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1. Abstracts derausgewählten Beiträge der ReferentenInhaltsverzeichnisThema direkt ansteuern: STRG +…
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  • 1. Abstracts derausgewählten Beiträge der ReferentenInhaltsverzeichnisThema direkt ansteuern: STRG + Anklicken......................................................................3Ösophagus/Magen/Duodenum..........................................................................................4Leber.................................................................................................................................29Hepatology 2004; Vol. 40, No. 4, Suppl.1: 238A..............................................................38BMJ. 2004 May 1;328(7447):1046. Epub 2004 Mar 30...................................................50Non-absorbable disaccharides for hepatic encephalopathy: systematic review ofrandomised trials.Als-Nielsen B, Gluud LL, Gluud C.Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical InterventionResearch, Copenhagen University Hospital, Department 7102, H:S Rigshospitalet,DK-2100 Copenhagen, Denmark. bodil.a@ctu.rh.dkOBJECTIVE: To assess the effects of non-absorbable disaccharides (lactulose andlactitol) in patients with hepatic encephalopathy. DATA SOURCES: Cochrane Hepato-Biliary Group controlled trials register, Cochrane Library, Medline, and Embase untilMarch 2003; reference lists of relevant articles; authors and pharmaceutical companies.REVIEW METHODS: Randomised trials that compared non-absorbable disaccharideswith placebo, no intervention, or antibiotics for hepatic encephalopathy were included.The primary outcome measures were no improvement of hepatic encephalopathy andall cause mortality. RESULTS: 22 trials were included. Compared with placebo or nointervention, non-absorbable disaccharides seemed to reduce the risk of noimprovement in patients with hepatic encephalopathy (relative risk 0.62, 95% confidenceinterval 0.46 to 0.84, six trials). However, high quality trials found no significant effect(0.92, 0.42 to 2.04, two trials). Compared with placebo or no intervention, non-absorbable disaccharides had no significant effect on mortality (0.41, 0.02 to 8.68, fourtrials). Non-absorbable disaccharides were inferior to antibiotics in reducing the risk ofno improvement (1.24, 1.02 to 1.50, 10 trials) and lowering blood ammoniaconcentration (weighted mean difference 2.35 micromol/l, 0.06 micromol/l to 13.45micromol/l, 10 trials). There was no significant difference in mortality (0.90, 0.48 to 1.67,five trials). CONCLUSIONS: There is insufficient evidence to support or refute the use of
  • 2. non-absorbable disaccharides for hepatic encephalopathy. Antibiotics were superior tonon-absorbable disaccharides in improving hepatic encephalopathy, but it is unclearwhether this difference is clinically important. Non-absorbable disaccharides should notserve as comparator in randomised trials on hepatic encephalopathy............................50Darmerkrankungen/Pankreas..........................................................................................51 Authors: H. Ogata, T. Matsui, M. Nakamura , M. Iida, M. Takazoe, Y. Suzuki, T. Hibi...........................................................................................................................56ST diameter......................................................................................................................702. DDW Abstracts.............................................................................................................75.........................................................................................................................................77Onkologie / Ernährung......................................................................................................78 Thema direkt ansteuern: STRG + Anklicken
