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Lorenz P, Koop H, Madisch A, Fischer N, Jansen PL. Leitlinienreport der aktualisierten S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013. Z Gastroenterol 2023; 61:e347-e357. [PMID: 37494072 DOI: 10.1055/a-2060-1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Pia Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Herbert Koop
- ehem. Klinik für Innere Medizin und Gastroenterologie, Helios-Klinikum Berlin-Buch, Berlin, Deutschland
| | - Ahmed Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
- Centrum Gastroenterologie, Agaplesion Krankenhaus Bethanien, Frankfurt am Main, Deutschland
| | - Nadine Fischer
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
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Madisch A, Koop H. Aktualisierung der S2k-Leitlinie Gastroösophageale Refluxkrankheit der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 2023; 61:797-798. [PMID: 37494074 DOI: 10.1055/a-2060-1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Ahmed Madisch
- Centrum Gastroenterologie Bethanien, Agaplesion Krankenhaus Bethanien, Frankfurt am Main, Deutschland
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
| | - Herbert Koop
- ehem. Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios-Klinikum Berlin-Buch, Berlin, Deutschland
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Leifeld L, Denzer U, Frieling T, Jakobs R, Koop H, van Leeuwen P, Madisch A, Rosien U, Stier A, Siegmund B, Tappe U, Lammert F, Lynen Jansen P. [Quality management in the field of gastroenterology - Proposals of the Quality Commission of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) for Outpatient and Inpatient Quality Assurance]. Z Gastroenterol 2021; 59:665-676. [PMID: 34255315 DOI: 10.1055/a-1451-6350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The quality of the medical care depends on numerous factors that can often be influenced by the doctor itself. It is a great challenge to follow the constant scientific progress in practice. Scientific standards in gastroenterology are defined in DGVS guidelines and regularly revised. The implementation of evidence-based recommendations in practice remains challenging. On the basis of the DGVS guidelines, the Quality Commission has therefore developed a selection of quality indicators with particular relevance using standardized criteria, the broad implementation of which could contribute to improved patient care in gastroenterology.
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Affiliation(s)
- Ludger Leifeld
- Klinik für Allgemeine Innere Medizin & Gastroenterologie - Medizinische Klinik III, St. Bernward Krankenhaus, Hildesheim
| | - Ulrike Denzer
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg
| | - Thomas Frieling
- Medizinische Klinik II - Gastroenterologie, Helios Klinikum Krefeld
| | - Ralf Jakobs
- Medizinische Klinik C mit Schwerpunkt Gastroenterologie, Klinikum Ludwigshafen
| | - Herbert Koop
- ehem. Klinik für Innere Medizin und Gastroenterologie, Helios-Klinikum Berlin-Buch, Berlin
| | - Pia van Leeuwen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin
| | - Ahmed Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover
| | - Ulrich Rosien
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg
| | - Albrecht Stier
- Klinik für Allgemein- u. Viszeralchirurgie, Helios Klinikum Erfurt
| | - Britta Siegmund
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité Campus Benjamin Franklin - Universitätsmedizin Berlin
| | | | | | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin
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Koop H. [Any gastroenterologist should recognize: splenic injury as a complication of colonoscopy]. Z Gastroenterol 2021; 59:470-471. [PMID: 33979846 DOI: 10.1055/a-1447-1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Herbert Koop
- ehem. Klinik für Allgemeine Innere Medizin und Gastroenterologie, HELIOS Klinikum Berlin-Buch, Berlin, Germany
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Horenkamp-Sonntag D, Liebentraut J, Engel S, Skupnik C, Albers D, Schumacher B, Koop H. Use of over-the-scope clips in the colon in clinical practice: results from a German administrative database. Endoscopy 2020; 52:1103-1110. [PMID: 32869229 PMCID: PMC7688408 DOI: 10.1055/a-1206-0778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED BACKGROUND : The efficacy and safety of over-the-scope (OTS) clips in the colon is limited. This study aimed to evaluate OTS clip use in the colon in routine colonoscopy. METHODS Using administrative data from a large health insurance company, patients with OTS clip placement during colonoscopy were identified and analyzed by specific administrative codes. Indication for OTS clipping was analyzed, and follow-up was evaluated for surgical and repeat endoscopic interventions. RESULTS In 505 patients, indications for OTS clips were iatrogenic perforations (n = 80; Group A), polypectomy (n = 315; Group B), colonic bleeding (n = 51; Group C), and various underlying diseases (n = 59; Group D). In 11 Group A patients (13.8 %), surgical interventions occurred, mostly within 24 hours after clipping (n = 9), predominantly overstitching (n = 8). OTS clipping during polypectomy (Group B) was for complications (e. g. bleeding in 27 %) or was applied prophylactically. Only five patients required early surgery, three of whom had colorectal cancer. In four Group C patients (7.8 %), surgical resections were performed (persistent bleeding n = 1, colorectal cancer n = 2), while six patients underwent early repeat colonoscopy for recurrent bleeding. During further follow-up (days 11-30), 17 patients underwent resection for colonic neoplasms (n = 12) or persistent bleeding (n = 4), but only one case could be directly traced back to local OTS clip complication. CONCLUSION Colonic OTS clipping appears safe and effective in selected indications and complications in clinical routine but must be anatomically and technically feasible, avoiding overuse.
