In den letzten Jahrzehnten ist den bildgebenden Verfahren mit zunehmender Inzidenz von kolorektalen Karzinomen eine immer wichtigere Rolle zugekommen, da insbesondere ein fruhzeitiger Nachweis maligner Prozesse entscheidend fur die Prognose sein kann. In einer prospektiven Studie wurde die virtuelle Kolographie mittels Mehrzeilen-CT (MSCT) mit der konventionellen Koloskopie bei Nachweis und Differenzierung von kolorektalen Lasionen verglichen. 78 Patienten (36 Frauen, 42 Manner, Durchschnittsalter 60,7 Jahre) aus einem Mischkollektiv wurden prospektiv an einem MSCT (Somatom Volume Zoom, Siemens, Forchheim) untersucht. Die Bilddaten wurden durch zwei geblindete Radiologen in Volume-Rendering-Technik ausgewertet. Als Goldstandard erfolgte die konventionelle Koloskopie in etablierter Technik im Anschluss an die MSCT-Kolographie. Bei der Auswertung ergab sich fur die MSCT-Kolographie eine Sensitivitat von 80% und eine Spezifitat von 86% fur alle polypoiden Lasionen unabhangig von ihrer Grose. In der Subgruppenanalyse wurden 7/7 Polypen groser als 10mm (100%), 13/16 Polypen zwischen 6 und 9mm (81%) und 19/26 Polypen kleiner oder gleich 5mm (73%) detektiert. Insgesamt wurden mit der MSCT-Kolographie 14 falsch positive Polypen nachgewiesen. Bei der Kostenanalyse zeigte sich, dass die MSCT-Kolographie mit · 335 aktuell noch zu teuer ist; erst ab Kosten von etwa · 160 ware die MSCT-Kolographie aus gesundheitsokonomischer Sicht sinnvoll. Die MSCT-Kolographie erlaubt eine sichere Detektion von Polypen uber 10mm Durchmesser; kleinere Befunde werden mit einer hoheren Sensitivitat nachgewiesen als bisher fur die Einschicht-Spiral-CT angegeben. Nachteilig bleiben weiterhin die hohe Anzahl falsch positiver Befunde, die hohe Strahlenbelastung fur den Patienten sowie das Fehlen der Moglichkeit einer histologischen Gewebesicherung. Neuere Studien zeigen allerdings, dass durch Reduzierung der Strahlenbelastung von 140 mAs auf 10 mAs ebenfalls eine verlassliche Aussage getroffen werden kann. Die Kosten fur eine MSCT-Kolographie bleiben aus gesundheitsokonomischer Sicht zu hoch, da bei computertomographischem Verdacht auf eine Neoplasie eine zusatzliche Koloskopie zur weiteren histologischen Abklarung erfolgen muss.

INTRODUCTION:The performance of endoscopic retrograde cholangiopancreaticography (ERCP) in patients with post-surgically altered anatomy is technically ambitious. Our study aimed at comparing a cohort of patients having successfully undergone single-balloon enteroscopy (SBE)-assisted ERCP to those in whom SBE-ERCP failed.METHODS:This trial is a prospective single center cohort study. Participants included 30 patients (median age 69.5 years, range 20-86 years) with previous pancreaticobiliary surgery. First, a conventional ERCP approach was attempted in all patients. Additionally, those patients in whom prior conventional ERCP had failed underwent SBE-ERCP (n = 26). Patients' baseline characteristics were retrieved and patient cohorts with and without successful SBE-ERCPs were compared and analyzed. Statistical analysis was applied. Univariate analysis was performed to detect possible risk factors of SBE-ERCP failure.RESULTS:The overall success rate of SBE-ERCP, including two patients with percutaneous transhepatic cholangiography- assisted rendezvous technique was 65.4% (17/26). Patients with malignant obstructive cholestasis had a significantly higher failure rate compared to those with benign strictures (84.2% vs. 14.2%, p < 0.001).DISCUSSION:SBE-ERCP is a promising tool for diagnostic and therapeutic procedures in the pancreaticobiliary system of selected, previously operated patients with failure of conventional ERCP. However, higher failure rates in malignant biliary obstruction should be taken into account.

