Einleitung: Für die Behandlung von Papillentumoren bedarf es neben einer suffizienten histologischen Verifizierung des Prozesses eines prätherapeutischen Stagings, nach dem entschieden wird, welche therapeutische Option (Operation, Papillektomie, Papillotomie) die für den Patienten sicherste Variante ist.

In contrast to the well-developed methods for morphological diagnosis of the gastrointestinal tract, there is no comparatively satisfying technique for functional disorders. One important example is irritable bowel syndrome (IBS), a disorder that affects a high percentage of all individuals. It can only be diagnosed by excluding organic diseases and by considering symptom criteria. In this case, the examination of the motility of the bowel may be a promising way to differentiate between the two major mechanisms of IBS: increased sensitivity of the intestine and altered gastrointestinal motility. To this aim, a recently developed method for monitoring magnetic markers in the gastrointestinal tract was utilized that works without the use of ionizing radiation. We give a short description of this method, showing a spatial resolution of 3-4 mm and a temporal resolution of 330 ms, and report on examples of the first in vivo experiments. Typical monitoring results are shown for the esophagus, the stomach, and the duodenum. The motility behavior is described for the lower parts of the gut as well. The advantages and drawbacks of this type of magnetic marker monitoring are discussed with special consideration of the noninvasive examination of the motility in different sections of the gut.

RANK Ligand (auch als NFĸB-Ligand oder RANKL bekannt), sein zellulärer Rezeptor RANK und sein Antagonist, das Osteoprotegerin (OPG) sind Schlüsselkomponenten der Regulation des Knochenumbaus. Eine Dysregulation der RANK/RANKL Interaktionen wird daher bei verschiedensten Krankheitsbildern angetroffen, die mit einer Verminderung der Knochendichte durch chronische überschießende T-Zellaktivierung einhergehen, so auch beim Morbus Crohn (MC).

Background: Associations of variations in the CARD15 gene (Arg702Trp, Gly908Arg and Leu1007fsinsC) and Crohn disease (CD) have been shown recently. These variations are neither necessary nor sufficient for the genetic predisposition of CD. Further genetic and environmental factors play a crucial role in the pathogenesis of CD. Methods: To evaluate putative interactions between the CARD15 and CD14 genes in CD, a functionally relevant polymorphism in the promoter region (T/C at position -159) has been genotyped for 650 healthy controls and 253 patients with CD by RFLP analyses. CD patients were genotyped for the variations of the CARD15 gene. Results: T allele and TT genotype frequencies of the CD14 promoter were significantly increased only in CD patients with at least one variation in the CARD15 gene compared to controls ( P = 0.02 and 0.0002, respectively). No significant association was found in CD patients without any of the variations. Conclusion: Interactions of the CARD15 and CD14 genes, both of which are involved in the recognition of lipopolysaccharides, increase the risk for developing CD.

Background: Inflammatory bowel diseases (IBD) are multifactorial disorders, characterized by failure to limit the inflammatory response to luminal antigens. Although genetic factors play an important role in the pathogenesis, little is known about the genes accountable. Immune response to intestinal bacteria seems to be crucial in the pathogenesis of IBD. Methods: To evaluate the role of the CD14 gene in IBD, a functionally relevant polymorphism in the promoter region (T/C at position - 159) has been genotyped in 219 patients with Crohn disease (CD), 142 patients with ulcerative colitis (UC) and 410 healthy controls by RFLP analysis. Results: T allele and TT genotype frequencies were found increased in CD patients compared to controls (P-c=0.044 and 0.005, respectively). Conclusion: An altered immune response to LPS seems to play a role in the genetic predisposition to CD but not to UC.

