[Diagnosis and therapy of ulcerative colitis--results of an evidence-based consensus conference of the German Society of Digestive and Metabolic Diseases].
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Colitis, Ulcerative↗
Biomedical subjects
G Moser
Publications and source records attributed to G Moser.
[Guidelines of the DGVS. Psychosomatic aspects. German Society of Digestive and Metabolic Diseases].
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Adaptation, Psychological↗
Is mycophenolate mofetil an effective alternative in azathioprine-intolerant patients with chronic active Crohn's disease?
OBJECTIVES: Up to 50% of patients with Crohn's disease (CD) develop steroid-dependent or refractory disease requiring immunosuppression. Azathioprine (AZA) is usually used for this purpose but must be withdrawn in up to 10% of patients because of adverse events. Mycophenolate mofetil (MMF) is of proven efficacy and safety in transplantation and in some autoimmune disorders. The aim of the present study was to investigate the effect of MMF, especially in AZA-intolerant patients with chronic active CD, in comparison to a matched control group treated with AZA. METHODS: In a retrospective study, 15 patients treated with MMF and 30 randomly chosen, matched patients treated with AZA for chronic active CD were compared over a period of 1 yr. Intolerance to AZA was the indication for MMF. Crohn's Disease Activity Index (CDAI), steroid demand, extraintestinal manifestations, and hematological and biochemical parameters were assessed at the start of therapy and 1, 2, 3, 6, 9, and 12 months thereafter. RESULTS: All patients who completed the 12 months of treatment (77% AZA, 60% MMF) achieved remission. Under MMF, the cumulative prednisolone dose could be reduced by 1 g in the first half year, whereas, under AZA, this reduction was possible only in the second half year. MMF patients had almost twice as many flare-ups (80% vs 47%). Adverse events prompted the withdrawal of AZA in five patients (17%) and of MMF in three (20%). CONCLUSIONS: Both drugs are effective in inducing remission. AZA seems to be more effective in maintaining remission. The onset of therapeutic effect is delayed less under MMF. Both drugs have steroid sparing potential, which is delayed under AZA. It seems that AZA still is the immunouppressant of choice in chronic active CD, but MMF is a reasonable alternative in patients who do not tolerate AZA.
Adult↗
Cross-cultural variation in disease-related concerns among patients with inflammatory bowel disease.
OBJECTIVE: The aim of this work was to study cross-cultural variations in the impact of inflammatory bowel disease (IBD) on health-related quality of life by an international comparison of disease-related concerns. METHODS: Item and factor scores on the Rating Form of Inflammatory Bowel Disease Patient Concerns and overall mean concern levels were compared by analysis of variance among 2002 IBD patients in eight countries. RESULTS: The overall level of concern varied from 51 out of 100 in Portugal to 19 in Sweden, with intermediate scores for Italy (43), Canada (40), United States (39), France (39), Austria (33), and Israel (25). Having surgery, an ostomy, the uncertain nature of the disease, and medication side effects were each rated among the first five in importance in six countries. Other items varied considerably. For example, concern regarding pain and suffering was high in Israel and low in Portugal, whereas concern over developing cancer was low in Italy. Concern over financial issues and access to high-quality health care were inversely associated with measures of national economic prosperity. CONCLUSIONS: 1) Cross-cultural comparisons of patient concerns related to IBD are feasible using translated scales. 2) Reporting tendencies vary greatly; within Europe, patients from southern countries report greater overall concern. 3) The complications and the variable evolution of disease elicit general concern, but the importance of specific issues varies among countries. 4) The reasons for national differences may have social, cultural, and/or economic determinants with relevance to the patient-physician relationship, patient education, and therapeutic decision making.
Canada↗
The porcine adenosine monophosphate deaminase 1 (AMPD1) gene maps to chromosome 4.
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AMP Deaminase↗
[Consensus of the Chronic Inflammatory Bowl Disease Study Group of the Austrian Society of Gastroenterology and Hepatology on the topic of "diagnosis and therapy of chronic inflammatory bowel diseases in adolescence"].
Although up to 20% of patients with Crohn's disease have their first flare during childhood or adolescence, there are no or only a few randomized, controlled studies. However, big differences and uncertainty may be observed between the diagnosis and therapy of pediatricians and gastroenterologists specialized for adults. In addition, special problems result from the enormous somatic and psychological evolution during adolescence. The diagnosis is done as in adult patients by enteroclysm and ileocolonoscopy (including multiple biopsies) whereas a deep sedoanalgesia or anesthesia should be performed routinely. Corticosteroids are the gold standard for therapy of Crohn's disease in the adolescence (especially in cases with high inflammatory activity), but also enteral nutrition over 4-12 weeks--or a combination of both. A recent randomized controlled study demonstrates the positive effect of 6-mercaptopurine in newly diagnosed patients with Crohn's disease in the adolescence. 5-aminosalicylates or the probably more effective azathioprine/6-mercaptopurine could be used for prevention of recurrence in Crohn's disease. The therapy of ulcerative colitis is performed as in adults including the very effective local rectal applications. An accompanying psychosomatic therapy is recommended especially in young patients with disturbed separation from the parents and inadequate coping. The indication for surgery is similar to adults. However, a specific indication for earlier surgery is given, if severe malabsorption and delay of growth takes place in spite of adequate therapy, because this delay of growth could be only caught up before puberty. A conservative therapeutic regimen is recommended in young patients with perianal Crohn's disease.
