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Hofer H, Willheim-Polli C, Knoflach P, Gabriel C, Vogel W, Trauner M, Müller T, Ferenci P. Correction: Identification of a novel Wilson disease gene mutation frequent in Upper Austria: a genetic and clinical study. J Hum Genet 2021; 66:1199. [PMID: 34131283 DOI: 10.1038/s10038-021-00918-w] [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: 11/09/2022]
Affiliation(s)
- Harald Hofer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claudia Willheim-Polli
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Knoflach
- Department of Internal Medicine I, Klinikum Wels Grieskirchen, Wels, Austria
| | | | - Wolfgang Vogel
- Department of Gastroenterology and Hepatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Müller
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Ferenci
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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Bilgilier C, Stadlmann A, Makristathis A, Thannesberger J, Kastner MT, Knoflach P, Steiner P, Schöniger-Hekele M, Högenauer C, Blesl A, Datz C, Huber-Schönauer U, Schöfl R, Wewalka F, Püspök A, Mitrovits N, Leiner J, Tilg H, Effenberger M, Moser M, Siebert F, Hinterberger I, Wurzer H, Stupnicki T, Watzinger N, Gombotz G, Hubmann R, Klimpel S, Biowski-Frotz S, Schrutka-Kölbl C, Graziadei I, Ludwiczek O, Kundi M, Hirschl AM, Steininger C. Prospective multicentre clinical study on inter- and intrapatient genetic variability for antimicrobial resistance of Helicobacter pylori. Clin Microbiol Infect 2017; 24:267-272. [PMID: 28669844 DOI: 10.1016/j.cmi.2017.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We report on a large prospective, multicentre clinical investigation on inter- and intrapatient genetic variability for antimicrobial resistance of Helicobacter pylori. METHODS Therapy-naive patients (n = 2004) who had undergone routine diagnostic gastroscopy were prospectively included from all geographic regions of Austria. Gastric biopsy samples were collected separately from antrum and corpus. Samples were analysed by histopathology and real-time PCR for genotypic resistance to clarithromycin and quinolones. Clinical and demographic information was analysed in relation to resistance patterns. RESULTS H. pylori infection was detected in 514 (26%) of 2004 patients by histopathology and confirmed in 465 (90%) of 514 patients by real-time PCR. PCR results were discordant for antrum and corpus in 27 (5%) of 514 patients, indicating inhomogeneous infections. Clarithromycin resistance rates were 17% (77/448) and 19% (84/455), and quinolone resistance rates were 12% (37/310) and 10% (32/334) in antrum and corpus samples, respectively. Combination of test results per patient yielded resistance rates of 21% (98/465) and 13% (50/383) for clarithromycin and quinolones, respectively. Overall, infection with both sensitive and resistant H. pylori was detected in 65 (14%) of 465 patients. CONCLUSIONS Anatomically inhomogeneous infection with different, multiple H. pylori strains is common. Prospective clinical study design, collection of samples from multiple sites and microbiologic methods that allow the detection of coinfections are mandatory for collection of reliable data on antimicrobial resistance patterns in representative patient populations. (ClinicalTrials.gov identifier: NCT02925091).
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Affiliation(s)
- C Bilgilier
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria
| | - A Stadlmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria
| | - A Makristathis
- Department of Laboratory Medicine, Division of Clinical Microbiology, Austria
| | - J Thannesberger
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria
| | - M-T Kastner
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria
| | - P Knoflach
- Department of Internal Medicine I, Klinikum Wels-Grieskirchen, Wels, Austria
| | - P Steiner
- Department of Internal Medicine I, Klinikum Wels-Grieskirchen, Wels, Austria
| | - M Schöniger-Hekele
- Department of Medicine III, Division of Gastroenterology and Hepatology, Austria
| | - C Högenauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - A Blesl
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - C Datz
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private Medical University Salzburg, Oberndorf bei Salzburg, Austria
| | - U Huber-Schönauer
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private Medical University Salzburg, Oberndorf bei Salzburg, Austria
| | - R Schöfl
- Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Ordensklinikum Linz, Elisabethinen, Austria
| | - F Wewalka
- Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Ordensklinikum Linz, Elisabethinen, Austria
| | - A Püspök
- Department of Internal Medicine II, Hospital of the Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - N Mitrovits
- Department of Internal Medicine II, Hospital of the Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - J Leiner
- Department of Internal Medicine, Ladislaus Batthyány-Strattmann Hospital Kittsee, Kittsee, Austria
| | - H Tilg
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - M Effenberger
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - M Moser
- Ordination Dr Moser, Hall/Tyrol, Austria
| | - F Siebert
- Department of Internal Medicine, Hospital of the Brothers of Saint John of God St Veit/Glan, St Veit, Austria
| | - I Hinterberger
- Department of Internal Medicine, Hospital of the Brothers of Saint John of God St Veit/Glan, St Veit, Austria
| | - H Wurzer
- Department of Internal Medicine, LKH Graz South-West, Graz, Austria
| | - T Stupnicki
- Department of Internal Medicine, LKH Graz South-West, Graz, Austria
| | - N Watzinger
- Department of Internal Medicine, Hospital Group Feldbach-Fürstenfeld, Feldbach, Austria
| | - G Gombotz
- Department of Internal Medicine, Hospital Group Feldbach-Fürstenfeld, Feldbach, Austria
| | - R Hubmann
- Ordination Dr Rainer Hubmann, Linz, Austria
| | - S Klimpel
- Ordination Dr Siegfried Klimpel, Traun, Austria
| | | | | | - I Graziadei
- Department of Internal Medicine, Academic Teaching Hospital, Hall/Tyrol, Austria
| | - O Ludwiczek
- Department of Internal Medicine, Academic Teaching Hospital, Hall/Tyrol, Austria
| | - M Kundi
- Department of Environmental Health, Center for Public Health, Medical University of Vienna, Austria
| | - A M Hirschl
- Department of Laboratory Medicine, Division of Clinical Microbiology, Austria
| | - C Steininger
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria.
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Dolak W, Schwaighofer H, Hellmich B, Stadler B, Spaun G, Plieschnegger W, Hebenstreit A, Weber-Eibel J, Siebert F, Emmanuel K, Knoflach P, Gschwantler M, Vogel W, Trauner M, Püspök A. Photodynamic therapy with polyhematoporphyrin for malignant biliary obstruction: A nationwide retrospective study of 150 consecutive applications. United European Gastroenterol J 2016; 5:104-110. [PMID: 28405328 DOI: 10.1177/2050640616654037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/17/2016] [Accepted: 05/16/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Photodynamic therapy (PDT) is a palliative treatment for malignant biliary obstruction. OBJECTIVE The objective of this article is to assess the feasibility and safety of this technique. METHODS In this nationwide, retrospective study of prospectively collected clinical data, all patients treated with PDT using polyhematoporphyrin in Austria from March 2004 to May 2013 were included. Feasibility, adverse events, stent patency and mortality rates were investigated. RESULTS Eighty-eight patients (54 male, 34 female, median age 69 years) underwent 150 PDT procedures at seven Austrian referral centers for biliary endoscopy. The predominant underlying disease was Klatskin tumor (79/88). All PDT procedures were feasible without technical issues. Cholangitis was the most frequent adverse event (21/88). Stent patency was 246 days (95% CI 203-289) median and was significantly longer for metal than for plastic stents (269 vs. 62 days, p < 0.01). The median survival was 12.4 months (95% CI 9.7-14.9 m) calculated from first PDT and 15.6 months (95% CI 12.3-18.7 m) calculated from initial diagnosis. In patients suffering from biliary tract cancer, Cox regression revealed the number of PDT treatment sessions as the only independent predictor of survival at a multivariate analysis (p = 0.048). CONCLUSION PDT using polyhematoporphyrin was feasible and safe in this nationwide analysis. Survival data suggest a benefit of PDT in this unselected real-life patient population. Prospective trials comparing PDT to other palliative treatments will help to define its role in the management of malignant biliary obstruction. The study is registered at ClinicalTrials.gov number: NCT02504957.