  • 3. Ösophagus/Magen/DuodenumReflux W. Voderholzer1. Abstracts von OriginalarbeitenGastroenterology. 2005 Mar;128(3):532-40.Nonresorbable copolymer implantation for gastroesophageal refluxdisease: a randomized sham-controlled multicenter trial.Deviere J, Costamagna G, Neuhaus H, Voderholzer W, Louis H, Tringali A,Marchese M, Fiedler T, Darb-Esfahani P, Schumacher B.Service de Gastro-Enterologie et dHepato-Pancreatologie, Universite Libre deBruxelles, Hopital Erasme, Brussels, Belgium. jdeviere@ulb.ac.beBACKGROUND & AIMS: This aim was to determine whether endoscopic implantation ofa biocompatible nonresorbable copolymer (Enteryx; Boston Scientific Corp, Natick, MA)is a more effective therapy for gastroesophageal reflux disease (GERD) than a shamprocedure. METHODS: In a randomized, single-blind, prospective, multicenter clinicaltrial, 64 patients with GERD were enrolled whose symptoms were well controlled byproton pump inhibitor (PPI) therapy and rapidly recurred after cessation of PPI therapy.Thirty-two patients were assigned to Enteryx implantation and 32 to a sham procedureconsisting of standard upper endoscopy. Patients in both groups with unsatisfactorysymptom relief after 3 months were eligible for re-treatment by Enteryx implantation. Theprimary study end point was > or =50% reduction in PPI use. Secondary end pointsincluded > or =50% improvement in GERD score and the proportion of patients notundergoing re-treatment procedure. Follow-up evaluations were performed at 3 and 6months. RESULTS: The percentage of Enteryx-treated patients achieving a > or =50%reduction in PPI use (81%) was greater than that of the sham group (53%), with a rateratio of 1.52 (confidence interval [CI], 1.06-2.28; P=.023). A higher proportion of theEnteryx (68%) than sham group (41%) ceased PPI use completely (rate ratio, 1.67; CI,1.03-2.80; P=.033). GERD health-related quality of life heartburn score improvement >or =50% was achieved by 67% of the Enteryx group versus 22% of the sham group (rateratio, 3.05; CI, 1.55-6.33; P <.001). More Enteryx-treated (81%) than sham-treated(19%) patients did not undergo re-treatment (rate ratio, 4.33; CI, 2.23-9.29; P <.001).CONCLUSIONS: Enteryx implantation more effectively reduces PPI dependency andalleviates GERD symptoms than a sham procedure.
  • 4. Am J Gastroenterol. 2004 Dec;99(12):2317-23.Characteristics and clinical relevance of proximal esophageal pHmonitoring.Cool M, Poelmans J, Feenstra L, Tack J.Department of Medicine, Division of Gastroenterology, University Hospitals Leuven,Belgium.OBJECTIVE: It is well established that various ENT disorders and symptoms may be amanifestation of gastroesophageal reflux disease (GERD). Measuring proximalesophageal acid exposure might be useful in the evaluation of patients with suspectedreflux-related ENT manifestations, but the limited available data are conflicting. The aimof the present study was to study the determinants of proximal esophageal acidexposure (PR) and to evaluate the clinical usefulness of ambulatory proximal pHmonitoring. METHODS: Twenty healthy controls and 346 patients with suspected refluxdisease underwent typical and atypical GERD symptom assessment, endoscopy,esophageal manometry and ambulatory combined dual esophageal pH, and Bilitecduodeno-gastro-esophageal reflux exposure (DGER) monitoring. The presence ofpathological PR and its relation to symptom pattern and distal esophageal acid exposure(DR) and DGER exposure were analyzed. RESULTS: Fifty-seven patients (16%) hadpathological PR. Demographic characteristics, symptom pattern, and manometricfindings did not differ in patients with normal or pathological PR. Patients withpathological PR had significantly higher DR and DGER. The multivariate analysisidentified only pathological DR as an independent risk factor for the presence ofpathological PR (odds ratio 4.515, 95% CI 2.48-8.23, p < 0.0001). Only 20 patients (6%)had pathological proximal reflux without pathological distal acid reflux. CONCLUSION:The findings of the present article do not support routine proximal esophageal pHmonitoring as a clinical tool: PR does not differentiate patients with typical or atypicalGERD manifestations and depends mainly on DR.