BACKGROUND/AIMS:Our investigation aimed to evaluate the impact of endoscopic transpapillary forceps biopsies (ETP) in bile duct strictures of unknown etiology based on the largest European patient cohort at a tertiary referral center. To date only studies with limited patient numbers exist.METHODOLOGY:Three-hundred-and-twelve patients (162 males, 150 females, mean age 62±12.7 years) with bile duct strictures of unknown etiology were examined with ETP. Sensitivity, specificity and accuracy of ETP were compared to the definite diagnosis proved by histopathology of surgical resection specimens or long-term follow-up of those patients not undergoing surgery.RESULTS:Using ETP a correct pe-interventional diagnosis was achieved in 211 out of 312 patients resulting in an accuracy rate of 67.6%. Eighty-six out of 187 malignant stenoses were correctly diagnosed by ETP, giving rise to sensitivity and specificity rates of 46 and 100%, respectively. Sensitivity of ETP in cholangiocellular carcinoma was significantly superior to that in pancreatic carcinoma (52.5% vs. 35.6%, p = 0.026). Sensitivity and accuracy rates of ETP did not depend on the localization of the stenosis in the common bile duct.CONCLUSIONS:ETP alone is not reliable enough in diagnosing bile duct malignancies as shown by low sensitivity and accuracy rates (false-negative rate of 32%).

Background and objective High calcium concentrations are an established risk factor for pancreatitis. We have investigated whether increasing magnesium concentrations affect pathological calcium signals and premature protease activation in pancreatic acini, and whether dietary or intraperitoneal magnesium administration affects the onset and course of experimental pancreatitis. Methods Pancreatic acini were incubated with up to 10 mM magnesium; [Ca2+]i (fura-2AM) and intracellular protease activation (fluorogenic substrates) were determined over 60 min. Wistar rats received chow either supplemented or depleted for magnesium (<300 ppm to 30 000 ppm) over two weeks before pancreatitis induction (intravenous caerulein 10 µg/kg/h/4 h); controls received 1 µg/kg/h caerulein or saline. C57BL6/J mice received four intraperitoneal doses of magnesium (NaCl, Mg2+ 55 192 or 384 mg/kg bodyweight) over 72 h, then pancreatitis was induced by up to eight hourly supramaximal caerulein applications. Pancreatic enzyme activities, protease activation, morphological changes and the immune response were investigated. Results Increasing extracellular Mg2+ concentration significantly reduced [Ca2+]i peaks and frequency of [Ca2+]i oscillations as well as intracellular trypsin and elastase activity. Magnesium administration reduced pancreatic enzyme activities, oedema, tissue necrosis and inflammation and somewhat increased Foxp3-positiv T-cells during experimental pancreatitis. Protease activation was found in animals fed magnesium-deficient chow—even with low caerulein concentrations that normally cause no damage. Conclusions Magnesium supplementation significantly reduces premature protease activation and the severity of pancreatitis, and antagonises pathological [Ca2+]i signals. Nutritional magnesium deficiency increases the susceptibility of the pancreas towards pathological stimuli. These data have prompted two clinical trials on the use of magnesium in patients at risk for pancreatitis.

