In case of chronic pancreatitis with pseudocysts, transgastric drainage is an efficient means of therapy that should be discussed before operation with necrosectomy and resection.

50 Patients with 78 focal liver lesions were examined via colour-coded Doppler system to study the vascularity of metastatic lesions and primary benign and malignant liver tumours. According to the amount of detectable colour Doppler signals, tumour vascularity was graded into 4 types. Metastases (n = 40) and cavernous haemangiomas (n = 12) seemed to be avascular with no evidence of increased vascularity (Type I/II). Conversely primary liver cancer (PLCA) (n = 7) and focal nodular hyperplasia (FNH) (n = 16) mainly produced arterial Doppler signals within the tumour (Type III/IV). AV shunts and partial portal vein thrombosis could be demonstrated in PLCA. Doppler colour flow imaging for detection of tumour vascularity may thus add to the specificity of ultrasonic tumour diagnosis.

There is a scarcity of research literature into the experience of pain for patients with IBD and the management of this pain.NACC (National Association for Colitis and Crohn' s -the UK IBD patients' organisation) carried out a survey of members in 2004.Aim: The aim of the survey was to explore the range of symptoms that patients with Ulcerative Colitis (UC) or Crohn' s Disease (CD) experience and, in particular, to understand more about how pain affects their lives.Method: A postal survey sent to 5000 members.Responders were asked to rank the symptoms experienced in order of the negative impact on their lives, both during a relapse and in remission.Those who identified pain as a problem were asked further questions including the type of pain, when it occurred and how intense it was. Results:The first 2000 responses were analysed.Pain was ranked as the most troublesome symptom during relapse by 30% of CD responders -but even during remission 12% ranked it as their worst symptom and only 20% stated that it had no effect during remission.Of the UC responders 9% ranked it as their most troublesome symptom during relapse but 9% also ranked it as their worst symptom when in remission and only 33% stated that pain was not a problem during remission.Of those who experienced abdominal pain only 32% of those with CD and 42% of those with UC said their pain was restricted to flare-ups.Over half of those with CD described their pain as >7 on a scale of 1-10 and 40% of those with UC rated it as >7.Joint and back pain was also experienced by over a third of all responders and was a problem both during remission and relapse for the majority. Conclusion:It is well known that pain is a symptom of relapsing CD, but the numbers of patients with UC experiencing pain is surprising.The mechanism for pain in those with IBD with no objective evidence of active disease is poorly understood -but for many the pain is undoubtedly present and impacts significantly on quality of life.Chronic pain in CD results in a number of patients being commenced on opiate analgesics.Two studies put this number at 5.1% and 13.1% respectively.These analgesics usually cause more problems -ranging from increased pain from constipation to being labelled as addicts by healthcare staff.Once started it is very hard to reduce these analgesics and many patients may not have access to or may not be referred to specialist Pain Services.More research is clearly needed into the experience of pain for patients with IBD -both CD and UC.Current pain management strategies should also be surveyed and a standard for pain management best practice developed.A collaborative approach across the ECCO member countries would be welcomed.

Einleitung: Die Compliance bei Colitis ulcerosa (CU) Patienten in Remission hinsichtlich einer Mesalazin-Einnahme ist nicht optimal, u.a. bedingt durch die mehrfach tägliche notwendige Einnahme mehrerer Dosen. Non-Compliance führt zu deutlich erhöhten Rezidivraten bei CU. In dieser Studie wurden die Wirksamkeit, Akzeptanz und Compliance bei CU-Patienten in Remission untersucht, die 2g Mesalazin Retardgranulat entweder als einmal tägliches 2g Sachet oder zweimal tägliches 1g Sachet erhielten.

A 27-year-old man was referred to the dermatological out-patient clinic because of inflammatory changes in the oral mucosa of unknown cause. 5 months earlier he had been diagnosed as having Crohn's disease of the terminal ileum. On both sides of the buccal mucosa there were rough erythematous vegetations and disseminated miliary abscesses, which extended to the labial gingiva and the soft palate. Further physical examination was unremarkable.Several inflammatory parameters were increased: C-reactive protein 100 mg/l, erythrocyte sedimentation rate 55/88 mm, eosinophilic cationic protein 35.8 ng/ml (normal range 2.3-16 ng/ml). White cell count was normal (7,25/nl), with a lymphocytopenia of 11.9%. There was no eosinophilia. Haemoglobin was reduced to 11.6 g/dl and the platelets raised to 526/nl. Smears of the oral mucosa showed no fungal, viral or bacterial infection. Biopsy revealed leucocytic microabscesses in the epithelium, granulation tissue and flat ulcerations with adjoining superficial necrotic zones.The clinical and histological picture as well as the association with Crohn's disease (CD) suggested pyostomatitis vegetans (PV). The PV was treated with disinfectant mouth washes which improved the subjective findings. Budesonide was given for CD.PV is a rare and usually isolated condition, but it can also occur in association with a chronic gastrointestinal disease such as ulcerative colitis and Crohn's disease. The diagnosis of PV indicates a thorough gastroenterological investigation.

Einleitung: Die meisten 5-ASA Präparate zur Behandlung der Colitis ulcerosa müssen mehrmals täglich eingenommen werden, was zu Non-Compliance und folglich eingeschränkter Wirksamkeit führen kann. Aus Pentasa® Retardgranulat wird 5-ASA während der gesamten Dünndarmpassage freigesetzt, so dass 5-ASA verzögert und kontinuierlich im gesamten Dickdarm zur Verfügung steht.