  • 5. 2. DDW AbstractsDDW Abstract T1692-Suppl. to Gastroenterol.2, 2005 Apr.;128(4):A531.Disclosures: Organization - Astra Zeneca, Sweeden, Relationship - Grant / ResearchSupportBaclofen Reduces Weakly Acidic Reflux in Ambulant Patients WithGERDD. Sifrim, J. Tack, J. Arts, P. Caenepeel, X. Zhang, J. Silny, H. Rydholm, J.JanssensWeakly acidic gastroesophageal reflux (pH drop between 7-4) might be associated withpersisting symptoms in patients with GERD “on” PPI, and also with chronic cough inadults or cardio-respiratory events in infants. Treatment with PPI does not affectsignificantly weakly acidic reflux. By reducing TLESRs, baclofen decreases acid reflux inpatients with GERD and bile reflux in patients refractory to PPI. Baclofen can alsoreduce postprandial weakly acidic reflux in patients with GERD studied in stationaryrecumbent position. However, most weakly acidic reflux occurs during daytime in uprightambulant conditions. We aimed to assess the effect of baclofen on total, acid andweakly acidic reflux in ambulant GERD patients. Methods: In a double blind,randomized, placebo controlled, cross-over designed study, 24h ambulatory ph-impedance monitoring, endoscopy and symptoms assessment were performed in 15patients with GERD “off” PPI therapy [5 men, 55 years (27-73)] before and after 4 weeksof treatment with placebo or Baclofen 20 mg (t.i.d). At inclusion, patients had NERD(n=6), esophagitis gradeA (n=7) esophagitis gradeB (n=2). 8 patients had HH. Refluxwas classified as acid (pH drop below 4), weakly acidic (nadir pH between 4 and 7) andweakly alkaline (impedance drops without pH change below 7). Results: Baclofen reducedthe 24h total number of reflux events by 38%, acid reflux by 46% and weakly acidicreflux by 28%. The main effect was observed in upright position and during thepostprandial periods (43%, 44% and 33% reduction, respectively, p< 0.05). Baclofen didnot modify supine reflux. Baclofen reduced, but not significantly, 24h esophageal acidexposure (7.5±1.4 vs. 5.5±0.9) and did not affect the air-liquid composition or theproximal extent of reflux. Esophagitis was healed in 4/9 patients and scores for the mostsevere symptom were improved in 10/15 patients. Conclusion: The total number ofreflux episodes (acid and weakly acidic) can be reduced by baclofen in ambulantpatients with GERD “off” PPI. Outcome studies from adult patients with persistingsymptoms “on” PPI or chronic cough as well as from infants with cardio-respiratoryevents are required to establish the clinical usefulness of pharmachological reduction ofweakly acidic reflux in GERD.* total reflux acid weakly Weakly all refluxp<0.05 acidic alkaline pH>424hs 61±7 - 30±5 - 24±3 - 7±4 - 3±1 31±5 - 22±4 41±6* 18±3* 19±4upright 57±7 - 28±5 - 23±3 - 6±3 - 4±1 29±4 - 19±3* 34±4* 15±2* 16±3*
  • 6. DDW Abstract 630- Suppl. to Gastroenterol.2, 2005 Apr.;128(4):A95.Disclosures: NoneDoes Surgical Fundoplication Improve Chronic Laryngeal Symptomsand Signs Unresponsive To Aggressive Medical Therapy? aProspective Cohort Study.J.M. Swoger, C. Millstein, J.E. Richter, D. Hicks, J. Ponsky, M. VaeziObjective: In patients with persistent laryngeal symptoms despite aggressive PPItherapy, gastroesophageal reflux disease (GERD) continues to be implicated.Continued reflux of intermittent or low volume acid or non-acid gastric contents issuggested as the potential cause. Such suggestions implicate surgical fundoplication asthe ultimate therapy for these unresponsive patients. However, there are no prospectivestudies assessing this contention. Methods: 72 patients with suspected GERD relatedlaryngeal symptoms/signs were initially treated with BID PPI’s for 4 months. All hadbaseline manometry, 24-hour pH, Bilitec, and laryngoscopy, with repeat pH monitoringon therapy at 4-months. 