Inflammatory bowel diseases (IBD) are multifactorial disorders characterised by the host's inability to limit the inflammatory response to luminal antigens. The association of polymorphisms in the CARD15 gene with Crohn's disease (CD) demonstrates the relevance of activated transcription factor NF(kappa)B in mononuclear cells. Interleukin 11 (IL11) mediates anti-inflammatory effects and is able to downregulate LPS-induced NF(kappa)B activation. The IL11 gene is therefore a good candidate involved in genetic predisposition to IBD. To evaluate the role of the IL11 gene in IBD, two polymorphisms, including a dinucleotide repeat in the promoter region, have been genotyped in 222 patients with CD, 152 patients with ulcerative colitis (UC) and 400 healthy controls. PCR-SSCP analysis of the coding region revealed a single polymorphism in exon 4 leading to an amino acid exchange (G335A; R112H), not significantly associated with either disease. Dinucleotide repeat frequencies of the IL11.A1 allele and of IL11.A1 homozygous individuals were significantly increased among the patients with UC (P < 0.002 and (P < 0.003, respectively) but not with CD. Altered expression of IL11 appears to be involved in the genetic predisposition of UC.

Objective Inflammatory bower diseases (IBD) are multifactorial disorders, characterized by failure to limit the inflammatory response to luminal antigens, Genetic factors play an important role in the pathogenesis, but little is known about the accountable genes, Increased secretion of pro-inflammatory cytokines appears crucial in the initiation of the inflammatory response,Methods To evaluate the role of the IL-6 gene in IBD, a functionally relevant polymorphism in the promoter region (G/C at position -174) has been genotyped in 169 patients with Crohn's disease (CD), 133 patients with ulcerative colitis (UC) and 440 healthy controls by using restriction fragment length polymorphism (RFLP) analysis,Results No significant differences were apparent in the allele, genotype and carrier frequencies between patients and controls.Conclusion High secretion of IL-6 does not seem to play a major role in the genetic predisposition to IBD, for I Gastroenterol Hepatol 13:45-47 (C) 2001 Lippincott Williams & Wilkins.

Imbalances in the regulation of Th1 and Th2 lymphocytes are crucial in inflammatory bowel diseases. Interleukin-4 is secreted by Th2 lymphocytes and downregulates cytokine production from Th1 lymphocytes. Functionally relevant polymorphisms have been described in the interleukin-4 and the interleukin-4 receptor α genes. Association of inflammatory bowel diseases with these polymorphisms has been reported recently suggesting high transcription and enhanced signalling activity in Crohn's disease. Our study, comprising 211 patients with Crohn's disease, 147 patients with ulcerative colitis and 446 healthy controls revealed significant association of Crohn's disease with the −590 T allele of the interleukin-4 gene (P = 0.03). This allele entails reduced expression of IL-4. The reason for these contrasting findings may be discussed in the context of a putatively predisposing allele in linkage disequilibrium with the alleles of the interleukin-4 gene.

Although genetic predisposition for inflammatory bowel disease (IBD) is well established, little is known about the accountable genes. The pathogenesis of IBD is characterized by an imbalanced activation of Th1- and Th2-lymphocytes. IL-10 represents an anti-inflammatory cytokine which downregulates the production of Th1-derived cytokines. To evaluate the role of the IL-10 gene in IBD, two polymorphisms in the promoter region (G/A at position -1082 and C/A at position -592) were genotyped in 142 patients with Crohn's disease (CD), 104 patients with ulcerative colitis (UC), and 400 healthy controls. Significant differences were not apparent, neither in the allele frequencies of either polymorphism, nor in the haplotype frequencies. Screening of the coding region of the IL-10 gene by polymerase chain reaction--single strand conformation polymorphism (PCR-SSCP) analysis revealed a rare sequence variation in exon 1 leading to an amino acid exchange (G-->A; G15R) in two patients with CD and five healthy controls. Therefore, polymorphisms of the IL-10 gene are not demonstrably involved in the predisposition of IBD in our cohorts of patients.