AIM:To report the largest patient cohort study investigating the diagnostic yield of intraductal ultrasound （IDUS） in indeterminate strictures of the common bile duct.METHODS:A patient cohort with bile duct strictures of unknown etiology was examined by IDUS.Sensitivity,specificity and accuracy rates of IDUS were calculated relating to the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery.Analysis of the endosonographic report allowed drawing conclusions with respect to the T and N staging in 147 patients.IDUS staging was compared to the postoperative histopathological staging data allowing calculation of sensitivity,specificity and accuracy rates for T and N stages.The endoscopic retrograde cholangio-pancreatography and IDUS procedures were performed under fluoroscopic guidance using a side-viewing duodenoscope （Olympus TJF 160,Olympus,Ltd.,Tokyo,Japan）.All procedures were performed under conscious sedation （propofol combined with pethidine） according to the German guidelines.For IDUS,a 6 F or 8 F ultrasound miniprobe was employed with a radial scanner of 15-20 MHz at the tip of the probe （Aloka Co.,Tokyo,Japan）.RESULTS:A total of 397 patients （210 males,187 females,mean age 61.43 ± 13 years） with indeterminate bile duct strictures were included.Two hundred and sixty-four patients were referred to the department of surgery for operative exploration,thus surgical histopathological correlation was available for those patients.Out of 264 patients,174 had malignant disease proven by surgery,in 90 patients benign disease was found.In these patients decision for surgical exploration was made due to suspicion for malignant disease in multimodal diagnostics （computed tomography scan,endoscopic ultrasound or magnetic resonance imaging）.Twenty benign bile duct strictures were misclassified by IDUS as malignant while 14 patients with malignant strictures were initially misdiagnosed by IDUS as benign resulting in sensitivity,specificity and accuracy ratesof 93.2%,89.5% and 91.4%,respectively.In the subgroup analysis of malignancy prediction,IDUS showed best performance in cholangiocellular carcinoma as underlying disease （sensitivity rate,97.6%） followed by pancreatic carcinoma （93.8%）,gallbladder cancer （88.9%） and ampullary cancer （80.8%）.A total of 133 patients were not surgically explored.32 patients had palliative therapy due to extended tumor disease in IDUS and other imaging modalities.Ninety-five patients had benign diagnosis by IDUS,forceps biopsy and radiographic imaging and were followed by a surveillance protocol with a follow-up of at least 12 mo;the mean follow-up was 39.7 mo.Tumor localization within the common bile duct did not have a significant influence on prediction of malignancy by IDUS.The accuracy rate for discriminating early T stage tumors （T1） was 84% while for T2 and T3 malignancies the accuracy rates were 73% and 71%,respectively.Relating to N0 and N1 staging,IDUS procedure achieved accuracy rates of 69% for N0 and N1,respectively.Limitations:Pretest likelihood of 52% may not rule out bias and overinterpretation due to the clinical scenario or other prior performed imaging tests.CONCLUSION:IDUS shows good results for accurate diagnostics of bile duct strictures of uncertain etiology thus allowing for adequate further clinical management.

Background and AimsPneumocystis jirovecii pneumonia also known as pneumocystis pneumonia (PCP) is an opportunistic respiratory infection in human immunodeficiency virus (HIV) patients that may also develop in non-HIV immunocompromised persons. The aim of our study was to evaluate mortality predictors of PCP patients in a tertiary referral centre.MethodsFifty-one patients with symptomatic PCP were enrolled in the study. The patients had either HIV infection (n=21) or other immunosuppressive conditions (n=30). Baseline characteristics (e.g. age, sex and underlying disease) were retrieved. Kaplan-Meier analysis was employed to calculate survival. Comparisons were made by log-rank test. A multivariate analysis of factors influencing survival was carried out using the Cox regression model. Chi-squared test and Wilcoxon-Mann-Whitney test was applied as appropriate.ResultsThe median survival time for the HIV group was >120 months compared with 3 months for the non-HIV group (P=0.009). Three-month survival probability was also significantly greater in the HIV group compared with the non-HIV group (90% vs 41%, P=0.002). In univariate log-rank test, intensive care unit (ICU) necessity, HIV negativity, age >50 years, haemoglobin <10g/dl, C-reactive protein>5mg/dL and multiple comorbidities were significant negative predictors of survival. In the Cox regression model, ICU and HIV statuses turned out to be independent prognostic factors of survival.ConclusionPCP is a serious problem in non-HIV immunocompromised patients in whom survival outcomes are worse than those in HIV patients.