4-month symptomatic non-responders (<50% improvement)with continued laryngeal “inflammation” and normalized esophageal acid exposure wereoffered laparoscopic Nissen Fundoplication. Post surgery, all underwent symptomassessment at 1, 3, 6, and 12 months; manometry and 24-hour pH at 3-months;laryngoscopy at 6- and 12months, and BRAVO pH monitoring at 12-months. Primaryoutcome of the study was symptom improvement/resolution at 12-months post-surgery.The outcome was then compared to the cohort who refused surgical fundoplication andcontinued on PPI therapy. Results: 26/72 (36%) patients (study cohort) remainedunresponsive to 4 months of aggressive PPI therapy. 10 patients (38%) agreed toundergo surgical fundoplication (mean age = 51.1, M= 4) and 16 patients (62%) did not(mean age = 50.6, M=4). The most common laryngeal symptoms were sore throat,hoarseness, and cough. Symptom severity (0-5) did not differ between groups (3.5 vs.3.53). pH studies at 3-months and at 12-months were normal in all patients postfundoplication (mean % time pH < 4 = 0.27%, 0.34%; respectively). 1/10 (10%) of thesurgical group reported improvement of their chronic laryngeal symptoms at 1 yearcompared to 1/16 of the control group (6.25%) (p= 1.0). Treatment of causes other thanGERD (allergies or asthma) improved symptoms in 2/10 (20%) of the surgical group,and 10/16 (62%) non-surgical cohort (p= 0.1).Conclusions: 1) Surgical fundoplicationdoes not improve laryngeal symptoms in patients unresponsive to aggressive PPItherapy. 2) In this group, the argument of intermittent, low volume or non-acid reflux asthe cause of persistent laryngeal symptoms needs to be replaced with evaluation andtherapy for other non-GERD causes.
  • 7. Barrett T. Rösch1. OriginalarbeitenGastroenterology. 2004 Jul;127(1):310-30.A critical review of the diagnosis and management of Barrettsesophagus: the AGA Chicago Workshop.Sharma P, McQuaid K, Dent J, Fennerty MB, Sampliner R, Spechler S, Cameron A,Corley D, Falk G, Goldblum J, Hunter J, Jankowski J, Lundell L, Reid B, ShaheenNJ, Sonnenberg A, Wang K, Weinstein W; AGA Chicago Workshop.University of Kansas School of Medicine and VA Medical Center, Kansas City, Missouri64128-2295, USA. psharma@kumc.eduBACKGROUND & AIMS: The diagnosis and management of Barretts esophagus (BE)are controversial. We conducted a critical review of the literature in BE to provideguidance on clinically relevant issues. METHODS: A multidisciplinary group of 18participants evaluated the strength and the grade of evidence for 42 statementspertaining to the diagnosis, screening, surveillance, and treatment of BE. Each memberanonymously voted to accept or reject statements based on the strength of evidenceand his own expert opinion. RESULTS: There was strong consensus on moststatements for acceptance or rejection. Members rejected statements that screening forBE has been shown to improve mortality from adenocarcinoma or to be cost-effective.Contrary to published clinical guidelines, they did not feel that screening should berecommended for adults over age 50, regardless of age or duration of heartburn.Members were divided on whether surveillance prolongs survival, although the majorityagreed that it detects curable neoplasia and can be cost-effective in selected patients.The majority did not feel that acid-reduction therapy reduces the risk of esophagealadenocarcinoma but did agree that nonsteroidal antiinflammatory drugs are associatedwith a cancer risk reduction and are of promising (but unproven) value. Participantsrejected the notion that mucosal ablation with acid suppression preventsadenocarcinoma in BE but agreed that this may be an appropriate strategy in asubgroup of patients with high-grade dysplasia. CONCLUSIONS: Based on this reviewof BE, the opinions of workshop members on issues pertaining to screening andsurveillance are at variance with published clinical guidelines.