Adolescent↗
Combined analyses of data from quantitative trait loci mapping studies. Chromosome 4 effects on porcine growth and fatness.
For many species several similar QTL mapping populations have been produced and analyzed independently. Joint analysis of such data could be used to increase power to detect QTL and evaluate population differences. In this study, data were collated on almost 3000 pigs from seven different F(2) crosses between Western commercial breeds and either the European wild boar or the Chinese Meishan breed. Genotypes were available for 31 markers on chromosome 4 (on average 8.3 markers per population). Data from three traits common to all populations (birth weight, mean backfat depth at slaughter or end of test, and growth rate from birth to slaughter or end of test) were analyzed for individual populations and jointly. A QTL influencing birth weight was detected in one individual population and in the combined data, with no significant interaction of the QTL effect with population. A QTL affecting backfat that had a significantly greater effect in wild boar than in Meishan crosses was detected. Some evidence for a QTL affecting growth rate was detected in all populations, with no significant differences between populations. This study is the largest F(2) QTL analysis achieved in a livestock species and demonstrates the potential of joint analysis.
Adipose Tissue↗
A hybrid on-line ECG segmenting system for long-term monitoring.
This paper introduces a new hybrid ECG beat segmenting system, which can be applied in the processing unit of single-channel, long-term ECG monitors for the on-line segmentation of the ECG signal. Numerous ECG segmentation techniques are already existing and applied, however sufficiently robust and reliable methods currently require more than one ECG signal channel and quite complex computations, which are practically not feasible in stand-alone, low-cost monitors. Our new system approach presents a time domain segmentation technique based on a priori physiological and morphological information of the ECG beat. The segmentation is carried out after classifying the ECG beat, using the linear approximation of the filtered ECG signal and considering the pathophysiological properties as well. The proposed algorithms require moderate computational power, allowing the practical realization in battery powered stand-alone long-term cardiac monitors or small-sized cardiac defibrillators. The prototype version of the system was implemented in Matlab. The test and evaluation of the system was carried out with the help of reference signal databases.
Algorithms↗
Characterization of three PCR-RFLPs in an intron of the porcine liver- and red cell-type pyruvate kinase (PKLR) gene.
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Alleles↗
[Psychosomatics in gastroenterology].
Never before has the correlation between psychosocial factors and digestive diseases or disorders been studied more intensively than in the past decade. The following article will provide you with a survey of the major studies, functional gastrointestinal disorders, gastroesophageal reflux disease, peptic ulcer and chronic inflammatory bowel diseases taking into account psychosocial factors. The biopsychosocial model is a remarkable step forward in the process of learning more about these diseases, The integrated way of looking at biological, psychological and social factors has become an absolute must for those who want to fully understand the development and the severity of symptoms as well as diagnostics and therapy of these disorders.
Colitis, Ulcerative↗
Identification of QTL affecting important traits on porcine chromosome 12.
To screen the whole porcine chromosome 12 for QTL affecting economically important traits, ten genetic markers were genotyped in two F2 populations generated from the cross of genetically diverse breeds: European Wild pig and commercial pig breed Pietrain (W x P), and Chinese Meishan and Pietrain (M x P). Fifty-one traits were recorded. A least squares method was used for chromosome-wide screening for QTL. An association analysis between genotypes at the GH locus and traits was also carried out. The least squares analysis did not reveal the presence of genome-wide significant QTL affecting the traits, while the association study showed significant (P < 0.01) associations between GH genotypes and fatness traits in M x P, but not in W x P. F2 pigs carrying the genotype C1A2/C4A2 at the GH locus displayed the thinnest backfat (21.76 mm), while the ones carrying the genotype C2A2/C2A2 had the thickest (31.41 mm).
Animals↗
Rapid and precise genotyping of porcine microsatellites.
Microsatellites are useful markers for genetic mapping and linkage analysis because they are highly polymorphic, abundant in genomes and relatively easily scored with polymerase chain reaction (PCR). A rapid genotyping system for microsatellites was developed, which included multiplex PCRs, multiple use of Hydrolink gels, automated fluorescent detection of fragments on an A.L.F. DNA sequencer, automatic assignment of alleles to each locus and verification of genotypes with a self-developed computer program "Fragtest". Eight multiplex PCRs have been developed to genotype 29 microsatellites for genetic and quantitative trait loci (QTL) mapping on pig chromosomes 6, 7, 12 and 13. Three to six microsatellites could be amplified in one multiplex PCR. Each multiplex reaction required only different concentrations of each pair of primers and a low concentration of dNTP (100 microM). A dNTP concentration of 100 microM proved to be optimal for the coamplification of microsatellites under the concentration of 1.5 mM MgCl2. Using four internal size standards added in each sample, the 5% Hydrolink gel could subsequently be used up to five times (total running time of 500 min) on the A.L.F. automated sequencer without significant loss of resolution and precision of fragment length analysis. Automatic assignment of alleles on each locus using "Fragtest" significantly increased the efficiency and precision of the genotyping. This system is thus a rapid, cheap, and highly discriminating genotyping system.