Cronkhite-Canada syndrome (CCS) is a rare non-familial disorder with multiple gastrointestinal polyps and ectodermal changes. Adenomatous and carcinomatous changes have been reported. Video capsule endoscopy is a useful non-invasive tool to reveal polypoid lesions of the gastrointestinal tract suspicious for malignancy. We report a case of a patient with CCS with excessively elongated intestinal villi resembling dense sea grass under water as well as multiple polyps of the intestinal mucosa revealed by video capsule endoscopy. This report presents for the first time small bowel video sequences of CCS qualifying video capsule endoscopy for screening purposes and early detection of malignancy.

OBJECTIVE:Bile duct stones that cannot be removed endoscopically are still a challenge in interventional gastroenterology. Extracorporeal shockwave lithotripsy (ESWL) with subsequent endoscopic extraction of residual fragments is an established treatment option if other endoscopic means are not successful. Our study aimed to investigate the efficacy and safety of ESWL for clearance of refractory bile duct stones. MATERIAL AND METHODS:A total of 73 consecutive patients treated for refractory choledocholithiasis with ESWL were retrospectively analyzed. Success and complication rates were calculated. RESULTS:Complete stone clearance was achieved in 66 cases (90%). Patients with complete clearance had a significantly lower body mass index or BMI (25.55 ± 5.01 kg/m² vs. 31.60 ± 6.26 kg/m², p = 0.035) and needed less ESWL treatments (3.61 ± 1.87 vs. 5.00 ± 1.63, p = 0.048). A relevant drop of hemoglobin occurred significantly more often in the group with partial clearance (43% vs. 6%, p = 0.005). CONCLUSIONS:ESWL proves to be an excellent clearing approach to refractory bile duct stones with high success rates. However, obesity is one risk factor for ESWL failure and higher procedural hazard.

Background Despite recent advances in imaging techniques, adequate classification of esophageal lesions is still challenging. Accurate staging of tumors of the esophagus is a precondition for targeted therapy. In this retrospective, multicenter study, we report the role of high-frequency endoscopic ultrasound (EUS) catheter probes in pretherapeutic staging of esophageal neoplasms and thus guiding treatment decisions. Methods A total of 143 patients (mean age of 63.8 ± 10.7 years) with esophageal carcinoma were recruited from five German centers (Münster, Oldenburg, Hannover, Wiesbaden, and Lüneburg). Tumor type was adenocarcinoma in 112 (78 %) cases and squamous cell carcinoma in 31 (22 %). Tumor localization was as follows: proximal 3, mid esophagus 7, and distal third 133. Histological correlation either through EMR or surgery was available. In all patients, pretherapeutic uT and uN classifications were compared to pT/pN classification obtained from surgically (esophagectomy, n = 93) or endoscopically (EMR, n = 50) resected tissue. Results Overall, accuracy of uT classification was 60 % and of uN classification was 74 %. Sensitivity, specificity, and accuracy rates for local tumor extension were as follows (%): T1: 68/97/83; T2: 39/84/75; T3: 72/81/79; T4: 13/97/93; T1/2: 73/81/75; T3/4: 78/82/81. Relating to positive lymph node detection, sensitivity and specificity were 76 and 71 %, respectively. Conclusions Miniprobe EUS is an established method for the staging of esophageal tumors. Our large multicenter cohort shows a solid accuracy of miniprobe EUS with respect to differentiating locally advanced from limited cancer and assisting to determine the treatment regimen in the era of neoadjuvant therapy; consequently, 78 % of patients would have been assigned to the adequate therapeutic regimen, whereas 11 % of patients would have been overtreated and 11 % undertreated.

