inulin is a reliable and inexpensive substrate for a hydrogen-based assessment of the OCTT. In contrast to the (13)C-LUBT, the H(2)-INBT does not require patients to refrain from physical activity and may additionally increase its acceptance for clinical purposes.
European Journal of Clinical Investigation 10/2007; 37(10):802-7. · 3.02 Impact Factor
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ABSTRACT: Duplex-Doppler ultrasound is a noninvasive method for the assessment of hepatic hemodynamics beyond conventional gray-scale imaging. The clinical value of the method for the grading and staging of chronic hepatitis C virus (HCV) infection and the prediction of hepatic steatosis still has to be determined. This study aimed to compare Duplex-Doppler and ultrasound with the histologic staging and the estimation of hepatic steatosis in chronic HCV infection.
One hundred and nineteen consecutive patients with chronic HCV infection underwent both liver biopsy and ultrasound with Duplex-Doppler. Maximum portal venous blood flow velocity, portal venous flow undulation, hepatic venous flow pattern and spleen size were assessed and compared with histologic findings. Histologic grading and staging was performed according to the modified HAI and hepatic steatosis was estimated.
Doppler ultrasound was unable to discriminate between different degrees of fibrosis. Sensitivity/specificity of portal venous flow and undulations for the diagnosis of hepatic cirrhosis was 74.5%/53% and 76.5%/100%. The PPV and NPV of reduced undulations was 100% and 96.2%. Mono- or biphasic hepatic venous flow indicated advanced hepatic steatosis (sensitivity 88.2%, specificity 74.5%, PPV 36.6%, NPV 97.5%). Spleen size was significantly enlarged both in patients with cirrhosis and steatosis.
Although Duplex-Doppler of the portal and hepatic veins is not a substitute for histologic grading and staging, portal vein undulations can predict liver cirrhosis with considerable accuracy. Moreover, triphasic patterns of hepatic venous flow virtually exclude significant fatty liver disease. Additional studies should perform intraindividual follow-up investigations to further define the role of Duplex-Doppler ultrasound in chronic HCV infection.
Liver international: official journal of the International Association for the Study of the Liver 01/2006; 25(6):1150-5. · 3.82 Impact Factor
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ABSTRACT: Epithelial tumors of the papilla of Vater are rare neoplasms of the gastrointestinal tract. The carcinogenesis of these tumors seems to be fairly analogous to the genetic mechanisms which have been described for colorectal carcinoma. Patients with familial adenomatous polyposis bear a particularly increased risk for periampullary tumors. Data on whether the prevalence of colorectal tumors is increased in patients with sporadic ampullary neoplasms are scarce.
26 consecutive patients (16 women, 10 men; median age 59 years) with sporadic adenomas (n = 19) or adenocarcinomas (n = 7) of the ampulla of Vater were retrospectively evaluated. The study patients were compared with 104 age-matched asymptomatic controls. All patients had undergone total colonoscopy.
Neoplastic colorectal polyps were present in a similar proportion (23%) of patients of the study group compared with 26% in the control group (p > 0.05). Overall, 16 polyps were found among patients with ampullary tumors and 40 in asymptomatic controls (p > 0.05). Colonoscopy detected rectal carcinoma in 2 patients (8%) of the study group. Patients with and without colorectal polyps differed neither significantly by age nor by ampullary histological findings. 50% of the colonic polyps in patients with ampullary neoplasms were located in the ascending colon.
The frequency of colorectal polyps in patients with ampullary tumors did not exceed the risk in the control group. However, the finding of 2 rectal carcinomas among patients with ampullary neoplasms supports the place of screening colonoscopy for the diagnostic work-up of ampullary tumors. Prospective multicenter studies should address this issue to provide a broad basis for future recommendations.
Zeitschrift für Gastroenterologie 10/2005; 43(10):1123-7. · 0.90 Impact Factor
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ABSTRACT: Targeted drug delivery to the colon is important for topical treatment of inflammatory bowel diseases. Established targeting systems predominantly focus on either pH- or time-dependent release, or bacterial degradation.
To perform a three-phase, crossover design trial evaluating a novel combined pH- and time-based multiunit delivery system.
Twelve healthy male volunteers each received 200 mg of caffeine as either uncoated immediate release tablets, coated pellets with pH-dependent rapid release (EUDRAGIT FS 30D), and pellets with pH- and time-based release (inner layer EUDRAGIT RL/RS 30D; outer layer EUDRAGIT FS 30D). Orocecal transit time was measured using lactose-[13C]ureide. Serum concentrations of caffeine were measured by high-performance liquid chromatography.
