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Biomedical subjects

P Knoflach

Publications and source records attributed to P Knoflach.

At least 19 recordsLinked to original sources
PubMed2005

Lansoprazole-associated collagenous colitis: a case report.

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.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

[Immunosuppressive therapy for inflammatory bowel disease: consensus by the Austrian working group on IBD].

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.

Administration, Oral↗
PubMed2004

Multicenter retrospective evaluation of capsule endoscopy in clinical routine.

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.

Adult↗
PubMed2003

[W.D.H.A. Syndrome due to occult neuroendocrine malignancy with concomitant liver metastases].

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.

Biopsy, Needle↗
PubMed2003

[Relevance of diagnostic and interventional endoscopy in elderly patients].

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.

Aged↗
PubMed2002

[Chronic reactive arthritis associated with Calmette-Guérin bacillus].

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.

Anti-Inflammatory Agents↗
PubMed2002

[Indications and results of endoscopic examinations in intensive care units].

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.

Endoscopy↗
PubMed2002

Examination, prevention and treatment of osteoporosis in patients with inflammatory bowel disease: recommendations and reality.

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.

Absorptiometry, Photon↗
PubMed2002

[Fever and weight loss as leading symptoms of infection with giardia lamblia].

Infections, malignancies and autoimmune diseases are the most important causes of fever of unknown origin.A case report of a 80-year old patient is described, who was admitted to our hospital because of fever lasting more than 2 weeks, weight loss and lack of appetite. Physical examination did not provide any relevant information, laboratory tests revealed an elevation of inflammation markers and anemia. Serological tests for infectious and autoimmune diseases and cultures of stool, blood and urine were all negative. Imaging did not show any pathological findings, colonoscopy and gastroscopy were macroscopically normal. Surprisingly, histology showed massive giardiasis of the duodenum. After initiation of therapy with metronidazol, fever and inflammation markers declined and the patient could be discharged from hospital without complaints on the 15(th) day after admission. Giardia lamblia is one of the most common intestinal pathogens worldwide. Infection can cause acute diarrhea, but may also be responsible for chronic abdominal complaints or may stay asymptomatic. To our knowledge, giardiasis has not been described as differential diagnosis of fever of unknown origin so far. In synopsis of clinical presentation and outcome after antibiotic therapy, we postulate that Giardia lamblia was the relevant cause of fever and weight loss in this case. In patients presenting with these symptoms, Giardia lamblia should be considered as differential diagnosis.

Aged↗
PubMed2002

[Obstructive jaundice and acute pancreatitis due to an obstruction of the afferent loop after billroth-II-resection].

An obstruction of the afferent loop after Billroth-II-resection is an extremely rare late complication of this procedure. We report on a 76-year-old female patient with a history of Billroth-II-resection 11 years ago who was admitted due to acute pancreatitis and obstructive jaundice. Abdominal sonography lead to the suspicion of a dilated afferent loop, which could be proven by means of magnetic resonance imaging. A tumorous lesion as cause of the obstructive jaundice was not detectable. Intraoperatively a volvulus of the small intestine and strangling adhesions near the Braun's anastomosis were seen, causing the obstruction of the afferent loop. Following reposition of the small intestine and adhesiolysis the patient gained a quick relief of symptoms and the jaundice disappeared completely.

Acute Disease↗
PubMed2002

[Colonoscopy and sigmoidoscopy in patients aged eighty years or older].

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.

Age Factors↗
PubMed2001

[Risk of osteoporosis in steroid therapy. When and how to counter the risk].

Many chronic inflammatory diseases require treatment with steroids, however, a remarkable proportion of steroid-treated patients suffer from osteoporosis as a major complication following longterm treatment. Steroid-induced osteoporosis with its complex pathogenesis represents one of the most important secondary causes of osteoporosis. If we care for patients with steroid therapy we have both to consider this problem and to focus on strategies to evaluate patients at risk. The dosage of the steroid, life style factors, menopausal status, low bone mineral density at baseline and previous osteoporotic fractures predispose for the manifestation of steroid-induced osteoporosis. Decisions in regard of prevention and therapy depend on risk factors of the individual patient. Supplementation of calcium and vitamin D is usually appropriate, and postmenopausal women should be offered hormone replacement therapy. The prescription of bisphosphonates is strongly recommended to patients at elevated risk or to patients with already documented osteoporosis.

Anti-Inflammatory Agents↗
PubMed2001

Concomitant manifestation of achalasia and sphincter of Oddi dysfunction.

We report the case of a 44-year-old woman who suffered from biliary-type pain after cholecystectomy, dysphagia, and weight loss. Examinations revealed sphincter of Oddi dysfunction (SOD) and achalasia. Complete relief of symptoms was achieved by endoscopic sphincterotomy and pneumatic dilation of the distal esophagus. This case report demonstrates for the first time the concomitant manifestation of two motility disorders of the upper gastrointestinal tract, i.e. achalasia and SOD. At present, any causal relationship seems speculative; however, both diseases were successfully treated using endoscopic procedures.

Adult↗