BACKGROUND/AIMS Ampulla of Vater tumors represent a rare tumor entity and bear a malignant potential. This study at our tertiary referral center aimed at evaluating the feasibility of endoscopic snare papillectomy and long-term endoscopic surveillance in comparison to results of a meta-analysis of comparative trials. METHODOLOGY Retrospective study in comparison to results of a meta-analysis. Twenty-one patients (mean age 60.2±12.8 years) with ampullary adenoma were included. All patients had undergone ERCP with endoscopic forceps biopsies prior to endoscopic snare papillectomy. Statistical analysis was applied including descriptive analysis of symptoms, therapy and complications. RESULTS ESP was technically successful in all 21 patients. Histopathology showed 18 adenomas and 3 focal adenocarcinomas which were referred to surgery for modified Whipple's procedure. Follow-up was available in all patients with a mean follow-up of 64 months. Adenoma recurrence occurred in three patients with a mean recurrence time of 25 months (range, 4-66 months). One patient had residual adenoma growth. CONCLUSIONS In the majority of cases ampullary adenomas can be treated endoscopically. Forceps biopsies alone are not reliable enough in detecting malignancy. All patients with ampullary tumor should therefore undergo ESP. Due to the recurrence rate of 16% patients should have close follow-up.

Purpose: Despite recent advancements in imaging techniques adequate diagnostics of esophageal lesions is still challenging. Accurate staging of tumors of the esophagus is a precondition for a targeted therapy. In this multicenter study we report our results of miniprobe EUS in preoperative staging of esophageal lesions in guiding treatment decisions. Methods: 190 patients recruited from five German centers (Münster, Oldenburg, Hannover, Wiesbaden and Lüneburg) suspicious for esophageal tumor were eventually included. 47 patients were excluded due to prior neoadjuvant therapy. Data from the remaining 143 patients was used for statistical analysis. Basic characteristic are as follows: mean age 63.8 +/- 10.7 years, sex: m/f 114/29; tumor distribution (proximal/mid/distal third: 3/7/133). In all patients miniprobe EUS was performed and histological correlation either through EMR or surgery was available. uT/uN stages were compared to pT/pN stages. Statistical analysis included calculation of sensitivity, specificity and accuracy rates. Results: The following tumor entities were diagnosed: SCC: 31; adenocarcinoma 112; Overall accuracy for T stage was 60% and 74% for N stage. Sensitivity, specificity and accuracy for miniprobe EUS was as follows (in %): T1: 68/97/83; T2: 39/84/75; T3:72/81/79; T4:13/97/93; T1/2: 73/81/75; T3/4: 78/82/81. Sensitivity and specificity for positive lymph node staging was 76% and 71%, respectively. Conclusion: Miniprobe EUS is an established method for the staging of esophageal tumors. Our large multicenter cohort shows a good accuracy of miniprobe EUS for differentiation of locally advanced vs. limited cancer, helping to determine the therapy regimen in the era of neoadjuvant therapy resulting that 89% of the patients would have been assigned to the adequate therapy regimen or would have been overtreated.

Precise pre-operative T- and N- staging for malignant bile duct strictures remains challenging. Nevertheless, accurate T and N staging is mandatory for assessment of therapeutic strategies. A variety of imaging modalities compete with each other for the best approach. According to previously published studies with limited number of patients intraductal ultrasound (IDUS) is supposed to be the favored diagnostic tool.With our subgroup analysis of the largest European IDUS cohort we aimed to evaluate the clinical impact of IDUS on preoperative T an N Staging of malignant bile duct strictures.

Adequate diagnosis of cholangiocarcinoma is a challenging task and determines further therapy. The classification of hilar cholangiocarcinoma according to Bismuth-Corlette is generally performed by ductographic means (via ERCP or MRCP). The aim of this study was to evaluate the impact of intraductal ultrasonography (IDUS) for staging hilar cholangiocarcinoma. .

R obscure gastrointestinal bleeding is a potentially life-threatening condition and accounts for 5% of all gastrointestinal bleeding episodes.1 In the majority of cases, the bleeding source is located in the small bowel. Diagnostic procedures typically comprise esophagogastroduodenoscopy and colonoscopy. In recent years, new endoscopic tools have been developed to further examine the small bowel. These tools include singleand double-balloon enteroscopy as well as video capsule endoscopy (VCE). A 51-year-old man was admitted to our department for further diagnostics of recurrent obscure gastrointestinal bleeding. At the time of admission, he presented with melena and weakness as bleeding symptoms. His hemoglobin level had dropped