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Affiliation(s)
- Werner Dolak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Hubert Schwaighofer
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Brigitte Hellmich
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria
| | - Bernhard Stadler
- Department of Internal Medicine I, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Georg Spaun
- Department of Surgery, Barmherzige Schwestern Linz, Linz, Austria
| | | | - Arnold Hebenstreit
- Department of Internal Medicine I, Klinikum Klagenfurt am Wörthersee, Austria
| | - Jutta Weber-Eibel
- Department of Internal Medicine I, Klinikum Klagenfurt am Wörthersee, Austria
| | - Franz Siebert
- Department of Internal Medicine, Barmherzige Brüder St. Veit an der Glan, Austria
| | - Klaus Emmanuel
- Department of Surgery, Barmherzige Schwestern Linz, Linz, Austria
| | - Peter Knoflach
- Department of Internal Medicine I, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Wolfgang Vogel
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Andreas Püspök
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Novacek G, Dejaco C, Gröchenig H, Högenauer C, Knoflach P, Miehsler W, Moschen A, Petritsch W, Vogelsang H, Tilg H. Vedolizumab in der Behandlung der Colitis ulcerosa und des Morbus Crohn – ein Konsensus der Arbeitsgruppe „Chronisch Entzündliche Darmerkrankungen“ der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie. Z Gastroenterol 2016; 54:456-67. [DOI: 10.1055/s-0042-103694] [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: 10/22/2022]
Affiliation(s)
- G. Novacek
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Wien, Austria
| | - C. Dejaco
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Wien, Austria
| | - H. Gröchenig
- Abteilung für Innere Medizin, Krankenhaus der Barmherzige Brüder, St. Veit an der Glan, Austria
| | - C. Högenauer
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Graz, Austria
| | - P. Knoflach
- 1. Interne Abteilung, Klinikum Wels, Austria
| | - W. Miehsler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Austria
| | - A. Moschen
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Austria
| | - W. Petritsch
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Graz, Austria
| | - H. Vogelsang
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Wien, Austria
| | - H. Tilg
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Austria
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Ferlitsch M, Heinze G, Salzl P, Britto-Arias M, Waldmann E, Reinhart K, Bannert C, Fasching E, Knoflach P, Weiss W, Trauner M, Ferlitsch A. Sex is a stronger predictor of colorectal adenoma and advanced adenoma than fecal occult blood test. Med Oncol 2014; 31:151. [PMID: 25115743 DOI: 10.1007/s12032-014-0151-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/27/2014] [Indexed: 02/08/2023]
Abstract
Due to high costs and limited availability of screening colonoscopy, some screening programs require a positive fecal occult blood test (FOBT) before screening colonoscopy is remunerated. As male sex is a strong predictor of adenoma and advanced adenoma, we evaluated whether a positive FOBT or male sex is a stronger risk factor for adenoma and advanced adenoma. FOBT and screening colonoscopy results from 18.665 consecutive patients participating in a "national health check program" between 2009 and 2011 were included in this cohort study. Age-corrected adenoma detection rates (ADR), advanced adenoma detection rates (AADR) and carcinoma detection rates were calculated for men and women according to FOBT result separately. ADR and AADR in FOBT-positive men (34.6 and 11.8 %) and FOBT-negative men (29.1 and 7.6 %) were higher than ADR and AADR in FOBT-positive women (20 and 6.9 %) and in FOBT-negative women (17.6 and 4.4 %), (p = 0.0003). Men with negative FOBT were at higher risk of having an adenoma and advanced adenoma than women with positive FOBT (p < 0.0001). Odds ratios of a positive FOBT for ADR and AADR were 1.3 (1.1-1.5) (p = 0.0047) and 1.6 (1.2-2.1) (p < 0.0001), respectively. Odds ratios of male sex to predict ADR and AADR were significantly higher with 1.9 (1.8-2.1) and 1.8 (1.6-2), respectively (p < 0.001). Male sex is a stronger predictor for colorectal adenoma and advanced adenoma than positive FOBT. These results should be taken into account analyzing FOBT-based screening programs.
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Affiliation(s)
- Monika Ferlitsch
- Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Freyung 6, 1010, Vienna, Austria,
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Kübeck M, Stöckl V, Stainer W, Schermaier T, Preisinger J, Schauer W, Hochleitner U, Höbling W, Barth TFE, Stadler B, Knoflach P, Kirchgatterer A. [Cystic echinococcosis and hepatocellular carcinoma--a coincidence? A case report]. Z Gastroenterol 2014; 52:657-62. [PMID: 25026008 DOI: 10.1055/s-0034-1366528] [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: 10/25/2022]
Abstract
INTRODUCTION The coincidence of echinococcosis and hepatocellular carcinoma (HCC) is quite rare. We report the case of a 45-year-old man who was admitted to our hospital because of abdominal pain in the right upper quadrant and jaundice. Clinical features and diagnostics: There was no history of weight loss or fever. No abdominal mass was palpable. The laboratory reports showed increased transaminase levels. Ultrasonography revealed an inhomogenous, cystic lesion measuring 6 cm in diameter in the segments VI and VII. Serology for echinococcosis was negative, alpha-fetoprotein (AFP) was considerably increased. CT scan showed a solid mass of 3,7 cm in diameter adjacent to the cystic lesion. THERAPY AND COURSE Anthelminthic therapy with albendazole caused a massive increase of cholestasis parameters and treatment had to be stopped. The simultaneous occurrence of serologically negative cystic echinococcosis and HCC was suspected and partial liver resection was performed. Histological examination confirmed both diagnoses and tumor resection in healthy tissue. 5 months after resection CT scan showed multicentric HCC affecting the whole liver. Palliative therapy with sorafenib was established. DISCUSSION The coincidence of HCC and cystic echinococcosis in the non-cirrhotic liver of a young man is a rare event. Despite resection in healthy tissue multicentric HCC was diagnosed 5 months later. Only few cases of simultaneous occurrence of HCC and echinococcosis have been published so far. Some authors considered echinococcosis as a trigger for HCC. A causal link between both entities has not been demonstrated until now.
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Affiliation(s)
- M Kübeck
- Innere Medizin V, Klinikum Wels-Grieskirchen, Grieskirchen
| | - V Stöckl
- Innere Medizin V, Klinikum Wels-Grieskirchen, Grieskirchen
| | - W Stainer
- Innere Medizin V, Klinikum Wels-Grieskirchen, Grieskirchen
| | - T Schermaier
- Abteilung für Chirurgie II, Klinikum Wels-Grieskirchen, Wels
| | - J Preisinger
- Abteilung für Chirurgie II, Klinikum Wels-Grieskirchen, Wels
| | - W Schauer
- Abteilung für Chirurgie II, Klinikum Wels-Grieskirchen, Wels
| | - U Hochleitner
- Institut für Pathologie, Klinikum Wels-Grieskirchen, Wels
| | - W Höbling
- Institut für Pathologie, Klinikum Wels-Grieskirchen, Wels
| | - T F E Barth
- Institut für Pathologie, Universitätsklinikum Ulm
| | - B Stadler
- Innere Medizin I, Klinikum Wels-Grieskirchen, Wels
| | - P Knoflach
- Innere Medizin I, Klinikum Wels-Grieskirchen, Wels
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Schwarz S, Suppan M, Höbling W, Grünberger A, Nömeyer R, Hubner D, Knoflach P. [Non-cirrhotic portal hypertension presented by acute upper gastrointestinal bleeding 7 years after oxaliplatin-chemotherapy]. Z Gastroenterol 2014; 52:654-656. [PMID: 25026007 DOI: 10.1055/s-0034-1366415] [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: 06/03/2023]
Abstract
After having received adjuvant FOLFOX treatment consisting of oxaliplatin, folinic acid and fluoruracil following hemicolectomy in colon cancer 7 years ago, the findings of non-cirrhotic portal hypertension presented by acute upper gastrointestinal bleeding in a 49-year old woman were interpreted as oxaliplatin-associated. Imaging techniques, hepatic venous pressure measurement and liver biopsy supported pre-sinusoidal damage due to NRH (nodular regenerative hyperplasia) as the underlying cause, even though histological findings were moderate. Following primary endoscopic treatment, a stable condition has thus far been achievable with standard drug therapy.
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Affiliation(s)
- S Schwarz
- Abteilung für Innere Medizin I, Klinikum Wels, Österreich
| | - M Suppan
- Abteilung für Innere Medizin I, Klinikum Wels, Österreich
| | - W Höbling
- Institut für Pathologie, Klinikum Wels, Österreich
| | - A Grünberger
- Institut für Radiologie, Klinikum Wels, Österreich
| | - R Nömeyer
- Abteilung für Innere Medizin I, Klinikum Wels, Österreich
| | - D Hubner
- Abteilung für Innere Medizin I, Klinikum Wels, Österreich
| | - P Knoflach
- Abteilung für Innere Medizin I, Klinikum Wels, Österreich
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Novacek G, Dejaco C, Knoflach P, Moschen A, Petritsch W, Vogelsang H, Reinisch W. [Adalimumab for the treatment of ulcerative colitis--a consensus report by the working group inflammatory bowel diseases of the Austrian Society of Gastroenterology and Hepatology]. Z Gastroenterol 2014; 52:204-211. [PMID: 24488763 DOI: 10.1055/s-0033-1355818] [Citation(s) in RCA: 1] [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: 06/03/2023]
Abstract
TNF alpha antibodies have clearly improved the outcome of moderately to severely active ulcerative colitis. Adalimumab is the first fully human, monoclonal TNF alpha antibody, which is administered subcutaneously. Since April 2012 adalimumab is approved for the treatment of moderately to severely active ulcerative colitis in patients who have not responded despite a full and adequate course of therapy with a corticosteroid and an immunosuppressant or who are intolerant to or have medical contraindications for such therapies. Adalimumab can induce and maintain clinical remission and mucosal healing compared to placebo in moderately to severely active ulcerative colitis, can reduce the rate of ulcerative colitis related hospitalisations and improve health-related quality of life. The response can be observed after two weeks of treatment. The safety profile of adalimumab is comparable to those of other TNF alpha inhibitors. Studies on the treatment of ulcerative colitis with adalimumab did not reveal new safety aspects. The present consensus report by the Working Group Inflammatory Bowel Diseases of the Austrian Society of Gastroenterology and Hepatology presents the existing evidence of adalimumab for the treatment of ulcerative colitis and is aimed to assist as code of its practice.
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Affiliation(s)
- G Novacek
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Österreich
| | - C Dejaco
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Österreich
| | - P Knoflach
- Klinikum Wels, 1. Interne Abteilung, Wels, Österreich
| | - A Moschen
- Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin I, Innsbruck, Österreich
| | - W Petritsch
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Graz, Österreich
| | - H Vogelsang
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Österreich
| | - W Reinisch
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Österreich
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Reinhart K, Bannert C, Dunkler D, Salzl P, Trauner M, Renner F, Knoflach P, Ferlitsch A, Weiss W, Ferlitsch M. Prevalence of flat lesions in a large screening population and their role in colonoscopy quality improvement. Endoscopy 2014; 45:350-6. [PMID: 23616125 DOI: 10.1055/s-0032-1326348] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND STUDY AIMS Flat lesions pose new challenges for endoscopists, but the importance of detecting them is still controversial. Most screening studies do not survey macroscopic polyp morphology. The aims were to evaluate the percentage of flat polyp findings in a large asymptomatic adult screening population (n = 52 521), to assess the impact of shape and size on malignant transformation, and to assess the role of flat lesions regarding quality assurance in colorectal cancer prevention. MATERIAL AND METHODS Retrospective analysis of screening colonoscopies performed between 2007 and 2011 according to the Austrian "Quality management for colon cancer prevention" program. RESULTS 17 771 patients with polyps were included in the study. Patients with flat polyps represented 24.2 % (n = 4293), 62.4 % (n = 11 097) were classified as having sessile and 13.4 % (n = 2381) as pedunculated polyps. Among those with flat polyps 51.4 % had adenomas (n = 2207). High grade dysplasia (HGD) was found in 2.1 % (n = 47) of flat adenomas, in 1.5 % (n = 89) of sessile adenomas and 4.7 % (n = 92) of pedunculated adenomas (P < 0.0001. The risk for containing HGD was 1.0 % for flat lesions ≤ 10 mm in size compared with 10.3 % for lesions > 10 mm, and 1.0 % for polypoid lesions ≤ 10 mm compared with 9.3 % for lesions > 10 mm (P < 0.0001). Multivariable logistic regression showed that polyp size (P < 0.0001) but not polyp shape (P = 0.438) is an independent predictor for HGD. Adenoma detection rate (ADR) correlated weakly with the flat polyp detection rate (Pearson r = 0.24). CONCLUSION Malignant potential of polyps is mostly affected by size but not by shape. Since flat polyp detection rate only correlates poorly with ADR we do not recommend its incorporation in quality assured screening colonoscopy.