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Affiliation(s)
| | | | | | | | - David Albers
- Department of Internal Medicine and Gastroenterology, Elisabeth-Krankenhaus Academic Hospital, University of Duisburg-Essen, Essen, Germany
| | - Brigitte Schumacher
- Department of Internal Medicine and Gastroenterology, Elisabeth-Krankenhaus Academic Hospital, University of Duisburg-Essen, Essen, Germany
| | - Herbert Koop
- Formerly Department of General Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Academic Hospital, Berlin, Germany
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Behrens A, Kreuzmayr A, Manner H, Koop H, Lorenz A, Schaefer C, Plauth M, Jetschmann JU, von Tirpitz C, Ewald M, Sackmann M, Renner W, Krüger M, Schwab D, Hoffmann W, Engelke O, Pech O, Kullmann F, Pampuch S, Lenfers B, Weickert U, Schilling D, Boehm S, Beckebaum S, Cicinnati V, Erckenbrecht JF, Dumoulin FL, Benz C, Rabenstein T, Haltern G, Balsliemke M, de Mas C, Kleber G, Pehl C, Vogt C, Kiesslich R, Fischbach W, Koop I, Kuehne J, Breidert M, Sass NL, May A, Friedrich C, Veitt R, Porschen R, Ellrichmann M, Arlt A, Schmitt W, Dollhopf M, Schmidbaur W, Dignass A, Schmitz V, Labenz J, Kaiser G, Krannich A, Barteska N, Ell C. Acute sedation-associated complications in GI endoscopy (ProSed 2 Study): results from the prospective multicentre electronic registry of sedation-associated complications. Gut 2019; 68:445-452. [PMID: 29298872 DOI: 10.1136/gutjnl-2015-311037] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Sedation has been established for GI endoscopic procedures in most countries, but it is also associated with an added risk of complications. Reported complication rates are variable due to different study methodologies and often limited sample size. DESIGNS Acute sedation-associated complications were prospectively recorded in an electronic endoscopy documentation in 39 study centres between December 2011 and August 2014 (median inclusion period 24 months). The sedation regimen was decided by each study centre. RESULTS A total of 368 206 endoscopies was recorded; 11% without sedation. Propofol was the dominant drug used (62% only, 22.5% in combination with midazolam). Of the sedated patients, 38 (0.01%) suffered a major complication, and overall mortality was 0.005% (n=15); minor complications occurred in 0.3%. Multivariate analysis showed the following independent risk factors for all complications: American Society of Anesthesiologists class >2 (OR 2.29) and type and duration of endoscopy. Of the sedation regimens, propofol monosedation had the lowest rate (OR 0.75) compared with midazolam (reference) and combinations (OR 1.0-1.5). Compared with primary care hospitals, tertiary referral centres had higher complication rates (OR 1.61). Notably, compared with sedation by a two-person endoscopy team (endoscopist/assistant; 53.5% of all procedures), adding another person for sedation (nurse, physician) was associated with higher complication rates (ORs 1.40-4.46), probably due to higher complexity of procedures not evident in the multivariate analysis. CONCLUSIONS This large multicentre registry study confirmed that severe acute sedation-related complications are rare during GI endoscopy with a very low mortality. The data are useful for planning risk factor-adapted sedation management to further prevent sedation-associated complications in selected patients. TRIAL REGISTRATION NUMBER DRKS00007768; Pre-results.
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Affiliation(s)
- Angelika Behrens
- Department of Internal Medicine and Gastroenterology, Evangelische Elisabeth Klinik, Teaching Hospital, Charité University Medicine, Berlin, Germany
| | - Anton Kreuzmayr
- Klinik für Innere Medizin und Gastroenterologie, Klinikum Traunstein, Essen, Germany
| | - Hendrik Manner
- Klinik für Innere Medizin und Gastroenterologie, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Herbert Koop
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Albrecht Lorenz
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Claus Schaefer
- Medizinische Klinik II, Klinikum Neumarkt, Neumarkt, Germany
| | - Mathais Plauth
- Klinik für Innere Medizin, Gastroenterologie, Klinikum Dessau, Dessau, Germany
| | - Jens-Uwe Jetschmann
- Klinik für Innere Medizin, Gastroenterologie, Klinikum Dessau, Dessau, Germany
| | | | - Marcus Ewald
- Medizinische Klinik - Schwerpunkt Gastroenterologie, Onkologie, Klinikum Kulmbach, Kulmbach, Germany
| | | | - Wanja Renner
- Medizinische Klinik II, Klinikum Bamberg, Bamberg, Germany
| | - Martin Krüger
- Klinik für Innere Medizin und Gastroenterologie, Ev. Krankehaus Bielefeld, Bielefeld, Germany
| | - Dieter Schwab
- Medizinische Klinik II, Krankenhaus Martha-Maria Nürnberg, Nuremberg, Germany
| | | | - Olaf Engelke
- Medizinische Klinik II, St. Anna Hospital, Herne, Germany
| | - Oliver Pech
- Klinik für Innere Medizin und interventionelle Gastroenterologie, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | | | - Sonja Pampuch
- Medizinische Klinik I, Klinikum Weiden, Weiden, Germany
| | - Berthold Lenfers
- Klinik für Gastroeterologie, St. Marien Hospital Klinikum Lünen, Luenen, Germany
| | - Uwe Weickert
- Medizinische Klinik II, SLK Kliniken Heilbronn, Heilbronn, Germany
| | - Dieter Schilling
- Medizinische Klinik II, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Stephan Boehm
- Medizinische Klinik für Innere Medizin, Gastroenterologie und Hepatologie, Katholische Kliniken Ruhrhalbinsel, Essen, Germany
| | - Susanne Beckebaum
- Medizinische Klinik für Innere Medizin, Gastroenterologie und Hepatologie, Katholische Kliniken Ruhrhalbinsel, Essen, Germany
| | - Vito Cicinnati
- Medizinische Klinik für Innere Medizin, Gastroenterologie und Hepatologie, Katholische Kliniken Ruhrhalbinsel, Essen, Germany
| | - Joachim F Erckenbrecht
- Klinik für Innere Medizin mit Gastroenterologie und Onkologie, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Franz Ludwig Dumoulin
- Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
| | - Claus Benz
- Innere Medizin, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Thomas Rabenstein
- Klinik für Innere Medizin, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Georg Haltern
- Gastroenterologie, Kreiskrankenhaus Dormagen, Dormagen, Germany
| | | | - Christian de Mas
- Klinik für Innere Medizin - Gastroenterologie, Marienhaus St.Elisabeth Neuwied, Neuwied, Germany
| | | | - Christian Pehl
- Innere Medizin, Krankenhaus Vilsbiburg, Vilsbiburg, Germany
| | - Christoph Vogt
- Innere Medizin, St. Josef Krankenhaus Moers, Moers, Germany
| | - Ralf Kiesslich
- Innere Medizin, St. Marienkrankenhaus, Frankfurt, Germany
| | | | - Irmtraut Koop
- Allgemeine Innere Medizin und Gastroenterologie, Ev. Amalie Sieveking-Krankenhaus, Hamburg, Germany
| | - Jens Kuehne
- Klinik für Innere Medizin, Pius-Hospital, Oldenburg, Germany
| | - Matthias Breidert
- Gastroenterologie und Infektiologie, Klinik Koesching, Koesching, Germany
| | | | - Andrea May
- Medizinische Klinik II, Sana Klinikum Offenbach, Offenbach, Germany
| | | | - Ronni Veitt
- Klinik für Innere Medizin I - Gastroenterologie, internistische Onkologie, Elisabeth Klinikum Schmalkalden, Schmalkalden, Germany
| | - Rainer Porschen
- Klinik für Innere Medizin, Klinikum Bremen-Ost, Bremen, Germany
| | - Mark Ellrichmann
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Alexander Arlt
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Wolfgang Schmitt
- Klinik für Gastroenterologie und Hepatologie, Klinikum Neuperlach, Munich, Germany
| | - Markus Dollhopf
- Klinik für Gastroenterologie und Hepatologie, Klinikum Neuperlach, Munich, Germany
| | - Werner Schmidbaur
- Klinik für Gastroenterologie und Hepatologie, Stiftungsklinik Weissenhorn, Weissenhorn, Germany
| | - Axel Dignass