Background and aims: Leukocyte infiltration, up-regulation of proinflammatory cytokines and severe oxidative stress caused by increased amounts of reactive oxygen species are characteristics of inflammatory bowel disease. The catechin (2R,3R)-2-(3,4,5-Trihydroxyphenyl)-3,4-dihydro-1(2H)-benzopyran-3,5,7-triol-3-(3,4,5-trihydroxybenzoate), named epigallocatechin-3-gallate, EGCG, has been demonstrated to exert anti-inflammatory and antioxidative properties, reducing reactive oxygen species in the inflamed tissues. The aim of this study was to evaluate the therapeutic effects of EGCG in a murine model of colitis induced by oral administration of dextran sodium sulfate. Methods: Mice received a daily oral administration of 6.9 mg/kg body weight EGCG or Piper nigrum (L.) alkaloid (2E,4E)-5-(1,3-benzodioxol-5-yl)-1-piperidin-1-ylpenta-2,4-dien-1-one, named piperine (2.9 mg/kg body weight) or the combination of the both — piperine was used in this combination to enhance the bioavailability of EGCG. Results:In vivo data revealed the combination of EGCG and piperine to significantly reduce the loss of body weight, improve the clinical course and increase overall survival in comparison to untreated groups. The attenuated colitis was associated with less histological damages to the colon and reduction of tissue concentrations of malondialdehyde, the final product of lipid peroxidation. Neutrophils accumulation indicator myeloperoxidase was found to be reduced in colon tissue, while antioxidant enzymes like superoxide dismutase and glutathione peroxidase showed an increased activity. In vitro, the treatment with EGCG plus piperine enhanced the expression of SOD as well as GPO and also reduced the production of proinflammatory cytokines. Conclusion: These data support the concept of anti-inflammatory properties of EGCG being generally beneficial in the DSS-model of colitis, an effect that may be mediated by its strong antioxidative potential.

AIM:To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt (TIPS) implantation in cirrhotic patients.METHODS:Eighty-one patients with liver cirrhosis and consequential portal hypertension had TIPS implantation (bare metal) for either refractory ascites (RA) (n = 27) or variceal bleeding (VB) (n = 54). Endpoints for the study were: technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clinical records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score (MELD score), underlying disease] were retrieved. The Kaplan-Meier method was employed to calculate survival from the time of TIPS implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox proportional hazards regression model. Results were expressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney U-test and the χ2 test as appropriate.RESULTS:No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient (PPG) reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg (VB) vs. 22.1 ± 5.5 mmHg (RA) before TIPS to 11.8 ± 4.0 vs. 11.7 ± 4.2 after TIPS implantation (P = 0.001 within each group). There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group (24 vs 6, P = 0.052). The median survival for the ascites group was 29 mo compared to > 60 mo for the bleeding group (P = 0.009). The number of radiological controls for stent patency was 6.3 for bleeders and 3.8 for ascites patients (P = 0.029). Kaplan-Meier calculation indicated that stent occlusion at first control (P = 0.027), ascites prior to TIPS implantation (P = 0.009), CHILD stage (P = 0.013), MELD score (P = 0.001) and those patients not having undergone liver transplantation (P = 0.024) were significant predictors of survival. In the Cox regression model, stent occlusion (P = 0.022), RA (P = 0.043), CHILD stage (P = 0.015) and MELD score (P = 0.004) turned out to be independent prognostic factors of survival. The anticoagulation management (P = 0.097), the porto-systemic pressure gradient (P = 0.460) and rebleeding episodes (P = 0.765) had no significant effect on the overall survival.CONCLUSION:RA, stent occlusion, initial CHILD stage and MELD score are independent predictors of survival in patients with TIPS, speaking for a close follow-up in these circumstances.