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Affiliation(s)
- K Reinhart
- Austrian Society for Gastroenterology and Hepatology: Quality Assurance Working Group
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10
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Papay P, Miehsler W, Tilg H, Petritsch W, Reinisch W, Mayer A, Haas T, Kaser A, Feichtenschlager T, Fuchssteiner H, Knoflach P, Vogelsang H, Platzer R, Tillinger W, Jaritz B, Schmid A, Blaha B, Dejaco C, Sobala A, Weltermann A, Eichinger S, Novacek G. Clinical presentation of venous thromboembolism in inflammatory bowel disease. J Crohns Colitis 2013; 7:723-9. [PMID: 23127785 DOI: 10.1016/j.crohns.2012.10.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [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: 09/18/2012] [Accepted: 10/13/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease (IBD) are at increased risk of venous thromboembolism (VTE), but data on frequency, site of thrombosis and risk factors are limited. We sought to determine prevalence, incidence as well as location and clinical features of first VTE among IBD patients. METHODS We evaluated a cohort of 2811 IBD patients for a history of symptomatic, objectively confirmed first VTE, recruited from 14 referral centers. Patients with VTE before IBD diagnosis or cancer were excluded. Incidence rates were calculated based on person-years from IBD diagnosis to first VTE or end of follow-up, respectively. RESULTS 2784 patients (total observation time 24,778 person-years) were analyzed. Overall, of 157 IBD patients with a history of VTE, 142 (90.4%) had deep vein thrombosis (DVT) and/or pulmonary embolism (PE), whereas 15 (9.6%) had cerebral, portal, mesenteric, splenic or internal jugular vein thrombosis. The prevalence and incidence rate of all VTE was 5.6% and 6.3 per 1000 person years, respectively. Patients with VTE were older at IBD diagnosis than those without VTE (34.4±14.8years vs 32.1±14.4years, p=0.045), but did not differ regarding sex, underlying IBD and disease duration. 121 (77.1%) VTE were unprovoked, 122 (77.7%) occurred in outpatients and 78 (60.9%) in patients with active disease. Medication at first VTE included corticosteroids (42.3%), thiopurines (21.2%), and infliximab (0.7%). CONCLUSION VTE is frequent in IBD patients. Most of them are unprovoked and occur in outpatients. DVT and PE are most common and unusual sites of thrombosis are rare.
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Affiliation(s)
- Pavol Papay
- Department of Internal Medicine III, Medical University Vienna, Austria
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11
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Novacek G, Haas T, Knoflach P, Petritsch W, Tilg H, Vogelsang H, Reinisch W. [Adalimumab for the treatment of adult Crohn's disease--update of a consensus report by the Working Group Inflammatory Bowel Disease of the Austrian Society of Gastroenterology and Hepatology]. Z Gastroenterol 2013; 51:1101-9. [PMID: 23996653 DOI: 10.1055/s-0033-1350165] [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: 10/26/2022]
Abstract
TNF alpha antibodies have clearly improved the outcome of moderate to severe Crohn's disease. Adalimumab is the first fully human, monoclonal TNF alpha antibody, which can be self-administered subcutaneously. Since August 2012 adalimumab is approved for the treatment of moderately to severely active Crohn's disease, in patients who have not responded despite a full and adequate course of therapy with a corticosteroid and/or an immunosuppressant or who are intolerant to or have medical contraindications for such therapies. Compared to placebo adalimumab can induce significantly more often steroid-free remission and mucosal healing in patients with moderate to severe Crohn's disease, reduce the rate of Crohn's disease-related hospitalisations and surgery and improve health-related quality of life. Adalimumab is clinically efficacious both in patients with Crohn's disease naïve to previous exposure to TNF-alpha antibodies and in those previously exposed with a rapid onset of action within days and confirmed maintenance performance over 3 years. The safety profile of adalimumab is comparable to those of other TNF alpha inhibitors. Due to its low immunogenicity allergic reactions are rare. The update of a consensus report by the Working Group Inflammatory Bowel Disease of the Austrian Society of Gastroenterology and Hepatology presents the existing evidence on adalimumab for the treatment of Crohn's disease and is aimed to assist as a code of practice in its applications.
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Affiliation(s)
- G Novacek
- Klinische Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Österreich
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12
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Bannert C, Reinhart K, Dunkler D, Trauner M, Renner F, Knoflach P, Ferlitsch A, Weiss W, Ferlitsch M. Sedation in screening colonoscopy: impact on quality indicators and complications. Am J Gastroenterol 2012; 107:1837-48. [PMID: 23147522 DOI: 10.1038/ajg.2012.347] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Quality indicators including cecal intubation rate (CIR) and adenoma detection rate (ADR) are established. Sex differences of quality indicators are observed, but the influence of sedation has not been investigated so far. The objective of this study is to assess the impact of sedation on quality indicators, including CIR and ADR, according to sex. METHODS We analyzed data of 52,506 screening colonoscopies performed by 196 endoscopists between November 2007 and April 2011 according to the Austrian "quality management for colon cancer prevention" program. RESULTS Sedation did not affect polyp detection rate (women P=0.7972, men P=0.3711) or ADR for both sexes (women P=0.2773, men P=0.8676). ADR was not significantly influenced by sedation (P=0.1272), but by age and sex (both P<0.0001), when the executing endoscopist was considered. Although women were more often sedated than men (90.70 vs. 81.83%; P<0.0001), CIR was slightly lower in women than in men (94.69 vs. 96.58%; P<0.0001). Sedation improved the CIR in women by 2.95% (94.96 vs. 92.01%; P<0.0001), whereas in men it was just by 1.28% (96.81 vs. 95.53%; P<0.0001). Sedated women only reached the CIR of unsedated men (94.96 vs. 95.53%; P=0.1005). Accounting for the intra-observer influence of the endoscopist, the overall CIR was influenced by the interaction of sex and age (P=0.0049), but not by sedation (P=0.1435). CONCLUSIONS Sedation does not increase adenoma or polyp detection, although it leads to an increase in CIR in men and women. This effect is more pronounced in women, yet CIR of men remains higher compared with women. Quality indicators are mainly influenced by the patient's age, sex, and the endoscopists' individual performance, rather than the endoscopists' subspeciality or procedural experience.
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Affiliation(s)
- Christina Bannert
- Quality Assurance Working Group of Austrian Society for Gastroenterology and Hepatology, Vienna, Austria
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13
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Hofer H, Willheim-Polli C, Knoflach P, Gabriel C, Vogel W, Trauner M, Müller T, Ferenci P. Identification of a novel Wilson disease gene mutation frequent in Upper Austria: a genetic and clinical study. J Hum Genet 2012; 57:564-7. [PMID: 22763723 DOI: 10.1038/jhg.2012.65] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Wilson disease (WD), a disorder of copper metabolism is caused by mutations in the ATP7B gene, a copper transporting ATPase. In the present study we describe a novel mutation in exon 9 of the ATP7B gene. The ATP7B gene was analyzed for mutations by denaturing HPLC and direct sequencing. DNA from 100 healthy blood donors from the same geographic area was examined as control. Sixteen (7.4%) out of the 216 patients diagnosed with WD in Austria carried the newly identified R816S(c.2448G>T) point mutation in exon 9 (4 male, age: 19 (6-30) years, median (range)). One patient was homozygous for R816S(c.2448G>T). Thirteen patients were compound heterozygotes (p.H1069Q(c.3207C>A)/R816S(c.2448G>T) (N=6), P539L/R816S(c.2448G>T) (N=3), each one G710S/R816S(c.2448G>T), P767P(2299insC)/R816S(c.2448G>T), W779G/R816S(c.2448G>T), T1220M/R816S(c.2448G>T)). In two patients no second mutation was identified. Interestingly, all but three of the patients originated within a distinct geographical area in Austria. Eleven patients presented with hepatic disease, 3 patients with neurological disease and 2 were asymptomatic sisters of an index case. A liver biopsy was available in 14 patients. Three patients showed advanced liver disease with liver transplantation for acute hepatic failure in two. The remaining patients had only mild histological changes, most commonly steatosis. Chronic hepatitis was described in five patients. Kayser-Fleischer ring was present in five patients. None of the 100 healthy controls carried the mutation. We describe a novel mutation in the ATP7B gene, occurring in patients originated from a distinct geographical area in Austria associated with a variable course of the disease.