  • 8. Am J Gastroenterol. 2004 Nov;99(11):2107-14.Identification of Barretts esophagus in relatives by endoscopicscreening.Chak A, Faulx A, Kinnard M, Brock W, Willis J, Wiesner GL, Parrado AR, GoddardKA.Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland,Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.AIM: Familial aggregation of Barretts esophagus and its associated cancers has beentermed familial Barretts esophagus (FBE). The aim of the study was to determinewhether endoscopic screening would identify Barretts esophagus (BE) in relatives ofprobands with BE or esophageal adenocarcinoma (EAC). METHODS: All living first-degree relatives of patients with long segment BE or EAC presenting to the endoscopysuite of two academic hospitals were sent validated questionnaires inquiring aboutgastroesophageal reflux symptoms and prior endoscopic evaluation. First-degreerelatives of affected probands or affected relatives who reported no prior upperendoscopy were offered screening unsedated esophagoscopy. Relatives with chronicgastroesophageal reflux symptoms were also offered an alternative of conventionalsedated upper endoscopy. The yield of screening endoscopy was measured. Screeningendoscopy findings were then compared between family members of known FBEpatients and those with "isolated" disease. RESULTS: One hundred and ninety-eightrelatives from 69 families, 23 known FBE probands and 46 probands with apparently"isolated" disease, were enrolled. Forty relatives (29 FBE relatives and 11 relatives ofprobands with "isolated" disease) reported prior upper endoscopy. Screening upperendoscopies performed on 62 (25 FBE and 37 "isolated" disease relatives) of theremaining 158 relatives identified Barretts epithelium in 13 (21%). Compared toprobands with apparently "isolated" disease, Barretts epithelium (EAC, BE, or SSBE)was identified significantly more often in siblings and offspring of FBE probands, p</=0.05. Endoscopic screening of relatives of FBE probands identified a multigenerationmultiplex FBE pedigree consistent with an autosomally dominant inherited trait.Endoscopic screening of relatives of probands with reported "isolated" diseased did notidentify any new FBE pedigrees. CONCLUSIONS: Endoscopy identified EAC, long-segment BE, and short-segment BE in a substantial proportion of first-degree relativesof affected members of FBE families. A familial susceptibility to develop Barrettsepithelium appears to be present in a subset of patients with BE and EAC.
  • 9. Gut. 2004 Oct;53(10):1402-7.The Munich Barrett follow up study: suspicion of Barrettsoesophagus based on either endoscopy or histology only--what is theclinical significance?Meining A, Ott R, Becker I, Hahn S, Muhlen J, Werner M, Hofler H, Classen M,Heldwein W, Rosch T.Central Interdisciplinary, Endoscopy Unit, Department of Gastroenterology, CampusVirchow, Charite University Hospitals, Berlin, Germany. Thomas.Roesch@charite.deBACKGROUND: The incidence of distal oesophageal adenocarcinoma is rising, withchronic reflux and Barretts oesophagus being considered risk factors. Reliable detectionof Barretts oesophagus during upper endoscopy is therefore mandatory but requiresboth endoscopy and histology for confirmation. Appropriate management of patientswith endoscopic suspicion but negative on histology, or vice versa, or of patients with noendoscopic suspicion but with a biopsy diagnosis of intestinal metaplasia at the gastro-oesophageal junction, has not yet been studied prospectively. PATIENTS ANDMETHODS: In a prospective multicentre study, 929 patients (51% male, mean age 50years) referred for upper gastrointestinal endoscopy were included; 59% had refluxsymptoms. The endoscopic aspect of the Z line and any suspicion of Barrettsoesophagus were noted, and biopsies were taken in all patients from the Z line (n = 4),gastric cardia (n = 2), and body and antrum (n = 2 each). Biopsies positive forspecialised intestinal metaplasia (SIM) were reviewed by a reference pathologist for afinal Barretts oesophagus diagnosis. All patients with endoscopic and/or histologicalsusp
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