BACKGROUND/AIMS Platelet activating factor (PAF) is a potent endogenous mediator in inflammatory processes. The role of this mediator, especially in connection with the unknown etiology of chronic inflammatory bowel diseases, remains poorly understood. A determination of PAF in stool may be helpful in recognizing quiescent inflammations in chronic inflammatory bowel diseases. A simple and reliable method for the determination of PAF in stool seems to be necessary to achieve this goal. METHODOLOGY PAF analysis was performed with the help of a commercial PAF radioimmunoassay (RIA) kit after solid phase extraction (SPE) of ethanolic stool extracts. PAF was determined in stool from 10 healthy volunteers (m = 4; f = 6), 13 patients with ulcerative colitis (m = 7; f = 6) and 15 patients with Crohn's disease (m = 9; f = 6). Fecal PAF concentrations were compared with activity index of disease, endoscopic index, localization of lesions, leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), medical prednisolone treatment, sex and age of the patients. RESULTS In healthy volunteers, no PAF was detectable in stool. In patients with Crohn's disease 319.2 +/- 143.5 pg PAF/g stool and in patients with ulcerative colitis 824.9 +/- 408.7 pg PAF/g stool could be determined. A significant correlation (p < 0.05) was found between PAF-content in stool and the endoscopical index and intestinal localization of inflammatory lesions. No further correlations could be detected in our patients. CONCLUSIONS Fecal PAF assessment may be used clinically as a non-invasive method to estimate severity of mucosal inflammation in patients with inflammatory bowel disease (IBD).

The objective of the present microcalorimetric investigation on mucosal biopsies from human gastric body (B) and descending duodenum (D) was to test whether a steady state of metabolism does persist and, if not, to find out how to assess the preexisting in vivo conditions. The measurements were performed at various incubation temperatures and partial pressures of oxygen. The measured curves fell exponentially after reaching an initial maximum without an initial steady state. Back-extrapolations to the time of taking the biopsies on the basis of a two-phase exponential decay curve gave baseline thermal power values at 37°C of 41 (D) and 15 (B) μW/mgdw, respectively, which roughly correspond to known values of basal oxygen consumption of heart and kidney. The higher values of the duodenum may be founded on a higher transport activity in vivo. Altogether, microcalorimetry seems to be a method for comparative evaluation of metabolic activity of human mucosa samples.

EINLEITUNG: Speziell bei Dünndarm-Erkrankungen sind die DiagnoseMöglichkeiten eingeschränkt, besonders dann, wenn wiederholte Untersuchungen erforderlich sind. Morbus Crohn ist dafür ein typisches Beispiel. In solchen Fällen ist Szintigraphie oder Röntgen-Diagnostik wegen der Strahlenbelastung zu vermeiden. Magnetresonanz-Tomographie wird bisher selten für Dünndarm-Untersuchungen eingesetzt, wobei als Gründe u.a. die Auflösungsbegrenzung durch Bewegungs-Artefakte und die vergleichsweise hohen Kosten genannt werden [1]. Andere Diagnose-Methoden, wie Biopsie und Endoskopie sowie Funktionsprüfungen besitzen jeweils nur begrenzte Aussagefahigkeit [2]. Daher ist die Messung von Transit-Zeiten im VerdauungsKanaJ ein wichtiges diagnostisches Hilfsmittel. Da die üblichen Methoden mittels Blutoder Atem-Test jedoch keine gute lokale Auflösung ergeben, sind in letzter Zeit verschiedene alternative Verfahren angewendet worden. Dabei wird die Position eines oral verabreichten Markers, der mit dem Speisebrei durch den Verdauungstrakt wandert, wiederholt (z.B. sonographisch) geortet. Die Spur des Markers kann dann als Kette von PositionsPunkten dargestellt werden, aus deren Abstand die lokale Passage-Geschwindigkeit ermittelt werden kann.

152 biopsies from the colon of healthy persons were incubated with several nutrition mediums in a microcalorimeter. The course of the heat-flow rate was measured at 1 min interval and graphically displayed as a function of time. For evaluation of the results, the maximum (P-max), the mean values (P), and the area under the curve as a measure of the total released energy (E-tot) of the power-time curves were determined.The mean enthalpy change of all samples over time was 3.9 mu W per sample. Depending on incubation conditions, mean values ranged between 2.5 and 7.1 mu W, maximal values between 3.5 and 13.3 mu W. The areas under the curve varied between 6.2 and 18.3 mJ. Our results also showed that bacterial growth can influence measured enthalpy changes if antibiotics are not present. Under identical incubation conditions, steel ampoules were better than glass ampoules with respect to methodic artifacts.We conclude that microcalorimetric investigations on bioptic material from colonic epithelium are possible. Interestingly, our measured enthalpy changes were lower than those expected from the oxygen consumption rates and other metabolic processes. The reason is yet to be explored. (C) 1997 Elsevier Science B.V.