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Affiliation(s)
- Harald Hofer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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14
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Resch G, Mallinger C, Schauer W, Thaler J, Knoflach P. Interval colorectal cancer despite screening colonoscopy: A single-center experience. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.401] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
401 Background: Colonoscopy is recommended as the primary screening method for colorectal cancer (CRC) and polypectomy is considered effective for preventing cancer. CRCs which occur within 5 years of screening colonoscopy are defined as interval cancer. Despite regular colonoscopy and complete polypectomy interval colorectal cancer may occur. Methods: All patients undergoing a colonoscopy were recorded in a colonoscopy registry, all CRC-patients who underwent colectomy were recorded in a surgery registry and all patients with newly diagnosed CRC were recorded in a tumor registry at the Klinikum Wels-Grieskirchen. In this retrospective analysis all patients with newly diagnosed CRC since the year 2000 were evaluated if a screening colonoscopy was done before the diagnosis of CRC at our institution. Results: Overall, 1.102 patients with CRC were evaluated. 939 patients underwent tumorectomy/colectomy at our department of surgery. In 65.8% (n=725) CRC was detected by colonoscopy at our institution and 85 out of these patients had a previous screening colonoscopy (range 14-176 months, median 55 months) at our institution. Interval cancers, which occur within 5 years since screening colonoscopy, were detected in 45 patients. Six patients could be identified with complete negative colonoscopy, 2 patients had inadequate bowel preparation, in 7 patients colonoscopy was not complete because of technical problems, 26 patients had a history of colorectal adenomas and 4 patients had inflammatory bowel disease. In 16 out of 26 patients with adenomas a CRC was detected distant from the side of the previous polypectomy. Conclusions: More emphasis and short-term control of incomplete and inadequately prepared colonoscopies, as well as a re-call system for post-polypectomy controls could reduce the number of so called interval CRSs.
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Affiliation(s)
- Gudrun Resch
- Department of Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Surgery, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Hematology and Medical Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Gastroenterology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Christian Mallinger
- Department of Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Surgery, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Hematology and Medical Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Gastroenterology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Walter Schauer
- Department of Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Surgery, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Hematology and Medical Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Gastroenterology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Josef Thaler
- Department of Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Surgery, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Hematology and Medical Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Gastroenterology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Peter Knoflach
- Department of Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Surgery, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Hematology and Medical Oncology, Klinikum Wels-Grieskirchen, Wels, Austria; Department of Gastroenterology, Klinikum Wels-Grieskirchen, Wels, Austria
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Gasche C, Evstatiev R, Haas T, Kaser A, Knoflach P, Petritsch W, Weiss G, Reinisch W. [Diagnosis and treatment of iron deficiency and anaemia in inflammatory bowel diseases. Consensus of the Austrian IBD Working Party]. Z Gastroenterol 2011; 49:627-32. [PMID: 21526463 DOI: 10.1055/s-0031-1273324] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Iron deficiency with and without anaemia is a common burden of patients with inflammatory bowel diseases (IBD) and has considerable impact on their quality of life and the ability to perform. The IBD working group of the Austrian Society of Gastroenterology and Hepatology developed five consensus statements on the following topics: (i) diagnosis of iron deficiency and (ii) anaemia, (iii) screening of iron deficiency, (iv) treatment of iron deficiency and (v) therapeutic goals. The clinical importance of intravenous iron replacement therapy in IBD with regard to effectiveness and compliance was discussed.
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Affiliation(s)
- C Gasche
- Medizinische Universität Wien, Klinik Innere Medizin 3, Abteilung Gastroenterologie und Hepatologie.
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Reinisch W, Dejaco C, Feichtenschlager T, Haas T, Kaser A, Miehsler W, Novacek G, Petritsch W, Platzer R, Tilg H, Vogelsang H, Knoflach P. [Infliximab therapy for Crohn's disease - a practical guideline: actualised consensus of the working group for chronic inflammatory bowel diseases of the Austrian Society for Gastroenterology and Hepatology]. Z Gastroenterol 2011; 49:534-42. [PMID: 21442574 DOI: 10.1055/s-0029-1245930] [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: 10/18/2022]
Abstract
Infliximab is a monoclonal antibody against tumor necrosis factor alpha (TNF-α), which is approved for the treatment of chronic inflammatory bowel disease (IBD) such as Crohn's disease (CD), fistulating Crohn's disease (FCD), ulcerative colitis (UC), and paediatric ulcerative colitis (PUC) from 6 years onwards. Besides its therapeutic efficacy, this antibody therapy is characterised by its side effects profile, which has been addressed in a seperate consensus statement by the Working Group for chronic inflammatory bowel diseases within the Austrian Society for Gastroenterology and Hepatology. Infliximab is an effective treatment option for the above-mentioned indications; however, use of this agent requires special knowledge to assess the benefit-risk profile for each patient individually.
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Affiliation(s)
- W Reinisch
- AKH Wien, Univ.-Klinik für Innere Medizin III, Klin. Abteilung f. Gastroenterologie und Hepatologie, Wien, Österreich.
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17
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Heibl C, Knoflach P. Clostridium septicum causing sepsis with severe disseminated intravascular coagulation in a patient with Crohn's disease. Am J Gastroenterol 2011; 106:170-1. [PMID: 21212763 DOI: 10.1038/ajg.2010.346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Miehsler W, Novacek G, Wenzl H, Vogelsang H, Knoflach P, Kaser A, Dejaco C, Petritsch W, Kapitan M, Maier H, Graninger W, Tilg H, Reinisch W. A decade of infliximab: The Austrian evidence based consensus on the safe use of infliximab in inflammatory bowel disease. J Crohns Colitis 2010; 4:221-56. [PMID: 21122513 DOI: 10.1016/j.crohns.2009.12.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 12/01/2009] [Indexed: 12/15/2022]
Abstract
Infliximab (IFX) has tremendously enriched the therapy of inflammatory bowel diseases (IBD) and other immune mediated diseases. Although the efficacy of IFX was undoubtedly proven during the last decade numerous publications have also caused various safety concerns. To summarize the immense information concerning adverse events and safety issues the Austrian Society of Gastroenterology and Hepatology launched this evidence based consensus on the safe use of IFX which covers the following topics: infusion reactions and immunogenicity, skin reactions, opportunistic infections (including tuberculosis), non-opportunistic infections (bacterial and viral), vaccination, neurological complications, hepatotoxicity, congestive heart failure, haematological side effects, intestinal strictures, stenosis and bowel obstruction (SSO), concomitant medication, malignancy and lymphoma, IFX in the elderly and the young, mortality, fertility, pregnancy and breast feeding. To make the vast amount of information practicable for routine application the consensus was finally condensed into a checklist for a safe use of IFX which consists of two parts: issues to be addressed prior to anti-TNF therapy and issues to be addressed during maintenance. Both parts are further divided into obligatory and facultative items.
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Affiliation(s)
- W Miehsler
- Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.
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Miehsler W, Novacek G, Wenzl H, Vogelsang H, Knoflach P, Kaser A, Dejaco C, Petritsch W, Kapitan M, Maier H, Graninger W, Tilg H, Reinisch W. A decade of infliximab: The Austrian evidence based consensus on the safe use of infliximab in inflammatory bowel disease. J Crohns Colitis 2010. [PMID: 21122513 DOI: 10.1016/j.crohns.2009.12.001]available] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Infliximab (IFX) has tremendously enriched the therapy of inflammatory bowel diseases (IBD) and other immune mediated diseases. Although the efficacy of IFX was undoubtedly proven during the last decade numerous publications have also caused various safety concerns. To summarize the immense information concerning adverse events and safety issues the Austrian Society of Gastroenterology and Hepatology launched this evidence based consensus on the safe use of IFX which covers the following topics: infusion reactions and immunogenicity, skin reactions, opportunistic infections (including tuberculosis), non-opportunistic infections (bacterial and viral), vaccination, neurological complications, hepatotoxicity, congestive heart failure, haematological side effects, intestinal strictures, stenosis and bowel obstruction (SSO), concomitant medication, malignancy and lymphoma, IFX in the elderly and the young, mortality, fertility, pregnancy and breast feeding. To make the vast amount of information practicable for routine application the consensus was finally condensed into a checklist for a safe use of IFX which consists of two parts: issues to be addressed prior to anti-TNF therapy and issues to be addressed during maintenance. Both parts are further divided into obligatory and facultative items.
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Affiliation(s)
- W Miehsler
- Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.
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20
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Novacek G, Weltermann A, Sobala A, Tilg H, Petritsch W, Reinisch W, Mayer A, Haas T, Kaser A, Feichtenschlager T, Fuchssteiner H, Knoflach P, Vogelsang H, Miehsler W, Platzer R, Tillinger W, Jaritz B, Schmid A, Blaha B, Dejaco C, Eichinger S. Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism. Gastroenterology 2010; 139:779-87, 787.e1. [PMID: 20546736 DOI: 10.1053/j.gastro.2010.05.026] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/11/2010] [Accepted: 05/13/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Patients with inflammatory bowel disease (IBD) are at increased risk of a first venous thromboembolism (VTE), yet their risk of recurrent VTE is unknown. We performed a cohort study to determine the risk for recurrent VTE among patients with IBD compared with subjects without IBD. METHODS We assessed 2811 patients with IBD for a history of VTE, recruited from outpatient clinics at 14 referral centers (June 2006-December 2008). Patients with VTE before a diagnosis of IBD or those not confirmed to have VTE, cancer, or a VTE other than deep vein thrombosis or pulmonary embolism, were excluded. Recurrence rates were compared with 1255 prospectively followed patients without IBD that had a first unprovoked VTE (not triggered by trauma, surgery, or pregnancy). The primary end point was symptomatic, objectively confirmed, recurrent VTE after discontinuation of anticoagulation therapy after a first VTE. RESULTS Overall, of 116 IBD patients who had a history of first VTE, 86 were unprovoked. The probability of recurrence 5 years after discontinuation of anticoagulation therapy was higher among patients with IBD than patients without IBD (33.4%; 95% confidence interval [CI]: 21.8-45.0 vs 21.7%; 95% CI: 18.8-24.6; P = .01). After adjustment for potential confounders, IBD was an independent risk factor of recurrence (hazard ratio = 2.5; 95% CI: 1.4-4.2; P = .001). CONCLUSIONS Patients with IBD are at an increased risk of recurrent VTE compared to patients without IBD.