In contrast to the uncoated tablet, both coated systems reached the ileocecal region almost at the same time (3.19 +/- 0.71 and 3.33 +/- 0.81 h). Serum caffeine profiles were significantly prolonged for the pH and time delivery system compared with the pH-only based system (median tmax 12.0 vs. 5.5 h; P < 0.001). This was further reflected by a lower Cmax value and a lower area under the curve within 24 h after application.
Compared with the conventional delivery systems, drug release from the new dosage form may offer a new dimension for the oral treatment of mid to distal ulcerative colitis.
Alimentary Pharmacology & Therapeutics 08/2004; 20(3):347-53. · 3.77 Impact Factor
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Endoscopy 09/2003; 35(8):713. · 5.21 Impact Factor
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ABSTRACT: Different noninvasive and invasive techniques are available for the detection of abdominal metastases in pancreatic carcinoma. Since small hepatic or peritoneal metastases are a crucial problem which precludes resection, accurate detection is mandatory. We compared laparoscopic staging of abdominal metastases in adenocarcinoma of the pancreas with MRI.
55 patients with pancreatic adenocarcinoma had been screened and 49 entered the retrospective study. All patients had undergone MRI of the upper abdomen with concomitant MR-cholangiopancreatography (MRCP) and diagnostic laparoscopy under conscious sedation. Patients without histologic proof of abdominal metastases underwent laparotomy.
In 6/10 patients, metastases were correctly detected by laparoscopy, yielding a sensitivity of 60% and a specificity of 92%.MRI predicted metastases in 6/10 patients with 60% sensitivity and 100% specificity. Laparoscopy showed metastases in 3 patients that were missed by MRI, but failed to identify metastases in 3 of 6 patients with metastases on MRI. Though only one patient showed previously undetected metastases during laparotomy, 3 patients with abdominal metastases underwent unnecessary laparotomy due to a lack of histologic proof of malignancy.
Whereas diagnostic laparoscopy is sensitive for the detection of small metastases and offers histologic verification, intrahepatic alterations are not detectable by sole visual inspection.MRI may compensate for this deficiency, but histologic proof of malignancy may be problematic. To date, no definite decision in favor of one of the presented procedures for the staging of abdominal metastases can be given.
Zeitschrift für Gastroenterologie 09/2003; 41(8):697-702. · 0.90 Impact Factor
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ABSTRACT: Colorectal cancer (CRC) is one of the most frequent tumors in western countries. More than 50% of all CRC are diagnosed at an advanced stage which precludes curative treatment. For this reason, early detection of CRC is mandatory to improve longterm outcome. Fecal occult blood testing (FOBT) once per year and subsequent colonoscopy (if the FOBT is positive) provides up to 30% decrease in mortality from CRC. Due to the fact that current data indicate a 60% reduction in CRC-associated mortality, colonoscopy has recently been approved for CRC screening by german public health insurance companies. Yet efforts in screening largely depend on patient compliance, particularly in view of cost-effectiveness. Introduction of new imaging techniques (CT-/MRI-colonography) may increase general acceptance, but clinical benefit and costs still remain to be determined in larger studies.
Der Radiologe 03/2003; 43(2):105-12. · 0.61 Impact Factor
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ABSTRACT: Fluorescence-based diagnostic techniques are an evolving field in the staging of hepatologic and gastroenterologic malignancies. The method aims at improved accuracy in the detection of locoregional and distant metastases. In hepatocellular carcinoma, detection of metastases is of utmost importance, because advanced tumors preclude curative surgical therapy. We present here our first experience of fluorescence-based diagnostic laparoscopy in a patient with hepatocellular carcinoma. We performed diagnostic laparoscopy in a 76-year-old woman who presented with a tumor of the liver and increased serum levels of alpha-fetoprotein. For photosensitization, 5-aminolevulinic acid (20 mg/kg bodyweight, p.o.) was used 6 hours prior to laparoscopy, which was performed with a prograde 0 degree telescope suitable for fluorescence-based laparoscopy. The D-Light AF system was used as a light source. Laparoscopy was carried out according to common guidelines in the white-light as in the blue-light mode. The main tumor and the satellite metastases clearly showed intense fluorescence compared with unaffected liver parenchyma and other abdominal organs. Fluorescence-based laparoscopy identified several small metastases which had been missed during conventional white-light illumination. Hepatocellular carcinoma was confirmed by the histological examination of several biopsies drawn from suspicious areas. Fluorescence-based laparoscopy provided additional information in the staging of hepatocellular carcinoma. The technique can further improve diagnostic accuracy in the staging of hepatocellular carcinoma, particularly in patients potentially suitable for partial liver resection or transplantation.
Endoscopy 11/2002; 34(10):831-4. · 5.21 Impact Factor