- Medizinische Klinik I, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Volker Schmitz
- Innere Medizin, Krankenhaus St. Marienwörth, Bad Kreuznach, Germany
| | - J Labenz
- Innere Medizin, Ev.-Jung-Stilling-KKH, Siegen, Germany
| | - Gernot Kaiser
- FB Wirtschafts- und Sozialwissenschaften, Hochschule Nordhausen, Nordhausen, Germany
| | - Alexander Krannich
- Koordinierungszentrum Klinische Studien, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nico Barteska
- Klinik für Gastroenterologie, Vivantes Klinikum im Friedrichshain, Teaching hospital, Charité University Medicine, Berlin, Germany
| | - Christian Ell
- Medizinische Klinik II, Sana Klinikum Offenbach, Offenbach, Germany
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Horenkamp-Sonntag D, Liebentraut J, Engel S, Koop H. Patientensicherheit: Häufigkeit unerwünschter Ereignisse im Zusammenhang mit der Durchführung von diagnostischen Koloskopie-Untersuchungen. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | - H Koop
- Helios Klinikum Berlin-Buch, Klinik für Allgemeine Innere Medizin und Gastroenterologie, Berlin, Deutschland
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Abstract
Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms persist in a substantial number of patients. Therefore, treatment strategies beyond PPI are urgently required. One such strategy may involve more reliable acid suppression, e.g., with new acid inhibitory drugs. Furthermore, the rapid appearance of an acidic compartment in the proximal stomach after a meal, which is largely responsible for postprandial heartburn, requires a specific kind of therapy in addition to PPI which still needs to be established. Pharmacological augmentation of the lower esophageal sphincter may represent another approach to diminish reflux, but the clinical efficacy of compounds tested so far is limited. Altered e-sophageal perception represents a major component involved in the generation of reflux symptoms, particularly in non-erosive reflux disease, but effective pharmacological intervention is largely lacking. Presumed reflux-induced respiratory symptoms (cough, laryngitis, etc.) in the absence of typical esophageal symptoms (e.g., heartburn) remain a hot topic, but recent research points towards a hypersensitivity syndrome and only a minor role of gastroesophageal reflux. Treatment options for this condition are still pending.
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Affiliation(s)
- Herbert Koop
- formerly Department of General Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Berlin, Germany
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Labenz J, Koop H. [Gastro-Oesophageal Reflux Disease - How to Manage if PPI are not Sufficiently Effective, not Tolerated, or not Wished?]. Laryngorhinootologie 2018; 97:166-175. [PMID: 29495041 DOI: 10.1055/s-0044-100740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie Standardtherapie der GERD mit PPI ist weniger wirksam als gedacht: Mindestens 30 % der Patienten haben
persistierende Symptome und Läsionen (Therapielücke). Bei persistierender Symptomatik oder Wunsch einer
alternativen Behandlung ist eine stratifizierte Diagnostik erforderlich. Alginate und neue Operationsverfahren
erweitern die Therapieoptionen
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Abstract
There is substantial discussion about inappropriate prescriptions and risks of proton pump inhibitor (PPI) therapy. This review critically reviews prescription manners regarding PPI both by general practitioners and in hospitals, demonstrates exit strategies after prolonged PPI treatment and evaluates clinically relevant risks of PPI therapy.
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Affiliation(s)
- Herbert Koop
- ehemals Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch
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Jung N, Koop H, Riessen R, Galle JC, Jany B, Märker-Hermann E. ["Choosing wisely" in infectious diseases : Overuse of antibiotics - too few vaccinations]. Internist (Berl) 2017; 57:527-31. [PMID: 27193347 DOI: 10.1007/s00108-016-0063-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The "choosing wisely" recommendations of the German Society of Internal Medicine (DGIM) and its specialist societies address diagnostic and therapeutic procedures, which are of particular medical importance but applied too often or too rarely in clinical practice. The aim is to further improve treatment of patients. Important topics of overuse and insufficient treatment related to the diagnostics, therapy, prevention and exclusion of infectious diseases could be identified. These topics not only play an important role in the discipline of infectious diseases but are also relevant for other internal medical disciplines. These topics related to infectious diseases have also been integrated into the recommendations of the German Society of Gastroenterology, Digestive and Metabolic Diseases as well as the German Societies for Internal Intensive Care and Emergency Medicine, for Pneumology, for Nephrology and for Rheumatology. The pivotal issues of the recommendations are the inappropriate use of antibiotics and insufficient vaccination rates.
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Affiliation(s)
- N Jung
- Klinik 1 für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50935, Köln, Deutschland. .,Geschäftsstelle Berlin, Deutsche Gesellschaft für Infektiologie (DGI), Berlin, Deutschland.
| | - H Koop
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS), Berlin, Deutschland
| | - R Riessen
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
| | - J-C Galle
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Nephrologie (DGfN), Berlin, Deutschland
| | - B Jany
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - E Märker-Hermann
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland
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Koop H, Koprdova S, Schürmann C. Chronic Abdominal Wall Pain. Dtsch Arztebl Int 2017; 113:51-7. [PMID: 26883414 DOI: 10.3238/arztebl.2016.0051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic abdominal wall pain is a poorly recognized clinical problem despite being an important element in the differential diagnosis of abdominal pain. METHODS This review is based on pertinent articles that were retrieved by a selective search in PubMed and EMBASE employing the terms "abdominal wall pain" and "cutaneous nerve entrapment syndrome," as well as on the authors' clinical experience. RESULTS In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall; in patients with previously diagnosed chronic abdominal pain who have no demonstrable pathological abnormality, this likelihood can rise as high as 30% . There have only been a small number of clinical trials of treatment for this condition. The diagnosis is made on clinical grounds, with the aid of Carnett's test. The characteristic clinical feature is strictly localized pain in the anterior abdominal wall, which is often mischaracterized as a "functional" complaint. In one study, injection of local anesthesia combined with steroids into the painful area was found to relieve pain for 4 weeks in 95% of patients. The injection of lidocaine alone brought about improvement in 83-91% of patients. Long-term pain relief ensued after a single lidocaine injection in 20-30% of patients, after repeated injections in 40-50% , and after combined lidocaine and steroid injections in up to 80% . Pain that persists despite these treatments can be treated with surgery (neurectomy). CONCLUSION Chronic abdominal wall pain is easily diagnosed on physical examination and can often be rapidly treated. Any physician treating patients with abdominal pain should be aware of this condition. Further comparative treatment trials will be needed before a validated treatment algorithm can be established.