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Affiliation(s)
- Gottfried Novacek
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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21
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Aschl G, Fritz E, Stadler B, Fleischer M, Priglinger H, Knoflach P. [Colocutaneous fistula after a PEG procedure with introducer technique and gastropexy]. Z Gastroenterol 2010; 48:760-2. [PMID: 20607634 DOI: 10.1055/s-0028-1109893] [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: 10/19/2022]
Abstract
INTRODUCTION The pull-PEG (percutaneous endoscopic gastrostomy) is the most commonly used procedure for PEG placement. Alternative methods may be used in patients with an obstructed oesophagus. We here present the case of an unusual complication during PEG placement with the new introducer technique and gastropexy. CASE REPORT A 74-year-old men with progressive thymus cell carcinoma was referred for a PEG procedure. Since the tumour stenosis in the oesophagus was only passable with a slim-sight endoscope (5,9 mm), we decided in favour of the direct PEG method with gastropexy. The procedure was performed without any complications. 35 days later we changed the balloon catheter and were able to easily inflate the balloon. Surprisingly, the X-ray performed thereafter, revealed a misplacement of the catheter in the colon without any notable contrast medium in the stomach. Although the patient expressed no complaints, he underwent surgery on the same day proving the colocutaneous fistula. There were no signs of peritonitis. The patient's postoperative recovery was uneventful. DISCUSSION Pull-PEG requires an intact oesophageal passage. The spread of bacteria and tumour cells is a possible risk factor. Direct punction PEG might be better in these cases. This method is not a standard procedure, but the recent implementation of an additional gastropexy represents a significant improvement. We experienced a rare complication, which was first described in 1987. However, this case is the first documented complication in association with gastropexy. This case shows that even gastropexy does not prevent colon interposition. Therefore, an endoscopic or radiological control of the tube placement after changing seems to be necessary.
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Affiliation(s)
- G Aschl
- Interne I, Klinikum Wels, Grieskirchnerstr, Osterreich.
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22
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Reinisch W, Haas T, Kaser A, Petritsch W, Vogelsang H, Feichtenschlager T, Novacek G, Siebert F, Tilg H, Knoflach P. Adalimumab in der Behandlung des Morbus Crohn – ein Konsensus der Arbeitsgruppe Chronisch Entzündliche Darmerkrankungen der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie. Z Gastroenterol 2009; 47:372-80. [DOI: 10.1055/s-0028-1109218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Topakian R, Heibl C, Stieglbauer K, Dreer B, Nagl M, Knoflach P, Aichner FT. Quantitative autonomic testing in the management of botulism. J Neurol 2009; 256:803-9. [DOI: 10.1007/s00415-009-5022-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 12/08/2008] [Accepted: 12/19/2008] [Indexed: 11/29/2022]
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Aschl G, Kirchgatterer A, Fleischer M, Hinterreiter M, Hubner D, Kranewitter W, Stadler B, Knoflach P. [The frequency of wound infections after PEG-placement and utilization of glycogel wound dressing: a randomized controlled trial]. Wien Klin Wochenschr 2008; 120:224-7. [PMID: 18500597 DOI: 10.1007/s00508-008-0959-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 03/27/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is the method of choice for long- term artificial enteral feeding. Standardized wound management such as daily dressing changes and local disinfection of the exit site helps to keep complication rates low. New bacteriostatic glycogel wound dressing has not yet been tested. We compared glycogel dressing to the usual method of wound aftercare with regard to wound infections. METHODS The standard wound management was compared to glycogel dressing. 100 consecutive patients were investigated in a prospective randomized trial from Aug. 2004 to Jan. 2006 regarding wound infections. We also compared indications for PEG placement, complications other than wound infection, and mortality. The exit site was examined and scored daily using a specific wound scoring system. After 30 days, the patients were followed up by phone calls to determine if any infection had occurred after discharge. RESULTS During our study, 98 out of 100 patients had a successful PEG procedure performed. Out of these 98 patients, 48 patients received standard wound dressing care and 50 patients used glycogel dressing. The indications for PEG placement were not significantly different between the two groups. A total of 88% of patients (n = 42) with standard wound care had no relevant infection (50%, n = 24 with score 0 or 1; 38%, n = 18 had score 2), 10% (n = 5) presented with serious local infection (score 3) and one patient (2%) had severe infection necessitating PEG removal (score 4). In the group using glycogel dressing, 88% of the patients (n = 44) did not show any relevant sign of infection (54%, n = 27 with score 0 or 1; 34%, n = 17 had score 2), 8% (n = 4) had serious local infection (score 3), 2% (n = 1) had severe infection (score 4) and 2% (n = 1) were lost to follow up. CONCLUSION Regarding wound infection rates after PEG placement, glycogel wound dressing was found to be as effective as standard wound dressing. Thus, omitting daily changes of regular wound dressings by using glycogel dressing instead may be advantageous for patients and generally help to decrease overall cost.
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Affiliation(s)
- Gerhard Aschl
- Interne Abteilung/Gastroenterologie, Klinikum Wels-Grieskirchen, Wels, Austria.
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Bunte C, Popp-Habeler J, Mischer P, Tuppy H, Haidenthaler A, Knoflach P, Kirchgatterer A. Concomitant manifestation of pyoderma gangrenosum and colorectal carcinoma. Scand J Gastroenterol 2008; 43:756-8. [PMID: 18569994 DOI: 10.1080/00365520701785251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pyoderma gangrenosum is an ulcerative skin disease of unknown origin and is commonly associated with inflammatory bowel disease, arthritis or lymphoproliferative disorders. Only sporadic cases of pyoderma gangrenosum in combination with malignant disease of the gastrointestinal tract have been reported until now. We report on a 53-year-old patient who suffered injury to the right scapula while gardening. Initially, the patient had only a superficial wound of the upper skin but in the subsequent weeks the lesion developed into an ulcerative defect and pyoderma gangrenosum was diagnosed. Laboratory test results, ultrasound of the abdomen and computed tomography of the chest and abdomen were normal. Immunosuppressive therapy with prednisolone and azathioprine was initiated. Four months later the patient was admitted to the gastroenterology department for further examination because of chronic fatigue, subfebrile temperature and a positive fecal occult blood test. Colonoscopy showed a semicircular carcinoma of the sigmoid colon measuring 3-4 cm. A left-sided hemicolectomy was performed. Microscopic examination revealed an adenocarcinoma (T3, N2, G3) and consequently the patient was given adjuvant chemotherapy. Nine months later the patient was asymptomatic and the pyoderma gangrenosum had recovered. Pyoderma gangrenosum is not only associated with inflammatory bowel disease or lymphoproliferative disorders. This case report demonstrates that colorectal carcinoma must also be considered as a possible differential diagnosis. The fast and complete remission of pyoderma gangrenosum following surgical treatment of colorectal carcinoma emphasizes a causal relationship.
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Affiliation(s)
- Christian Bunte
- Department of Internal and Geriatric Medicine, Hospital St. Franziskus, Grieskirchen, Austria.
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Tilg H, Feichtenschlager T, Knoflach P, Petritsch W, Schöfl R, Vogelsang H, Reinisch W. Infliximab in der Therapie der Colitis ulcerosa. Z Gastroenterol 2007; 45:907-11. [PMID: 17701864 DOI: 10.1055/s-2007-963393] [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: 10/23/2022]
Abstract
Infliximab, a chimeric monoclonal anti-tumour necrosis factor alpha (TNF) antibody has dramatically changed the management of various chronic inflammatory disorders such as Crohn's disease (CD), rheumatoid arthritis, ankylosing spondylitis or psoriasis. This drug is well established for the treatment of CD in case of steroid-refractoriness, failure to respond to an immunosuppressant agent or fistulizing disease. The immunological concept that ulcerative colitis (UC) reflects primarily a T-helper cell type-2 mediated disease prevented the earlier use of anti-TNF agents in this disease. Promising initial pilot studies in steroid-refractory UC patients led to two large placebo-controlled trials in patients with moderate to severe UC. These studies clearly showed a benefit for infliximab treatment in UC with mucosal healing and improved life quality. Infliximab therefore can be used in patients not responding adequately to steroids and/or immunosuppressants. Furthermore, one study showed evidence that infliximab might also be effective in severe, intravenous steroid-refractory UC. Therefore, infliximab might be used alternatively to cyclosporine A or tacrolimus in this patient group. Infliximab has now been established as an additional treatment option in patients with chronic-active UC not responding to an immunosuppressive agent and/or in case of severe acute UC. Experienced gastroenterologists should be involved in the decision making for such a therapy to balance thoroughly the benefit/risk ratio for our patients.
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Affiliation(s)
- H Tilg
- Die Institutsangaben sind am Ende des Beitrags gelistet.
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Kirchgatterer A, Bunte C, Aschl G, Fritz E, Hubner D, Kranewitter W, Fleischer M, Hinterreiter M, Stadler B, Knoflach P. Long-term outcome following placement of percutaneous endoscopic gastrostomy in younger and older patients. Scand J Gastroenterol 2007; 42:271-6. [PMID: 17327948 DOI: 10.1080/00365520600880864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 02/04/2023]
Abstract
OBJECTIVE Percutaneous endoscopic gastrostomy (PEG) is the method of choice in maintaining enteral nutrition in patients with swallowing and nutritional disorders of different etiology. The aim of this study was to assess the long-term outcome of patients following placement of a PEG. MATERIAL AND METHODS All patients who received a PEG between October 1999 and September 2000 were included in this prospective study. Long-term function, replacement or removal of the PEG, complications and survival of the patients were analyzed in group A (younger than 75 years) and group B (75 years or older). RESULTS The indications for PEG placement in group A (54 patients, mean age 54.5 years) were neurological (66.7%) and malignant (31.5%) disorders, whereas in group B (40 patients, mean age 81 years) the indications were predominantly neurological diseases (87.5%). The majority of patients (91 of 94 patients; 96.8%) could be followed long term or until death. In group A, 46 patients (85.2%) had uncomplicated long-term function of their PEG and interventions were necessary in only 8 patients. Removal of the PEG was possible during the course in 17 patients (31.5%). In group B, uncomplicated long-term function was observed in 34 patients (85%) and interventions were required in only 6 patients. Removal of the PEG was not possible in group B. Survival rates for 1-, 2- and 5 years in group A were 73.9%, 61.8% and 43.9%, respectively, and in group B 41.4%, 31.9% and 15.9%, respectively; the difference was statistically significant (p=0.002). CONCLUSIONS Excellent long-term function of PEG was seen in this study of 94 consecutive patients, and interventions were necessary only in a minority of patients. The prognosis for older patients was worse; however, the 2-year survival rate of 32% justified the PEG insertion.
