Berendt W. Aichbichler

Anti-cardiolipin antibodies in patients with inflammatory bowel disease.

Elevated levels of anti-cardiolipin antibodiesare associated with an increased risk for venous andarterial thrombosis. In patients with inflammatory boweldisease thrombosis is a well known complication. We determined the prevalence of elevatedanti-cardiolipin antibodies in 136 patients withinflammatory bowel disease compared with 136 healthycontrols and analyzed thromboembolic complications inpatients with increased anti-cardiolipin antibodylevels. Anti-cardiolipin antibody titers weresignificantly elevated in patients with Crohns disease(5.7 units/ml) and ulcerative colitis (5.3 units/ml)compared to the control group (2.5 units/ml). We foundno correlation between disease activity andanti-cardiolipin antibody levels. Seven patients haddeep venous thrombosis in their history, in three ofthem this was complicated by pulmonary embolism. In onlytwo of the seven patients with deep venous thrombosiswere anti-cardiolipin antibody levels increased. Inconclusion, anti-cardiolipin antibody titers were significantly increased in patients withinflammatory bowel disease. Elevated anti-cardiolipinantibody levels appear to play no role in thepathogenesis of thromboembolic events in patients withinflammatory bowel disease.

Mycophenolate mofetil in patients with Crohn's disease.

Objective:Intolerance to azathioprine is a rare but important problem in treating chronically active Crohns disease. We performed this study to evaluate mycophenolate mofetil as an alternative immunosuppressive therapy for patients with Crohns disease who did not tolerate azathioprine.Methods:Four patients with highly active perianal Crohns disease and two patients with chronically active, steroid-dependent Crohns disease were included. All patients consumed 2 g/day of mycophenolate mofetil for a median of 8 months (range, 6–12 months). Disease activity was measured by the Perianal Crohns Disease Activity Index in patients with perianal disease and by the Crohns Disease Activity Index in patients with chronically active Crohns disease.Results:Azathioprine-induced side effects disappeared after the drug was discontinued. All patients improved during treatment with mycophenolate mofetil, as shown by a remarkable reduction in the respective clinical scores. Five patients showed no side effects during treatment with mycophenolate mofetil. After 4 months’ treatment one patient developed diarrhea that was probably not due to mycophenolate mofetil.Conclusions:Mycophenolate mofetil could be an alternative therapy to azathioprine in patients with Crohns disease.

Mycophenolate mofetil for Crohn's disease: short-term efficacy and long-term outcome

Aim : To assess the long‐term efficacy of the antimetabolite agent mycophenolate mofetil in patients with Crohns disease.

Gastric adenocarcinoma mimicking achalasia in a 15-year-old patient: a case report and review of the literature.

Although adenocarcinoma of the cardia is extremely rare in adolescent patients, the endoscopist should be alert to this disease in patients of any age with dysphagia, even if symptoms, and results of a barium study, upper endoscopy, and esophageal manometry are suggestive of primary achalasia, especially if family history is negative for achalasia. In addition, secondary achalasia should be suspected in patients who do not respond to therapy with botulinum toxin within 2 months. Because none of the mentioned tests can distinguish between primary achalasia and secondary forms due to carcinoma of the cardia, biopsy specimens should be obtained. It appears that, although there is a minimal risk for complications, a diagnostic procedure such as biopsy would be appropriate when the information obtained could be essential. In some cases EUS can be an additional diagnostic tool, because lesions of the submucosa and the surrounding area can be identified by EUS.

Diagnostik und Therapie bei verifizierten chronisch entzündlichen Darmerkrankungen