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Affiliation(s)
- Herbert Koop
- Department of General Practice, Internal Medicine and Gastroenterology, HELIOS Klinikum Berlin-Buch
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Koop H, Koprdova S, Schürmann C. In Reply. Dtsch Arztebl Int 2016; 113:504. [PMID: 27545704 PMCID: PMC5527837 DOI: 10.3238/arztebl.2016.0504b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Herbert Koop
- *Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Germany,
| | - Simona Koprdova
- *Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Germany,
| | - Christine Schürmann
- *Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Germany,
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Labenz J, Koop H, Tannapfel A, Kiesslich R, Hölscher AH. The epidemiology, diagnosis, and treatment of Barrett's carcinoma. Dtsch Arztebl Int 2015; 112:224-33; quiz 234. [PMID: 25869347 DOI: 10.3238/arztebl.2015.0224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/25/2014] [Accepted: 11/29/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Roughly 3000 new cases of Barrett's carcinoma arise in Germany each year. In view of recent advances in the epidemiology, diagnosis, and treatment of this disease, an update of the clinical recommendations is in order. METHODS This review is based on selected relevant publications, including current reviews, meta-analyses, and guidelines. RESULTS The risk of progression of Barrett's esophagus to carcinoma lies between 0.10% and 0.15% per year. Risk factors for progression include male sex, age over 50 years, obesity, longstanding and frequent reflux symptoms, smoking, length of the Barrett's esophagus, and intraepithelial neoplasia. Well-differentiated carcinomas that are confined to the esophageal mucosa can be resected endoscopically with a cure rate above 90%. For more advanced, but still locally confined tumors, surgical resection is the treatment of choice. In stages cT3/4, the prognosis can be improved with neo-adjuvant chemo - therapy or combined radiotherapy and chemotherapy. Metastatic Barrett's carcinoma can be treated by endoscopic, chemotherapeutic, radiotherapeutic, and palliative methods. CONCLUSION Early carcinoma can often be cured by endoscopic resection. Locally advanced carcinoma calls for multimodal treatment. Current research focuses on means of preventing the progression of Barrett's esophagus, the scope of applicability of endoscopic techniques, and the optimization of multimodal treatment strategies for advanced disease.
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Affiliation(s)
- Joachim Labenz
- Department of Internal Medicine and Gastroenterology, Diakonie Klinikum, Jung-Stilling Hospital, Siegen, Department of General Practice, Internal Medicine and Gastroenterology, HELIOS Hospital Berlin-Buch, Institute of Pathology, Ruhr-University Bochum, Dr.-Horst-Schmidt-Kliniken, Wiesbaden, Department of General, Visceral and Cancer Surgery, University of Cologne
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Koop H, Fuchs KH, Labenz J, Lynen Jansen P, Messmann H, Miehlke S, Schepp W, Wenzl TG. [S2k guideline: gastroesophageal reflux disease guided by the German Society of Gastroenterology: AWMF register no. 021-013]. Z Gastroenterol 2014; 52:1299-346. [PMID: 25390216 DOI: 10.1055/s-0034-1385202] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- H Koop
- Allgemeine Innere Medizin, HELIOS Klinikum Berlin-Buch, Berlin
| | - K H Fuchs
- Chirurgie, Markus-Krankenhaus, Frankfurt am Main
| | - J Labenz
- Innere Medizin 2, Jung-Stilling Krankenhaus, Siegen
| | | | | | - S Miehlke
- Magen-Darm-Zentrum Facharztzentrum Eppendorf, Hamburg
| | - W Schepp
- Klinik für Gastroenterologie, Hepatologie und gastroent. Onkologie Klinikum Bogenhausen, München
| | - T G Wenzl
- Klinik für Kinder- und Jugendmedizin, Uniklinikum der RWTH Aachen
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Fischbach W, Darius H, Gross M, Koop H, Kruck I, Petersen KU. Concomitant use of thrombocyte aggregation inhibitors and proton pump inhibitors (PPIs). Z Gastroenterol 2011; 49:395-402. [PMID: 21391173 DOI: 10.1055/s-0029-1246027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- W Fischbach
- Medizinische Klinik II, Klinikum Aschaffenburg, 63739 Aschaffenburg, Germany.
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Fischbach W, Darius H, Gross M, Koop H, Kruck I, Petersen KU. [Concomitant use of platelet aggregation inhibitors and proton pump inhibitors (PPIs): Position paper of the German Society for Digestive and Metabolic Diseases (DGVS) and the German Society of Cardiology (DGK).]. Z Gastroenterol 2010; 48:1156-63. [PMID: 20839167 DOI: 10.1055/s-0029-1245603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Wolfgang Fischbach
- Medizinische Klinik II und Klinik für Palliativmedizin, Klinikum Aschaffenburg, Akademisches Lehrkrankenhaus der Universität Würzbug, Aschaffenburg.
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Koop H. [Gastroenterology 2009: Plea for a quality offensive]. Z Gastroenterol 2009; 47:1123-4. [PMID: 19899018 DOI: 10.1055/s-0028-1109878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H Koop
- Klinik für Innere Medizin II - Gastroenterologie, HELIOS Klinikum Berlin-Buch.
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Koop H, Riemann J. Viszeralmedizin 2009: Gelebte Interdisziplinarität als Voraussetzung für optimale Behandlungsqualität. Dtsch Med Wochenschr 2009; 134:1803. [DOI: 10.1055/s-0029-1237513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Koop H. Neue Therapieansätze bei Ulcus duodeni und ventriculi. Dtsch Med Wochenschr 2008; 117:1247-50. [PMID: 1354156 DOI: 10.1055/s-2008-1062438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- H Koop
- Zentrum für Innere Medizin, Universität Marburg
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23
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Koop H. Überwachungsstrategien beim Barrett-Ösophagus - contra. Dtsch Med Wochenschr 2007; 132:1769. [PMID: 17713888 DOI: 10.1055/s-2007-984965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- H Koop
- II. Innere Klinik-Gastroenterologie, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
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24
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Koop H. Gastroösophageale Refluxkrankheit: wirklich ein interdisziplinäres Krankheitsbild in der Viszeralmedizin? Visc Med 2006. [DOI: 10.1159/000097996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Morgner-Miehlke A, Koop H, Blum AL, Hermans ML, Miehlke S, Labenz J. [Symptom- versus endoscopy-based diagnosis and treatment of gastroesophageal reflux disease (GERD)]. Z Gastroenterol 2006; 44:399-410. [PMID: 16688658 DOI: 10.1055/s-2006-926619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The current guidelines of the German Society for Digestive Diseases (DGVS) endoscopy recommends for patients representing with reflux symptoms. In daily routine as well as in Guidelines from other countries and international guidelines, however, a symptom-based strategy for the management of patients with reflux disease is favoured. Since either strategies is dependent on specific clinical findings, neither can be recommended. The preference for one or the other strategy depends on the prevalence of so-called alarm symptoms, risk factors for a reflux carcinoma or Barrett's metaplasia, demographic factors, e. g., age and gender, patient's wish and initial response to empirical therapy with proton pump inhibitors (PPI). However, most patients with characteristic reflux symptoms without any alarm symptoms and/or other risk factors can be safely managed with a symptom-based strategy in acute and long-term care.