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Fritz E, Kirchgatterer A, Hubner D, Aschl G, Hinterreiter M, Stadler B, Knoflach P. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc 2006; 64:899-905. [PMID: 17140895 DOI: 10.1016/j.gie.2006.05.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [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] [Received: 02/25/2005] [Accepted: 05/09/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary disease frequently occurs in the elderly, but there are limited data on ERCP in the elderly population. PATIENTS A total of 502 patients (group A, 97; group B, 405) underwent 724 ERCP procedures. MAIN OUTCOME MEASUREMENTS All consecutive ERCPs performed between 2000 and 2002 at a single center were retrospectively reviewed for patients >/=80 years old (group A) and patients <80 years old (group B) to evaluate endoscopic findings, interventions, complications, and mortality related to complications. RESULTS The number of important chronic concomitant diseases was significantly higher in the older group (average per patient 1.08 vs 0.57, P < .001). Successful cannulation was achieved in 88% in group A versus 86% in group B, and endoscopic sphincterotomy was performed in 63.2% versus 51.4%. Periampullary diverticulum was found significantly more often in patients of group A (39.2%) than of group B (14.1%, P < .001). Stents were used in 24.1% of ERCP procedures in group A and in 22.9% in group B. There was no significant difference in the complication rate between group A (6.8%) and group B (5.1%) and in early mortality (1.03% vs 0.25%), respectively. CONCLUSION ERCP is a safe and effective intervention in the elderly because complication and early mortality rates are comparable to those of younger patients, although comorbidity is significantly higher.
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Affiliation(s)
- Eva Fritz
- Department of Internal Medicine I, Klinikum Wels, Wels, Austria
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Abstract
Ileocolonoscopy including biopsies is the first line investigation in suspected inflammatory bowel disease (IBD). In up to 90 % of the cases ulcerative colitis and Crohn's disease are differentiated on endoscopic presentation. Standardised reporting of endoscopic results increases the validity and comparability of IBD findings. When there is a firm diagnosis of IBD, colonoscopy should only be performed for specific questions. An upper gastrointestinal endoscopy is only indicated in patients with upper gastrointestinal symptoms. Push and capsule endoscopy should also be limited to specific questions and situations. IBD with extended colitis is associated with an increased risk for colorectal cancer. Endoscopic surveillance with accurate biopsy sampling is a valuable tool for the prevention of colorectal cancer.
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Affiliation(s)
- W Petritsch
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz.
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Heibl C, Hubner D, Sautner T, Knoflach P. Divertikulose des Jejunums mit Divertikulitis und gedeckter Perforation als Ursache rezidivierender Abdominalschmerzen – eine Kasuistik. Z Gastroenterol 2006. [DOI: 10.1055/s-2006-955548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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de Boer NKH, Reinisch W, Teml A, van Bodegraven AA, Schwab M, Lukas M, Ochsenkühn T, Petritsch W, Knoflach P, Almer S, van der Merwe SW, Herrlinger KR, Seiderer J, Vogelsang H, Mulder CJJ. 6-Thioguanine treatment in inflammatory bowel disease: a critical appraisal by a European 6-TG working party. Digestion 2006; 73:25-31. [PMID: 16493198 DOI: 10.1159/000091662] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [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] [Received: 07/20/2005] [Accepted: 11/22/2005] [Indexed: 02/04/2023]
Abstract
Recently, the suggestion to use 6-thioguanine (6-TG) as an alternative thiopurine in patients with inflammatory bowel disease (IBD) has been discarded due to reports about possible (hepato) toxicity. During meetings arranged in Vienna and Prague in 2004, European experts applying 6-TG further on in IBD patients presented data on safety and efficacy of 6-TG. After thorough evaluation of its risk-benefit ratio, the group consented that 6-TG may still be considered as a rescue drug in stringently defined indications in IBD, albeit restricted to a clinical research setting. As a potential indication for administering 6-TG, we delineated the requirement for maintenance therapy as well as intolerance and/or resistance to aminosalicylates, azathioprine, 6-mercaptopurine, methotrexate and infliximab. Furthermore, indications are preferred in which surgery is thought to be inappropriate. The standard 6-TG dosage should not exceed 25 mg daily. Routine laboratory controls are mandatory in short intervals. Liver biopsies should be performed after 6-12 months, three years and then three-yearly accompanied by gastroduodenoscopy, to monitor for potential hepatotoxicity, including nodular regenerative hyperplasia (NRH) and veno-occlusive disease (VOD). Treatment with 6-TG must be discontinued in case of overt or histologically proven hepatotoxicity.
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Affiliation(s)
- N K H de Boer
- Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
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Dejaco C, Haas T, Kirchgatterer A, Miehsler W, Wenzl H, Knoflach P, Petritsch W, Vogelsang H, Reinisch W, Tilg H. Aminosalicylate und Steroide in der Behandlung von chronisch entzündlichen Darmerkrankungen - Konsensuspapier der Arbeitsgruppe für chronisch entzündliche Darmerkrankungen der ÖGGH. Z Gastroenterol 2006; 44:525-38; discussion 539. [PMID: 16773519 DOI: 10.1055/s-2006-926796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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
5-aminosalicylates (5-ASA) and steroids constitute a cornerstone of medical therapy in patients with inflammatory bowel diseases (IBD). Whereas the efficacy of 5-ASA in Crohn's disease (CD) is equivocal, ulcerative colitis (UC) is the main indication for this drug. In UC, 5-ASA is effective in the treatment of mild to moderate acute disease and in maintenance of remission. Furthermore, 5-ASA topical therapy is an important treatment option in patients with mild to moderate proctitis and/or left-sided UC and shows additive efficacy to oral therapy. From retrospective data a chemo-preventative activity of long-term 5-ASA therapy in UC is delineated. Steroids are treatment of first choice for moderate to severe cases of CD and UC. Budesonide, a modified steroid with less side effects, plays a major role in the treatment of ileocolonic CD +/- involvement of the right colon and is used as treatment of choice in mild-to-moderate cases. In case of acute, severe disease conventional steroids are superior compared to budesonide and therefore budesonide should only be used after considerable improvement of disease activity. The necessity to apply steroids in a given patient represents a negative prognostic indicator for the course of disease and should incite the early introduction of immunosuppressive therapy in this case. Steroids are only effective as short term therapy of IBD and are to be avoided for maintenance treatment. In all cases of steroid therapy an osteoporosis prophylaxis with calcium and vitamin D is recommended. Topical steroid treatment is less effective in left-sided UC compared to 5-ASA.
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Affiliation(s)
- C Dejaco
- Univ.-Klinik f. Innere Medizin IV, Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, AKH, Währinger Gürtel 18 - 20, A-1090 Wien
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Abstract
A 57-year-old man developed chronic, watery diarrhea four weeks after Helicobacter pylori eradication therapy including lansoprazole followed by lansoprazole monotherapy for gastroesophageal reflux disease. Four weeks later the patient was admitted to our hospital. By repeated testing other causes of diarrhea, e. g., infectious diarrhea including Clostridium difficile colitis were excluded. Endoscopy showed a normal colon, histopathology of random biopsies of all sections of the colon demonstrated the characteristic features of collagenous colitis. Withdrawal of lansoprazole lead to prompt and sustained relief. Two months later repeat colonoscopy with biopsies showed no evidence of collagenous colitis. Collagenous colitis as a subtype of microscopic colitis is a rare cause of chronic diarrhea with unknown pathogenesis. The reported case represents an unusual association between medication with the proton pump inhibitor lansoprazole and the development of collagenous colitis suggesting the importance of evaluation of drug use in patients with microscopic colitis.
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Affiliation(s)
- M Rammer
- 1st Medical Department, Division of Gastroenterology, General Hospital Wels, Grieskirchnerstrasse 42, 4600 Wels, Austria.
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Abstract
HISTORY AND ADMISSION FINDINGS A 58-year-old woman with type 1 diabetes and coronary artery disease was admitted to hospital because of diminished appetite, weight loss, abdominal pain and anemia. Earlier treatment of duodenal ulcer and cholecystectomy had not achieved sustained relief. On physical examination paleness and general weakness was noted. INVESTIGATIONS Laboratory tests showed a normocytic, normochromic anemia, anisocytosis, polychromasia and basophilic stippling of erythrocytes. Bone marrow examination revealed a hyperreactive erythropoesis with basophilic stippling of erythrocytes and incomplete differentiation of erythroid progenitor cells. Inherited or acquired enzymopathies of erythrocytes were ruled out. Urinary collection showed remarkable elevation of porphyrin concentration. DIAGNOSIS, TREATMENT AND COURSE Suspected poisoning was confirmed by elevated lead concentrations in whole-blood (85.8 microg/dl) and urine (106.3 microg/l). A souvenir of Rhodes, a ceramic mug with lead-containing glaze, was identified as the source of the lead poisoning, the lead dissolving into hot tea put in the mug. Treatment with D-penicillamine was begun, and within five weeks anemia disappeared and the patient achieved complete resolution of symptoms. CONCLUSION Recognition of the cause of lead poisoning is of critical importance. This case report demonstrates difficulties in diagnosing and identifying the source of poisoning.