ZusammenfassungGrundlagenColitis ulcerosa und Morbus Crohn sind entzündliche Darmerkrankungen mit chronischem Verlauf. Sie sind gekennzeichnet durch intermittierend auftretende akute Schübe.MethodikZiel dieser Übersicht soll die Zusammenfassung diagnostischer Maßnahmen vor Einleitung einer Therapie bei gesicherter chronisch entzündlicher Darmerkrankung sowie die Darstellung verschiedener medikamentöser Therapiemöglichkeiten sein.ErgebnisseBei bereits in der Vorgeschichte verifizierter Grunderkrankung ist das Ausmaß der diagnostischen Maßnahmen und die Art der Therapie individuell unterschiedlich. Sowohl beim Morbus Crohn als auch bei der Colitis ulcerosa sind die Basis für das Ausmaß der Diagnostik neben einer genauen Anamnese eine physikalische Untersuchung und ein limitierter Laborastatus inklusive Stuhlkultur. Die routinemäßige Durchführung einer Endoskopie bei jedem akuten Schub einer chronisch entzündlichen Darmerkrankung ist nicht notwendig. In der Verlaufsbeobachtung ist beim Morbus Crohn die Röntgenuntersuchung bezüglich der Beurteilung von Fisteln und Stenosen der Endoskopie überlegen. Die konservative Therapie richtet sich nach Aktivität und Lokalisation der Grunderkrankung. Mehrere etablierte Medikamente wie Salazosulfapyridin, 5-Aminosalizylsäure, Kortikosteroide und Azathioprin stehen zur Verfügung. Sowohl als Basistherapie im akuten Schub als auch in der Rezidivprophylaxe werden heute in erster Linie Präparate mit 5-Aminosalizylsäure eingesetzt. Die Auswahl der zur Verfügung stehenden galenischen Präparationen richtet sich nach der Krankheitslokalisation. Bei hoher entzündlicher Aktivität und bei Versagen der Basistherapie sind nach wie vor Kortikosteroide Mittel erster Wahl. Azathioprin hat sich in der Therapie des chronisch aktiven Morbus Crohn etabliert. Dagegen hat sich das Immunsuppressivum Cyclosporin A nur bei akuter, kortisonresistenter Colitis ulcerosa durchgesetzt. Die Wahrscheinlichkeit einer Operation im Verlauf der Erkrankung ist bei Patienten mit bekanntem Morbus Crohn etwa 90%, bei Patienten mit einer Colitis ulcerosa etwa 25%. Operationsindikationen und Zeitpunkt sollten in enger Kooperation zwischen Gastroenterologen und Abdominalchirurgen abgestimmt werden.SchlußfolgerungenBei einem Schub einer verifizierten chronisch entzündlichen Darmerkrankung ist das Ausmaß der diagnostischen Maßnahmen unterschiedlich. Obligat sind ein limitierter Laborstatus sowie eine Stuhlkultur. Die Durchführung einer Endoskopie insbesondere zur Überprüfung des konservativen Therapieerfolges ist nicht notwendig. Die Auswahl konservativer Therapien wie 5-Aminosalizylsäure, Kortikosteroide und verschiedener Immunsuppressiva richtet sich nach dem Grad der Entzündung und der Lokalisation der Grunderkrankung.SummaryBackgroundUlcerative colitis and Crohns disease are chronic inflammatory bowel diseases which are characterized by recurrent exacerbation of acute inflammation, demanding different diagnostic approaches and medical treatment.MethodsThis article reviews the diagnostic procedures and recommended treatment in patients with established diagnosis.ResultsManagement with each relapse of Crohns disease and ulcerative colitis include a detailed medical history, a physical examination, blood tests and one stool culture. Routine endoscopy with each relapse of inflammatory bowel disease is not necessary. To evaluate fistulas and stenosis in the course of Crohns disease radiology is superior to endoscopy. Medical treatment depends on activity, extent and site of the disease. Well established drugs for therapy include sulphasalazine, 5-aminosalicylic acid, corticosteroids and azathioprin. 5-Aminosalicylic acid is the drug of choice in moderately active disease and for maintenance therapy. The use of different galenic preparations of 5-aminosalicylic acid should depend on extent and site of the disease. Corticosteroids are drugs of first choice in patients with high inflammatory activity. Their use is also indicated if therapy with 5-aminosalicylic acid fails. Azathioprin is well established in the treatment of chronic active Crohns disease. The immunosuppressive agent cyclosporine A has been shown to be effective only in severe ulcertive colitis which is refractory to corticosteroids. About 90% of patients with Crohns disease and 25% with ulcerative colitis will need surgical intervention during the course of the disease. Criteria and timing for surgical intervention should be planned in close cooperation between gastroenterologist and abdominal surgeon.ConclusionsManagement with each relapse of a verified inflammatory bowel disease is individually different. A blood test and a stool culture should be done obligatory. Routine endoscopy with each relapse is not necessary. Well established drugs for therapy include 5-aminosalicylic acid, corticosteroids and different immunosuppressive agents. The choice of medical treatment depends of activity, extent and site of the disease.