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Affiliation(s)
- A Morgner-Miehlke
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus Dresden
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26
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Koop H. [Diagnosis of gastroesophageal reflux disease and dyspepsia]. Praxis (Bern 1994) 2006; 95:1175-7. [PMID: 16909685 DOI: 10.1024/0369-8394.95.31.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Prerequisite in the diagnosis of heartburn and dyspepsia is a careful medical history which has to take into account both the differential diagnosis as well as alarm symptoms necessitating immediate and more extensive diagnostic procedures. The by far most prevalent diseases are gastroesophageal reflux disease (GERD), functional dyspepsia and peptic ulcers (today overwhelmingly due to ulcerogenic drugs but less common to Helicobacter pylori). In the further diagnostic evaluation, endoscopy is the most valuable tool revealing GERD as the dominating lesion whereas ulcers become much less frequent and malignancies are rare under 50 years of age; thus, empiric therapy is an attractive strategy in such younger population. Ultrasound investigations are recommended predominantly in cases with suspected biliary disease but not in general. Apart from basic laboratory blood tests further diagnostic procedures do not play a role in the primary evaluation in this setting.
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Affiliation(s)
- H Koop
- II. Innere Klinik-Gastroenterologie, HELIOS Klinikum Berlin-Buch, Berlin.
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Koop H, Schepp W, Müller-Lissner S, Madisch A, Micklefield G, Messmann H, Fuchs KH, Hotz J. [Consensus conference of the DGVS on gastroesophageal reflux]. Z Gastroenterol 2005; 43:163-4. [PMID: 15700206 DOI: 10.1055/s-2005-857870] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Koop
- II. Innere Klinik HELIOS Klinikum Berlin - Klinikum Buch, Berlin
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Koop H. [Acid suppression -- increased risk for pneumonia: resuscitation of an already refuted concept?]. Z Gastroenterol 2005; 43:687-8. [PMID: 16001351 DOI: 10.1055/s-2005-858260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- H Koop
- II. Innere Klinik, HELIOS Klinikum Berlin-Buch
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Abstract
Acid-suppressant drugs predominate in the treatment of gastroesophageal reflux disease. Proton pump inhibitors (PPI) are the first-line choice in both reflux esophagitis and nonerosive reflux disease (NERD). H(2)-blockers play a minor role and should not be used in erosive esophagitis. Other drugs such as mucosa-protective compounds, prokinetics, and antacids do not play a role, either alone oder in combination with acid suppressants. Proton pump inhibitors should also be used in maintenance therapy which is not associated with significant risks. There is a general trend toward on-demand treatment (already established in NERD). In cases refractory to therapy, the choice of drug should be critically analyzed (in case H(2)-blockers are used), and increasing the PPI dose is recommended; persistent symptoms should lead to reevaluation of the diagnosis. Asymptomatic Barrett's esophagus represents no indication for treatment, which in symptomatic patients is carried out in the normal fashion.
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Affiliation(s)
- H Koop
- II. Innere Klinik-Gastroenterologie, HELIOS Klinikum Berlin-Buch, Akademisches Lehrkrankenhaus der Charité-Universitätsmedizin in Berlin.
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Koop H, Classen M, Liebe S, Lütke A, Wienbeck M. Themenkomplex III: Therapie der nichterosiven Refluxkankheit (NERD). Z Gastroenterol 2005; 43:176-9. [PMID: 15700209 DOI: 10.1055/s-2005-857873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Koop H. [Diagnosis of gastro-esophageal reflux disease]. Praxis (Bern 1994) 2004; 93:1959-1962. [PMID: 15656006 DOI: 10.1024/0369-8394.93.47.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The diagnosis of gastro-esophageal reflux disease (GERD) predominantly relies on the patient's history and endoscopically visible alterations of the esophageal mucosa. Heartburn as the dominating symptom is highly suggestive of GERD though not specific whereas heartburn as one complaint among others is of limited value. Endoscopy enables the definite diagnosis of reflux esophagitis; however, the majority of patients (approximately 60%) does not exhibit erosions (non-erosive form of GERD). In these patients a short course of empiric PPI therapy gives valuable information about the presence or absence of GERD. Only those patients non-responsive to adequate PPI doses should undergo pH-metry. Other diagnostic investigation (e.g. manometry) should be restricted to selected cases.
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Affiliation(s)
- H Koop
- II. Innere Klinik, Gastroenterologie, HELIOS Klinikum Berlin-Buch.
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Koop H. [Helicobacter pylori: changes of indications for eradication therapy]. Dtsch Med Wochenschr 2004; 129 Suppl 2:S91-3. [PMID: 15368180 DOI: 10.1055/s-2004-831383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H Koop
- II. Innere Klinik -- Gastroenterologie, HELIOS Klinikum Berlin-Buch, Berlin.
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Abstract
Gastroesophageal reflux disease (GERD) is a very common disorder, mainly occurring in Western countries. The nonerosive form of GERD, which occurs in more than half of the patients affected, deserves particular attention. Administering symptomatic therapy without a prior endoscopic examination has become an attractive option, since it also provides diagnostic information. Proton-pump inhibitors (PPIs) have become established as the standard therapy, but new insights into the pathophysiology of the condition may lead to new treatment options using gamma-aminobutyric acid (GABA) agonists. Endoscopic therapy is still at the experimental stage and has yet to prove its value as an alternative to PPI and surgery. However, it is questionable whether antireflux surgery is more cost-effective in the longer term.[nl]Gastroenterologists are now much more aware of Barrett's esophagus than was the case a few years ago. Barrett's esophagus is a frequent finding in patients with reflux symptoms, but is a rare cause of death in affected patients. For several reasons, there is a large gap between recommendations regarding surveillance, on the one hand, and everyday practice on the other. New diagnostic procedures such as chromoendoscopy may allow better detection of premalignant and malignant alterations in metaplastic mucosa, but the safety of such techniques has been questioned. Prophylactic ablation is a debatable approach, whereas endoscopic interventions in patients with high-grade dysplasia and early adenocarcinoma are continuing to develop as attractive alternatives to esophagectomy in selected patients. It remains to be seen whether chemoprevention using cyclooxygenase-2 (COX-2) inhibitors should be carried out in high-risk patients with Barrett's esophagus, in order to prevent malignant transformation to esophageal cancer.
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Affiliation(s)
- H Koop
- Department of Medicine II/Gastroenterology, Helios Hospital, Buch Hospital (Academic Teaching Hospital of Humboldt University), Berlin, Germany.