BACKGROUND:Differentiation between inflammatory and fibromatous strictures in Crohn's disease (CD) is difficult but crucial for therapeutic decisions. The aim of this study was to assess the best noninvasive imaging method for the detection and differentiation of inflammatory and fibromatous stenoses in CD in comparison to endoscopic and histologic evaluation.METHODS:Patients with suspected CD strictures were included. According to a formalized endoscopic and histologic protocol, strictures were classified as inflammatory, mixed, and fibrostenotic. Strictures were further analyzed using fluorine 18-labeled fluoro-2-deoxy-D-glucose ((18) FDG) / positron emission tomography (PET) low-dose computed tomography (CT), magnetic resonance (MR) enteroclysis and transabdominal ultrasound using standardized scoring systems.RESULTS:Thirty patients with 37 strictures were evaluated (inflamed n = 22; mixed n = 12, fibromatous n = 3). (18) FDG-PET/CT detected 81%, MR-enteroclysis 81%, and ultrasound 68% of the strictures. Correct differentiation rates of strictures were 57% for MRE, 53% for (18) FDG-PET/CT, and 40% for ultrasound. Differences of detection rates and differentiation rates were not statistically significant. When combining transabdominal ultrasound with (18) FDG-PET/CT or MR-enteroclysis all strictures that required invasive treatment were detected.CONCLUSIONS:Detection rates of the strictures were not significantly different between (18) FDG-PET/CT, MR-enteroclysis, and ultrasound. Despite good stricture detection rates relating to our gold standard, (18) FDG-PET/CT nor MR-enteroclysis nor ultrasound can accurately differentiate inflamed from fibrotic strictures. A combination of MR-enteroclysis and ultrasound as well as a combination of (18) FDG-PET/CT and ultrasound resulted in a 100% detection rate of strictures requiring surgery or endoscopic dilation therapy, suggesting the combination of these methods as an alternative to endoscopy at least in the group of patients not able to perform an adequate bowel preparation.

Treatment options for inflammatory bowel disease (IBD) are incompletely helpful, and surgery is often needed. One promising class of future therapeutic agents for IBD is melanocortin-related peptides, which exhibit potent immunomodulatory effects. We investigated KdPT, a tripeptide derivative of the C-terminus of α-melanocyte-stimulating hormone, as an anti-inflammatory small molecule in vivo and in vitro. Intestinal inflammation was studied after oral administration of dextran sodium sulfate and in IL-10 gene-deficient mice. The effects of KdPT on key colonic epithelial cell functions were studied in vitro and in vivo by evaluating proliferation, wound healing, transepithelial resistance, and expression of tight junction proteins. Melanin assays were performed to determine the melanotropic effects of KdPT. KdPT-treated animals showed markedly reduced severity of inflammation in both colitis models. In colonic epithelial cells, KdPT increased proliferation, accelerated closure of wounds, and improved transepithelial electrical resistance after stimulation with interferon-γ/tumor necrosis factor-α. Moreover, treatment with KdPT also prevented the loss of tight junction protein expression and improved barrier function in vivo. KdPT acted independently of IL-1 receptor type I in vivo and did not affect melanogenesis in vitro. KdPT is capable of attenuating the course of experimental colitis in different models and maintains epithelial cell function. Furthermore, KdPT does not induce pigmentation, emphasizing the potential of this small molecule for the future treatment of IBD.

Grundlage für die tabellarische Darstellung der fachspezifischen Differenzialdiagnosen ist die klinisch relevante Schmerzlokalisation. Sie erfolgt über die Zuordnung der Schmerzsymptomatik zu den Regionen rechter Oberbauch, Epigastrium, linker Oberbauch, mittleres Abdomen, rechter Unterbauch, mittlerer Unterbauch, linker Unterbauch, Flanken sowie zum gesamten Abdomen. Da die Schmerzen auch in die Bauchdecken und in den Thorax ausstrahlen können, sind für diese Bereiche ebenfalls die Differenzialdiagnosen aufgeführt. Innerhalb der jeweiligen Lokalisation sind die Differenzialdiagnosen, die entsprechenden wegweisenden Nebensymptome und Befunde sowie die Möglichkeiten zur Sicherung der Diagnose nochmals unterteilt. Praxisnah wird zwischen akuten, subakuten und chronischen Schmerzen und, soweit relevant, Schmerzsymptomen mit und ohne Abwehrspannung unterschieden.