Animals↗
Health-related quality of life in patients with Crohn's disease: influence of surgical operation--a prospective trial.
Improvement of health-related quality of life (HRQOL) is a major determinant in decision-making for surgery in patients with Crohn's disease (CD). This study was designed to investigate the short- and long-term effect of surgical resection for CD on HRQOL. Sixteen patients were investigated within one week before surgery and 3, 6, and 24 months postoperatively. Besides the Crohn's disease activity index (CDAI), four instruments: the time trade-off technique (TTO), the direct questioning of objectives (DQO), the rating form of inflammatory bowel disease patients concerns (RFIPC), and the Beck depression inventory--were used for assessment of HRQOL. CDAI decreased significantly after operation and 10 patients remained in remission for 24 months. Two patients had postoperative relapses and went into remission after prednisolone treatment. Four patients developed chronic active disease. HRQOL was significantly improved in all patients three and six months postoperatively. Except for the four patients with chronic active disease, all other patients (N = 12) had also significantly improved HRQOL after 24 months. In conclusion, surgical resections in CD lead to a long-term improvement of HRQOL with the exception of patients with chronic active disease. This finding might be taken in consideration for the indication of surgery in CD.
Adult↗
Frequency-dependent shear viscosity, sound velocity, and sound attenuation near the critical point in liquids. III. The shear viscosity.
We compare theoretical results for the shear viscosity calculated in one-loop order within the field-theoretical method of the renormalization-group theory with experiments. Our expressions describe the nonasymptotic crossover in both temperature and density, and allow us to consider effects of finite gravitation and finite frequency at which the experiments are performed. In doing so we treat the critical exponent x(eta) of the shear viscosity as an independent parameter, keeping the one-loop value of the Kawasaki amplitude fixed. Within our model we also consider the temperature and density dependence of the thermal diffusion including gravitational effects.
Journal Article↗
Transabdominal bowel sonography for the detection of intestinal complications in Crohn's disease.
BACKGROUND: The course of Crohn's disease is characterised by the occurrence of intestinal complications such as strictures, intra-abdominal fistulas, or abscesses. Standard diagnostic procedures may fail to show these complications, in particular fistulas. AIMS: To test the value of transabdominal bowel sonography (T) for the detection of intestinal complications in Crohn's disease. METHODS: T was prospectively performed in 213 patients with Crohn's disease in a university based inflammatory bowel disease referral centre. Thirty three underwent resective bowel surgery and were included in this study. The accuracy of T to detect strictures, intra-abdominal fistulas, or abscesses was compared with surgical and pathological findings. RESULTS: T was able to identify strictures in 22/22 patients and to exclude it in 10/11 patients (100% sensitivity, 91% specificity). Fistulas were correctly identified in 20/23 patients and excluded in 9/10 patients (87% sensitivity, 90% specificity). Intra-abdominal abscesses were correctly detected in 9/9 patients and excluded in 22/24 patients (100% sensitivity, 92% specificity). CONCLUSIONS: In experienced hands T is an accurate method for the detection of intestinal complications in Crohn's disease. T is thus recommended as a primary investigative method for evaluation of severe Crohn's disease.
Abdominal Abscess↗
Immunohistopathological findings in an adult llama with listeriosis.
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Animals↗
[Cyclosporin A therapy in steroid-refractory patients with chronic inflammatory bowel diseases].
About eighty percent of patients with severe ulcerative colitis refractory to steroids are responsive to intravenous cyclosporine therapy within a few days. However, no controlled data are available on intravenous cyclosporine therapy in steroid refractory Crohn's disease. In this study 7 patients with severe ulcerative colitis and 4 patients with active Crohn's disease unresponsive to prednisone were treated with high dose intravenous cyclosporine. A response was estimated by a decrease of Crohn's disease activity index (Best) and colitis activity index (Rachmilewitz). Six of 7 patients with ulcerative colitis showed a significant decrease in colitis activity index (index before therapy: 15 +/- 2; one week later: 7 +/- 1; p < 0.001). In these patients prednisone could be tapered to a dose less than 20 mg/day within 6 months during oral cyclosporine and concomitant azathioprine therapy. Cyclosporine medication was withdrawn within a few weeks and the clinical response could be preserved for another 6 months. In 3 of 4 patients with Crohn's disease intravenous cyclosporine led to a temporary improvement of the Crohn's disease activity index (before treatment: 343 +/- 43, after one week: 194 +/- 20; p < 0.05). Nevertheless, all of these patients had an early relapse under oral cyclosporine therapy. Our data confirm the efficacy of intravenous cyclosporine as a rapid acting drug for severe ulcerative colitis. Maintenance therapy with azathioprine preserved the clinical response for one year. In patients with steroid refractory Crohn's disease intravenous cyclosporine showed only a short term effect.
Administration, Oral↗