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Jürgensen JS, Kettritz R, Schneider W, Koop H, Hildebrand TS, Frei U, Eckardt KU. Catastrophic antiphospholipid syndrome masquerading as ischaemic colitis. Rheumatol Int 2003; 23:204-6. [PMID: 12679877 DOI: 10.1007/s00296-003-0296-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2002] [Accepted: 01/03/2003] [Indexed: 11/24/2022]
Abstract
We describe a young woman whose initial presentation was dominated by acute diarrhoea. Life-threatening multiorgan failure rapidly ensued and necessitated mechanical ventilation and dialysis treatment. An initially elongated activated partial thromboplastin time prompted further coagulation tests that led to the detection of positive lupus anticoagulant, a highly elevated IgG-anticardiolipin (aCL) antibody titre, and prolonged dilute Russell's viper venom time. Histological examination of samples obtained during endoscopy revealed widespread intestinal thrombotic microangiopathy. In view of these serologic and histologic features, a diagnosis of the malignant variant of the antiphospholipid syndrome (APS), also termed 'catastrophic APS', was established. In spite of this syndrome's grim prognosis, the patient recovered following intensive anticoagulation and adjunct treatment with steroids and immunoglobulins.
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Affiliation(s)
- Jan Steffen Jürgensen
- Department of Nephrology and Medical Intensive Care, Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Abstract
Gastroesophageal reflux disease (GERD) is a common clinical problem. More frequent and extended acidic reflux episodes are characteristic of GERD, although substantial (nonacid) reflux per se is also observed in control individuals. Helicobacter pylori may protect some people from reflux disease, but others do not experience deterioration of GERD as a result of H. pylori eradication, for reasons so far unknown. Medical treatment, preferably with proton-pump inhibitors, is well established and is also recommended in endoscopy-negative forms of the disease, although the efficacy is less marked in comparison with erosive esophagitis. Surgery has emerged as an alternative to medical therapy, but the long-term results do not now appear to be as promising as was initially claimed. A number of new endoscopic techniques for the treatment of GERD have been developed, but the future for these is unclear. Barrett's esophagus develops in some patients with GERD for unknown reasons, and surveillance should be carried out in these patients due to the risk of subsequent malignant transformation. Several new approaches have been developed for detecting premalignant conditions, but these need to be investigated further. Ablative techniques are still under intensive investigation, and appear to be promising, at least in a subset of patients, although they are not devoid of major complications. Whether antireflux therapy, irrespective of the method used, can slow down the development of cancer is still an intriguing and clinically important question.
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Affiliation(s)
- H Koop
- Dept. of Medicine II, HELIOS Hospital Berlin, Buch Hospital (Academic Teaching Hospital of Humboldt University), Berlin, Germany.
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Abstract
We report experiments to transform Dictyostelium discoideum using a simple home-made particle gun. Stable transformants were obtained at frequencies of up to 2500 clones/microg DNA. This is five times more than we achieve with the same vector using electroporation protocols. We also show that the particle inflow gun can be used for analysis of developmentally regulated gene expression in a transient assay.
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Affiliation(s)
- B Wetterauer
- Zoologisches Institut der Universität München, Munich, Germany.
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Abstract
Peptic strictures are a rare complication of severe gastroesophageal reflux disease. An esophagobronchial fistula as a complication of a severe long-term reflux esophagitis with peptic stenosis is here described for the first time: A 43-year-old mentally disabled patient suffered from recurrent bronchopneumonia. Endoscopy revealed an esophagobronchial fistula originating in a peptic stricture. Under short-term fasting, intravenous feeding and application of a proton pump inhibitor (PPI) closure of this fistula was achieved within 4 days. Subsequently, dilatation was carried out. The case demonstrates that pulmonary complications in patients with peptic esophageal strictures may not only be due to aspiration of refluxate but--rarely--also to fistulae between the esophagus and the bronchial tree.
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Affiliation(s)
- M Klein
- Dept. of Medicine II, Gastroenterology, Klinikum Buch, Berlin, Germany
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Abstract
Despite continuous improvement of Helicobacter pylori (Hp) eradication therapy, new treatment regimens are necessary if established first-line treatments fail. In the present pilot study, a recently described rifabutin-based triple therapy was evaluated after preceding failure of triple therapy. Rifabutin (150 mg), amoxicillin (1 g), and lansoprazole (30 mg) were administered twice daily for 1 week to 25 patients infected with Hp who had previously failed to respond to eradication treatment and/or who had developed resistance to macrolides and nitroimidazoles. Four patients were lost to follow-up. Eradication rate of rifabutin-based triple therapy was 86% (18/21; per protocol) and 72% (18/25; intention-to-treat). Side effects were minimal. It is concluded that this new drug combination is an effective therapy for Hp strains resistant to clarithromycin or metronidazole; however, rifabutin-based treatment regimens for Hp eradication should be restricted to patients infected with resistant strains.
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Affiliation(s)
- H Bock
- Department of Medicine II, Klinikum Buch, Academic Teaching Hospital, Humboldt-University, Berlin, Germany.
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Koop I, Ilchmann R, Izzi L, Adragna A, Koop H, Barthelmes H. Detection of autoantibodies against tissue transglutaminase in patients with celiac disease and dermatitis herpetiformis. Am J Gastroenterol 2000; 95:2009-14. [PMID: 10950050 DOI: 10.1111/j.1572-0241.2000.02086.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Endomysial autoantibodies (EmA) are specific for celiac disease. The target antigen has been identified as tissue tranglutaminase (tTG). Our aim was to study the accuracy of a newly developed enzyme-linked immunosorbent assay (ELISA) for easy detection of tTG autoantibodies. METHODS Thirty-one sera from patients with histologically proven celiac disease and 23 healthy controls were examined for EmA using monkey esophagus and human umbilical cord as substrate. IgA-tTG autoantibodies were determined by newly developed ELISA. Additionally, sera from patients with dermatitis herpetiformis (n = 20), inflammatory bowel disease (IBD; n = 32), chronic liver disease (n = 36), and diabetes mellitus (n = 19) were tested. RESULTS The sensitivity of the tTG autoantibody ELISA accounted for 90% detection in patients with untreated celiac disease. The specificity was 76% owing to positive values in the lower range in patients with IBD (15%), chronic liver disease (36%), and diabetes (22%), all of whom were negative for EmA. In dermatitis herpetiformis patients 90% were EmA-positive. Of these, only 47% showed elevated tTG autoantibodies. Preincubation of sera from dermatitis patients with tTG abolished immunofluorescent staining of endomysial structures. CONCLUSION Detection of mid- to high-titer tTG autoantibodies is highly specific for celiac disease. However, in the low-titer range, overlap exists with liver disease, IBD, and diabetes. Tissue transglutaminase autoantibodies may evolve as a new screening and follow-up method for celiac disease. Although tTG seems to be a major autoantigen in dermatitis herpetiformis, the low sensitivity of both tTG ELISA and immunofluorescence using human umbilical cord suggests differential involvement of tTG in this disease.