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Affiliation(s)
- A Kirchgatterer
- I. Interne Abteilung mit Gastroenterologie und Hepatologie, Diabetologie und Rheumatologie, Klinikum Kreuzschwestern Wels GmbH, Wels, Osterreich.
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Tilg H, Knoflach P, Petritsch W, Vogelsang H, Reinisch W. [Infliximab in the treatment of Crohn's disease -- a practical approach. Infliximab and chronic Crohn's disease--Consensus statement of the Working Group on Chronic Inflammatory Crohn's Diseases of the OGGH]. Z Gastroenterol 2005; 42:1256-63. [PMID: 15508068 DOI: 10.1055/s-2004-813567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- H Tilg
- Krankenhaus Hall i.T., Akademisches Lehrkrankenhaus der Universität Innsbruck, Hall i.T., Osterreich.
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Kirchgatterer A, Steiner P, Hubner D, Fritz E, Aschl G, Preisinger J, Hinterreiter M, Stadler B, Knoflach P. Colorectal cancer in geriatric patients: Endoscopic diagnosis and surgical treatment. World J Gastroenterol 2005; 11:315-8. [PMID: 15637734 PMCID: PMC4205327 DOI: 10.3748/wjg.v11.i3.315] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence of colorectal cancer in geriatric patients undergoing endoscopy and to analyze their outcome.
METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. Patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival.
RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). Patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively.
CONCLUSION: Nearly two-thirds of 88 geriatric patients with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatric patients is demonstrated.
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Affiliation(s)
- Andreas Kirchgatterer
- First Department of Medicine/Gastroenterology, General Hospital Wels, A-4600 Wels/Austria, Grieskirchnerstrasse 42, Austria.
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Maieron A, Hubner D, Blaha B, Deutsch C, Schickmair T, Ziachehabi A, Kerstan E, Knoflach P, Schoefl R. Multicenter retrospective evaluation of capsule endoscopy in clinical routine. Endoscopy 2004; 36:864-8. [PMID: 15452781 DOI: 10.1055/s-2004-825852] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [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: 12/21/2022]
Abstract
BACKGROUND AND STUDY AIMS The small bowel is anatomically difficult to examine; disease conditions are rarely located in it, but can be serious. Neither conventional radiography nor push enteroscopy has sufficient sensitivity and specificity to detect distinct lesions. Wireless capsule endoscopy can theoretically allow imaging of the entire small bowel, with only minimal discomfort for the patient. PATIENTS AND METHODS Between November 2001 and May 2003, 191 patients received 195 capsules. Data were collected retrospectively from consecutive patients in three centers. The indications for capsule endoscopy were obscure or occult bleeding, suspected Crohn's disease, or other reasons in 151, 25, and 15 patients, respectively. The clinical outcome after 6 months was evaluated on the basis of interviews with patients or relatives. RESULTS Visualization of the entire small bowel was adequate in 78.4 % of the examinations. The colon was not reached in 16.9 % of cases, and there were minor technical problems in 4.6 %. Relevant pathological findings were identified in 56.2 % of 151 patients with obscure bleeding or iron-deficiency anemia (64 % of whom received blood transfusions). The most common findings were angiodysplasia in 39.7 % of cases and ulcers of the small bowel in 7.3 %. In addition, individual cases of tumors and parasitic worms were detected. Seven of the 25 patients with suspected Crohn's disease (28 %) had the disease confirmed. Three of five patients with polyposis syndrome of the colon were found to have polyps in the small bowel. CONCLUSIONS Wireless capsule endoscopy can be recommended as part of the routine work-up in patients with obscure bleeding or iron-deficiency anemia. In patients with Crohn's disease, the method may be helpful in establishing or ruling out the diagnosis.
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Affiliation(s)
- A Maieron
- Dept. of Internal Medicine 4, Krankenhaus der Elisabethinen, Fadingerstrasse 1, 4010 Linz, Austria.
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Reinisch W, Dejaco C, Knoflach P, Petritsch W, Vogelsang H, Tilg H. Immunsuppressiva in der Therapie chronisch entzündlicher Darmerkrankungen. Z Gastroenterol 2004; 42:1033-45; discussion 1046-7. [PMID: 15455280 DOI: 10.1055/s-2004-813500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Azathioprine (AZA) or 6-mercaptopurine (6-MP) are the immunosuppressive drugs of choice in the treatment of inflammatory bowel disorders (IBD). Optimal dosage for AZA is around 2.5 mg/kg body weight and induction of remission by these drugs may take 6 - 7 months. Intramuscularly applied Methotrexate (MTX) is the second choice, while its efficacy starts earlier than that of AZA; studies assessing oral low-dose MTX treatment are lacking. Cyclosporin is the standard treatment in case of steroid-refractory severe ulcerative colitis. This drug may also be used in patients with severe extraintestinal manifestations of IBD. Regarding other immunosuppressive drugs such as mycophenolic acid or 6-thioguanine respective controlled clinical study data are not available. The risk of malignancy using immunosuppressive drugs such as AZA is low and furthermore, especially AZA and 6-MP can be used rather safely during pregnancy.
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Affiliation(s)
- W Reinisch
- Univ.-Klinik f. Innere Medizin IV, Abteilung Gastroenterologie und Hepatologie, AKH Wien, Austria
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Kirchgatterer A, Knoflach P. [Natural therapy instead of chemistry? Probiotics in gastroenterology]. Acta Med Austriaca 2004; 31:13-7. [PMID: 15259592] [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: 04/30/2023]
Abstract
Probiotics are living microorganisms that upon ingestion exert health benefits. The impact of probiotics on gut flora represents a new and interesting therapeutic approach in a number of diseases of the gastrointestinal tract. According to actual publications and guidelines of medical societies, the clinical relevance of probiotics can be described as follows: (a) In the case of ulcerative colitis, available data demonstrate benefits of probiotic therapy. (b) The available data regarding pouchitis are limited, but the therapeutic effect seems to be excellent. (c) In the case of Crohn's disease, the role of probiotics is not clearly defined, thus the results of new trials have to be awaited before probiotic therapy is recommended. (d) Further indications such as antibiotic-associated diarrhea, acute pancreatitis or irritable bowel syndrome have been reported recently. The results of these clinical trials have been encouraging, but they often included only a small number of patients and therefore a clear-cut assessment seems difficult at the moment.
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Affiliation(s)
- Andreas Kirchgatterer
- Interne Abteilung/Gastroenterologie, Allgemeines öffentliches Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz, Wels, Osterreich.
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Kirchgatterer A, Lugmayr H, Aspöck G, Wallner M, Knoflach P. Renal infarction due to combination of fibromuscular dysplasia and factor V Leiden mutation. Nephrol Dial Transplant 2004; 19:512-3. [PMID: 14736990 DOI: 10.1093/ndt/gfg536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aschl G, Kirchgatterer A, Allinger S, Hinterreiter M, Hubner D, Kranewitter W, Stadler B, Wimmer L, Knoflach P. [Indications and complications of percutaneous endoscopic gastrostomy]. Wien Klin Wochenschr 2003; 115:115-20. [PMID: 12674688 DOI: 10.1007/bf03040290] [Citation(s) in RCA: 9] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) plays an important role in maintaining enteral nutrition in patients with swallowing disorders of different etiologies. The aim of our study was to record indications and complications of PEG-placement in a one-year period. METHODS All patients were investigated prospectively regarding indications, wound infections, other complications and mortality between 1999-10-01 and 2000-09-30. The exit site was examined daily, after 30 days a follow-up by telephone was carried out. RESULTS The PEG-procedure was performed in 93 patients, one patient received a percutaneous endoscopic jejunostomy. The mean age of the patients was 65.4 years (range 7 months--92 years). The most frequent indications were neurological diseases (n = 61, 65%). 21 patients had a PEG-placement because of malignancies (22%), 9 patients following brain injury (10%) and 3 patients (3%) due to other benign swallowing disorders. 63 patients (67%) had no complications, 28 patients (30%) had wound infections, and in two patients hemorrhage was observed (small hematoma requiring no further intervention). One patient had laparotomy because of suspected perforation--however, laparotomy was negative. In 7 patients (7%) wound infections (n = 28) were mild and needed only local or no therapy. In 18 patients (19%) we found a relevant infection that required systemic antibiotic therapy. 2 patients had serious local infections that caused further interventions. One patient died from sepsis caused by wound infection. Patients receiving antibiotic therapy at the time of PEG-placement suffered from wound infections in 25%. Patients with malignant diseases more often had wound infections. 8 patients died after 7 days and 19 patients after 30 days (8% and 19%, respectively) from their underlying disease. CONCLUSIONS PEG is regarded as a small intervention with low morbidity and mortality. However, our analysis of daily practice shows a remarkable rate of complications. The high mortality in our study reflects the seriousness of the comorbidities. Antibiotic therapy failed to prevent wound infection in 25% of our patients.
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Affiliation(s)
- Gerhard Aschl
- I. Interne Abteilung/Gastroenterologie, Allgemein öffentliches Krankenhaus der Barmherzigen Schwestern v. Hl. Kreuz, Wels, Osterreich.