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Affiliation(s)
- I Koop
- Department of Internal Medicine, Charité, Humboldt-University, Berlin
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Abstract
Gastroesophageal reflux disease (GERD) is still an important clinical problem. Continuing efforts are being made to establish a classification of the condition that would allow improved communications for both clinical and research purposes. In medical treatment, the trends are toward proton-pump inhibitor therapy at all stages of GERD, calling into question the role of endoscopy for tailoring individual therapy. Arguments against the use of H. pylori eradication therapy in GERD have gained importance. Surgeons are continuing to report excellent results with fundoplication, but careful studies are needed to prove whether antireflux surgery is really capable of saving costs, as its proponents claim. Barrett's esophagus is still a topic of lively interest. Since there is no method of primary prevention, endoscopy has a crucial role in detecting affected patients and guiding them toward one of the various surveillance strategies--which are not yet clearly established. The debate over short-segment Barrett's esophagus, and especially over "microscopic" Barrett's esophagus (at the squamocolumnar junction), has not yet been resolved. However, there is now less doubt that GERD is a condition associated with a substantially higher risk for the development of esophageal adenocarcinoma. Given this risk of malignant transformation, there is continuing competition between different ablation techniques; however, careful data from much larger populations will be needed before ablation reaches the stage of broad clinical application. Until specific guidelines become available, patients with Barrett's esophagus should receive endoscopic follow-up until it can be ascertained which individuals are at risk for cancer and require ablation of Barrett's mucosa.
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Affiliation(s)
- H Koop
- Second Dept. of Medicine, Klinikum Buch, Academic Teaching Hospital, Berlin, Germany.
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Stolte M, Meining A, Seifert E, Koop H. Reply. Virchows Arch 1999. [DOI: 10.1007/s004280050414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stolte M, Meining A, Koop H, Seifert E. Eradication of Helicobacter pylori heals atrophic corpus gastritis caused by long-term treatment with omeprazole. Virchows Arch 1999; 434:91-4. [PMID: 10071241 DOI: 10.1007/s004280050310] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Long-term treatment with proton pump inhibitors in patients with Helicobacter pylori gastritis can lead to atrophic changes in the corpus mucosa. What is still unclear, however, is whether this atrophy can regress in response to Helicobacter pylori eradication. We report on a male patient with Helicobacter pylori gastritis receiving long-term treatment (4 years) with omeprazole for gastrooesophageal reflux disease, who developed autoaggressive gastritis with progressive atrophy, hypochlorhydria, hypergastrinaemia and nodular ECL-cell hyperplasia. To determine whether these changes might be induced to regress, Helicobacter pylori eradication therapy was administered. Ten months after Helicobacter pylori eradication autoaggressive lymphocytic infiltrates were no longer detectable, and the glands in the corpus mucosa had normalised despite continued treatment with omeprazole - a finding that was confirmed at two further follow-up surveys performed at 6-month intervals. This case report shows that atrophy of the corpus mucosa developing under long-term treatment with a proton pump inhibitor can be cured by eradicating Helicobacter pylori.
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Affiliation(s)
- M Stolte
- Department of Pathology, Klinikum Bayreuth, Germany
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43
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Koop H. [Prevention of gastric cancer: Helicobacter--eradication and immunization]. Praxis (Bern 1994) 1998; 87:1233-1235. [PMID: 9789457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Adenocarcinoma of the stomach (excluding carcinoma of the cardia) has been established as a consequence of gastric infection with Helicobacter pylori (H.p.). The specific role of H.p. in the pathogenesis is unknown so far; yet, several other factors are involved in the development of the neoplasia. Since-in contrast to the wide prevalence of the infection-only very few persons will develop gastric carcinomas, prophylaxis by H.p. eradication is not advisable. This may change after a vaccination has become available; however, studies on the characterization of efficient vaccines are still under investigation. Thus, H.p. eradication treatment may, if at all, be used as prophylaxis for gastric carcinoma only in clinical studies and in subjects at a high risk for this tumour.
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Affiliation(s)
- H Koop
- II. Innere Klinik-Gastroenterologie, Klinikum Buch, Berlin
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Schwab GP, Blum AL, Bodner E, Dallemagne B, Glaser K, Koop H, Pace F, Rösch W, Siewert JR, Wetscher G. Gastro-oesophageal reflux disease: medical or surgical treatment? Report of an interactive workshop. J Gastroenterol Hepatol 1997; 12:785-9. [PMID: 9504886 DOI: 10.1111/j.1440-1746.1997.tb00372.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.
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Affiliation(s)
- G P Schwab
- Universitätsklinik für Chirurgie, Innsbruck, Austria
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45
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Mössner J, Koop H, Porst H, Wübbolding H, Schneider A, Maier C. One-year prophylactic efficacy and safety of pantoprazole in controlling gastro-oesophageal reflux symptoms in patients with healed reflux oesophagitis. Aliment Pharmacol Ther 1997; 11:1087-92. [PMID: 9663834 DOI: 10.1046/j.1365-2036.1997.00242.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Pantoprazole is a benzimidazole derivative which selectively inhibits the proton pump H+. K+-ATPase necessary for the final step in gastric acid secretion. AIM To investigate the tolerability and the prophylactic effect of pantoprazole 40 mg once daily on relapse in patients whose reflux oesophagitis had been healed. METHODS The safety of pantoprazole 40 mg once daily was assessed in an open 1-year trial on 222 patients whose reflux oesophagitis had been healed with omeprazole or pantoprazole. Relapse was defined as endoscopically-confirmed reflux oesophagitis (at least Grade I), with endoscopies being performed for patients experiencing 3 consecutive days of disease-specific symptoms. RESULTS Kaplan-Meier survival analysis at 6 and 12 months gave estimated treatment failure rates of 2% and 6% from confirmed relapses (per-protocol), and of 9% and 30% for a worst-case group (all withdrawals counted as failures). The only population shift in laboratory variables was a doubling of the median serum gastrin level over the first 6 months; thereafter it stabilized. Fifty-four (24%) patients experienced adverse events; 15 of these withdrew. Serious adverse events were reported for 12 patients. CONCLUSIONS Pantoprazole appears to be highly effective and to have a good safety profile for long-term prophylaxis of reflux oesophagitis.