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Rammer M, Kirchgatterer A, Höbling W, Stockhammer M, Knoflach P. [W.D.H.A. Syndrome due to occult neuroendocrine malignancy with concomitant liver metastases]. Z Gastroenterol 2003; 41:185-9. [PMID: 12592602 DOI: 10.1055/s-2003-37309] [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: 10/27/2022]
Abstract
In June 1999, a 62-year-old man is hospitalised to evaluate the sonographic suspicion of liver metastases. The biopsy of the liver shows a malignant neuroendocrine tumour. Further diagnostic investigation including gastroscopy, colonoscopy, enteroclysis, thoracal and abdominal CT and somatostatin-receptor-scintigraphy does not localise the primary tumour. In the absence of clinical symptoms a wait and see procedure with clinical and imaging controls at regular intervals is arranged. Beginning in spring of 2001--nearly two years after the initial diagnosis--the patient suffers from progredient diarrhoea and weight loss leading to hospitalisation in September 2001. The existence of secretory diarrhoea, hypokalaemia and hypercalcaemia arouses suspicion of vipoma. This is proven by a remarkably elevated plasma concentration of vasoactive intestinal peptide (VIP). Once more, an accurate investigation is started but no primary tumour can be discovered despite extensive liver metastases. A vipoma is a rare differential diagnosis of secretory diarrhoea. This case report describes the remarkable constellation of liver metastases of a malignant neuroendocrine neoplasm without a primary tumour and the clinical presentation of a W.D.H.A. syndrome (watery diarrhoea, hypokalaemia and hypo- or achlorhydria). Despite extensive disease, therapy with octreotide and prednisolone provides a good clinical response.
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Affiliation(s)
- M Rammer
- I. Interne Abteilung/Gastroenterologie, Allgemeines öffentliches Krankenhaus der Barmherzigen Schwestern, Wels, Austria.
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Kirchgatterer A, Knoflach P. [Relevance of diagnostic and interventional endoscopy in elderly patients]. Acta Med Austriaca 2003; 30:113-6. [PMID: 15055155] [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: 04/29/2023]
Abstract
The demographic development will lead to an increase in endoscopic examinations in elderly patients. Indications feasibility, complication rate and therapeutic consequences following detection of pathologic findings are important for assessing the relevance of endoscopy in geriatric patients. Indications and results of colonoscopy as well as special features of clinical presentation and endoscopic intervention in cases of acute gastrointestinal bleeding are discussed. The placement of a percutaneous endoscopic gastrostomy and the endoscopic retrograde cholangiopancreaticography represent inconvenient endoscopic techniques in elderly patients. However, according to recent data, these procedures are assessed as being safe and effective.
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Affiliation(s)
- A Kirchgatterer
- I. Internenen Abteilung/Gastroenterologie, Allgemeines öffentliches Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz, Wels.
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Kirchgatterer A, Wenzl HH, Aschl G, Hinterreiter M, Stadler B, Hinterleitner TA, Petritsch W, Knoflach P. Examination, prevention and treatment of osteoporosis in patients with inflammatory bowel disease: recommendations and reality. Acta Med Austriaca 2002; 29:120-3. [PMID: 12424936 DOI: 10.1046/j.1563-2571.2002.02018.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of developing osteopenia and osteoporosis. Our aim was to evaluate the current practices of examination, prevention and treatment of osteoporosis in IBD patients in a routine clinical setting. METHODS A total of 154 consecutive patients with IBD (63 female, 91 male; 36 ulcerative colitis, 115 Crohn's disease, 3 indeterminate colitis), referred to two gastroenterological units for scheduled follow-up examinations, were included. Patient charts were evaluated regarding bone densitometry already performed and any prophylactic or therapeutic interventions in cases of low bone mineral density. RESULTS Bone mineral density (BMD) measurements had been performed only in 38 patients (25%). BMD was abnormally low in 27 of the examined patients (71%), 20 of whom had osteopenia and seven had osteoporosis. Among the subgroup of patients on long-term steroid therapy (77 patients), 30 had been referred to bone densitometry during the course of disease, and 21 of them were found to have low bone mineral density. Preventive measures were prescribed in 12 patients (9% of the whole study population). In the majority of the patients with low bone mineral density, calcium and vitamin D were used as treatment. CONCLUSIONS Despite the high prevalence of osteopenia and osteoporosis in patients with IBD, only a minority of these patients were included in a structured program in accordance with modern guidelines for diagnosing and preventing this extraintestinal complication in a routine clinical setting.
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Affiliation(s)
- A Kirchgatterer
- First Department of Medicine/Gastroenterology, General Hospital, Grieskirchnerstrasse 42, A-4600 Wels.
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Kirchgatterer A, Hubner D, Aschl G, Hinterreiter M, Stadler B, Knoflach P. [Colonoscopy and sigmoidoscopy in patients aged eighty years or older]. Z Gastroenterol 2002; 40:951-6. [PMID: 12518261 DOI: 10.1055/s-2002-36157] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The demographic development will lead to an increase in endoscopic examinations in elderly patients. Indications, feasibility and therapeutic consequences following detection of pathologic findings are important assessing the relevance of endoscopy in geriatric patients. METHODS We analyzed all colonoscopies and sigmoidoscopies which were performed between January 1995 and December 2000 in patients older than 80 years. The parameters indication, sedation, colonoscopy completion rate, endoscopic findings, therapeutic consequences and complications were evaluated. RESULTS A total of 951 endoscopies in patients older than 80 years (781 colonoscopies, 170 sigmoidoscopies; mean age 84.3 years) were performed. The most frequent indications were: abdominal pain (n = 144; 15 %), bleeding (n = 115; 12 %), constipation (n = 97; 10 %), anemia (n = 85; 9 %), and history of polyps (n = 78; 8 %). Sedation was used in 183 examinations (19 %), mostly with midazolam (n = 179). Colonoscopy was completed successfully to the coecum in 71 %. 214 examinations were unremarkable (23 %). Frequent pathologic findings were: diverticular disease (n = 396; 42 %), polyps (n = 256; 27 %), and colorectal carcinoma (n = 75; 8 %). Curative surgery was possible in 55 % and palliative surgery in 9 % of patients with colorectal carcinoma, respectively. A complication was observed in six patients (0.6 %), four bleedings following polypectomy, one perforation after dilatation of a stenotic tumor, and one transient neurologic deficit. CONCLUSIONS Endoscopy of the lower gastrointestinal tract is feasible in geriatric patients with a low rate of complications. The low number of normal findings and the frequent diagnosis of colorectal carcinoma were remarkable. In spite of old age more than half of the patients with carcinoma could be operated curatively emphasizing the importance of endoscopic investigations in this age group.
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Affiliation(s)
- A Kirchgatterer
- I. Interne Abteilung/Gastroenterologie, Allgemeines öffentliches Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz, Wels, Austria.
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Abstract
HISTORY AND ADMISSION FINDINGS After successful transurethral resection of a superficial bladder cancer a 59-year old patient was treated with intravesical instillation of bacillus Calmette-Guérin (BCG) six times to prevent tumor recurrence. Four weeks later the patient was admitted to our department presenting with symmetrical polyarthritis accompanied by pain and stiffness and conjunctivitis. INVESTIGATIONS Laboratory tests showed evidence of severe inflammation, but cultures of blood, urine and joint fluid specimens were negative, as were tests for autoantibodies and serologic tests for organisms known to cause reactive arthritis. DIAGNOSIS In this patient, the history, admission findings and laboratory tests led to the diagnosis of BCG-immunotherapy associated reactive arthritis. TREATMENT AND COURSE Nonsteroidal antiinflammatory therapy was ineffective but glucocorticoid therapy resulted in a partial response. With additional administration of the antituberculosis agent isoniazid for 3 months, all symptoms resolved. CONCLUSION Reactive arthritis can be induced by BCG-immunotherapy. The treatment with nonsteroidal antiinflammatory drugs and steroids is sufficient in many patients. In case of unresponsiveness, however, antituberculosis therapy is indicated.
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Affiliation(s)
- C Neumayr
- Allgemeines öffentliches Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz, I. Interne Abteilung mit Gastroenterologie und Hepatologie, Diabetologie und Rheumatologie, Wels, Osterreich, Germany. neumayr@
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Weber T, Kirchgatterer A, Kronabethleitner G, Höbling W, Mannhalter C, Chott A, Knoflach P. A 75-year-old man with fever, diarrhea, weight loss and a mid-esophageal mass. Endoscopy 2002; 34:678. [PMID: 12173096 DOI: 10.1055/s-2002-33232] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- T Weber
- 1st Medical Department, Allgemeines Krankenhaus der Barmherzigen Schwestern, Wels, Austria.
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Aschl G, Kirchgatterer A, Allinger S, Hinterreiter M, Stadler B, Knoflach P. [Indications and results of endoscopic examinations in intensive care units]. Acta Med Austriaca 2002; 29:48-51. [PMID: 12050945 DOI: 10.1046/j.1563-2571.2002.02003.x] [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: 11/20/2022]
Abstract
The aim of the study was to analyze retrospectively all endoscopies performed on 3 intensive care units in a tertiary referral center with more than thousand beds during a period of ten years. The study evaluates all endoscopies with regard to indication and findings. In the years 1989-1998 a total of 326 endoscopic examinations was performed, most of them were done as an upper gastrointestinal endoscopy (88%). In more than 87% the indication was a suspected gastrointestinal bleeding. The most frequent findings consisted in ulcers of the stomach or duodenum and esophageal varices, then followed by Mallory-Weiss-lesions, esophagitis and erosive gastritis. The etiology of gastrointestinal bleeding was similar to that of non intensive care patients. Specific causes of bleeding such as esophagitis caused by nasogastric tubes were only found in 3% of all bleedings. The numbers of endoscopies on the 3 intensive care units were increasing during the ten year period, however the numbers of the patients treated on the intensive care units were also increasing, but the increase of endoscopies was not always parallel to the rising number of intensive care patients.
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Affiliation(s)
- G Aschl
- I. Interne Abteilung/Gastroenterologie, Allgemeines Krankenhaus der Barmherzigen Schwestern vom heiligen Kreuz, Grieskirchner Strasse 42, A-4600 Wels.
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Kirchgatterer A, Weber T, Hinterreiter M, Knoflach P, Allerberger F. Haemorrhagic colitis due to Escherichia coli O103:H2 associated with infliximab therapy in a patient with rheumatoid arthritis. Rheumatology (Oxford) 2002; 41:355-6. [PMID: 11934982 DOI: 10.1093/rheumatology/41.3.355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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