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Affiliation(s)
- J Mössner
- Universitätsklinikum Leipzig, Germany
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46
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Sass NL, Koop H. [Long-term gastrointestinal monitoring--pH-metry and mobility]. Internist (Berl) 1997; 38:811-9. [PMID: 9410828 DOI: 10.1007/s001080050091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- N L Sass
- II. Innere Klinik-Gastroenterologie, Klinikum Buch, Berlin
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47
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Beckh K, Dirks A, Koop I, Koop H, Adler G. Impairment of hepatic transport processes in perfused rat liver by the specific CCK receptor antagonist loxiglumide. Res Exp Med (Berl) 1997; 197:125-135. [PMID: 9406280 DOI: 10.1007/s004330050062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The specific cholecystokinin (CCK) receptor antagonist loxiglumide has been used in several human and animal studies to investigate the role of CCK in gastrointestinal physiology. In the present study, the interference of this CCK receptor antagonist with hepatic transport processes was characterized in the perfused rat liver. Indocyanine green, an organic dye which is secreted into bile without being metabolized, was taken up in control experiments at a rate of 68.1 +/- 7.7%. The CCK receptor antagonist lowered the extraction to 0.5 +/- 2.6% (P < 0.001). The compound diminished the hepatic extraction of CCK-8 from 90.95 +/- 2.60% to 4.90 +/- 1.95% (P < 0.001) and of gastrin from 22.2 +/- 1.1% to 8.2 +/- 1.9% (P < 0.001). The hepatic extraction of lidocaine, which is metabolized by the cytochrome P450 system, was only slightly altered. For leukotrienes and taurocholate, the rate-limiting step for transport into bile is secretion across the canalicular membrane; the hepatic extraction of leukotriene D4 was markedly diminished by loxiglumide whereas the transport of taurocholate was only slightly inhibited. The present study demonstrates that the specific CCK receptor antagonist loxiglumide diminished the hepatic extraction of various substances, including peptides and organic anions. It did not interfere with the cytochrome P450 system. The pronounced reduction of hepatic uptake of indocyanine green and leukotriene may be due to an interference with the transport system of these substances in the liver.
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Affiliation(s)
- K Beckh
- Department of Internal Medicine, University of Ulm, Germany
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48
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Koop H. [Therapy of Helicobacter infection]. Praxis (Bern 1994) 1996; 85:1448-1450. [PMID: 8975355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Infection with Helicobacter pylori (H.p.) leads to mostly asymptomatic chronic gastritis. However, H.p. plays a role in peptic ulcer, giant fold gastritis (Menetrier's disease), and possibly in gastric carcinoma and low-grade MALT lymphoma. Whether functional dyspepsia also represents a Helicobacter-induced entity is questionable. H.p. should be eradicated in patients with peptic ulcer disease, Menetrier+s disease and - but in controlled studies only - in MALT lymphomas. Triple therapy with low-dose proton pump inhibitors and two antibiotics is the most favourable treatment compared to dual therapy with omeprazole and amoxicillin/clarithromycin despite the unresolved question of the development of drug resistance.
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Affiliation(s)
- H Koop
- II. Innere Klinik-Gastroenterologie, Klinikum Buch, Berlin
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49
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Koop I, Schindler M, Bosshammer A, Scheibner J, Stange E, Koop H. Physiological control of cholecystokinin release and pancreatic enzyme secretion by intraduodenal bile acids. Gut 1996; 39:661-7. [PMID: 9026479 PMCID: PMC1383388 DOI: 10.1136/gut.39.5.661] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The physiological relevance of duodenal bile acids in the control of cholecystokinin release and pancreatic enzyme secretion is still unknown. AIMS To provide a near physiological situation by perfusing a bile acid mixture mimicking the individual endogenous bile acid composition of the person under investigation. For maximal reduction of endogenous bile output the CCK-A receptor antagonist loxiglumide was infused intravenously. SUBJECTS AND METHODS Seven healthy volunteers were studied on four different days by a duodenal marker perfusion technique. The individual bile acid composition in duodenal juice and test meal stimulated bile acid output was assessed on day 1. Bile acids were perfused at an amount of 30 or 100% as determined on day 1 in combination with the test meal in the presence or absence of loxiglumide. Pancreatic enzymes, bilirubin, and bile acid output were determined in duodenal juice. Plasma cholecystokinin (CCK) and plasma pancreatic polypeptide (PP) were measured radioimmunologically. RESULTS Bile acid perfusion did not significantly alter stimulated pancreatic enzyme, bilirubin or bile acid output or plasma CCK. Loxiglumide did not alter basal CCK release but increased test meal stimulated CCK output fourfold (p < 0.05). The addition of bile acids to the test meal at a dose resembling 30% of bile acid output as determined on day 1 prevented this increase. Plasma PP concentration remained unchanged by bile acids and were mostly undetectable during loxiglumide infusion. CONCLUSIONS The CCK producing cell is under constant suppression by intraduodenal bile acids which cannot be further enhanced by a physiological bile acid mixture. However, removal of duodenal bile acids by inhibition of gall bladder contraction unmasks this suppression leading to a dramatic increase in plasma CCK levels. As little as one third of postprandially released bile acids completely reverse this effect. Bile acids are the most important luminal regulator of CCK release in humans.
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Affiliation(s)
- I Koop
- Department of Internal Medicine, University Hospital, Marburg, Germany
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50
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Koop H, Kuly S, Flüg M, Eissele R, Mönnikes H, Rose K, Lühmann R, Schneider A, Fischer R, Arnold R. Intragastric pH and serum gastrin during administration of different doses of pantoprazole in healthy subjects. Eur J Gastroenterol Hepatol 1996; 8:915-8. [PMID: 8889461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE AND DESIGN The effect of increasing doses of pantoprazole, a newly developed proton pump inhibitor, given at once daily doses of 40, 80 and 120 mg, on intragastric pH and serum gastrin profiles was studied in 15 healthy subjects in a randomized, double-blind, crossover study and compared to recordings without therapy. Measurements of intragastric pH and serum gastrin were performed on the 7th day of treatment by continuous pH recording and radioimmunoassay in blood samples obtained in 1-h intervals, respectively. RESULTS Pantoprazole significantly increased gastric pH above basal at all pantoprazole doses studied: median 24-h pH rose from 1.2 without therapy to 3.4, 3.3 and 3.6 at 40, 80 and 120 mg daily, respectively. The corresponding integrated 24-h gastrin output was 1632, 2338 and 2248 pg/ml x 24 h compared to 575 pg/ml x 24 h without pantoprazole. There was no interindividual correlation between values of 24-h median pH and 24-h gastrin output at any pantoprazole dose studied. However, fasting gastrin levels closely correlated with 24-h gastrin output (r = 0.789; P < 0.0001). The acid inhibitory effect was significantly (P < 0.01) augmented in Helicobacter pylori positive subjects. CONCLUSION It is concluded that pantoprazole is an effective inhibitor of gastric acid secretion. Increasing a single pantoprazole dose above 40 mg does not lead to increased median pH elevation. The individual extent of acid inhibition does not predict the magnitude of gastrin elevation. Acid inhibition appears more efficient in Helicobacter pylori positive subjects.
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Affiliation(s)
- H Koop
- Department of Internal Medicine II, Klinikum Buch, Berlin, Germany
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