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Kucharzik T, Dignass A, Atreya R, Bokemeyer B, Esters P, Herrlinger K, Kannengiesser K, Kienle P, Langhorst J, Lügering A, Schreiber S, Stallmach A, Stein J, Sturm A, Teich N, Siegmund B. Aktualisierte S3-Leitlinie Colitis ulcerosa (Version 6.1) – Februar 2023 – AWMF-Registriernummer: 021-009. Z Gastroenterol 2023; 61:1046-1134. [PMID: 37579791 DOI: 10.1055/a-2060-0935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- T Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Städtisches Klinikum Lüneburg, Lüneburg, Deutschland
| | - A Dignass
- Medizinische Klinik I, Agaplesion Markus Krankenhaus, Frankfurt, Deutschland
| | - R Atreya
- Medizinische Klinik 1 Gastroent., Pneumologie, Endokrin., Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Bokemeyer
- Interdisziplinäres Crohn Colitis Centrum Minden - ICCCM, Minden, Deutschland
| | - P Esters
- Medizinische Klinik I, Agaplesion Markus Krankenhaus, Frankfurt, Deutschland
| | - K Herrlinger
- Innere Medizin I, Asklepios Klinik Nord, Hamburg, Deutschland
| | - K Kannengiesser
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Städtisches Klinikum Lüneburg, Lüneburg, Deutschland
| | - P Kienle
- Abteilung für Allgemein- und Viszeralchirurgie, Theresienkrankenhaus, Mannheim, Deutschland
| | - J Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg Klinikum am Bruderwald, Bamberg, Deutschland
| | - A Lügering
- Medizinisches Versorgungszentrum Portal 10, Münster, Deutschland
| | - S Schreiber
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig Holstein, Kiel, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Jena, Jena, Deutschland
| | - J Stein
- Abteilung Innere Medizin mit Schwerpunkt Gastroenterologie, Krankenhaus Sachsenhausen, Frankfurt, Deutschland
| | - A Sturm
- Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - N Teich
- Internistische Gemeinschaftspraxis, Leipzig, Deutschland
| | - B Siegmund
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité Campus Benjamin Franklin - Universitätsmedizin Berlin, Berlin, Deutschland
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2
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Baldotto C, Teich N, Monteiro M, Aguiar P, Andrade M, Longo C, Batista M, Lima R, Azevedo D, Carvalho N, Andrade P, Zukin M, Araújo L. FP02.06 Implementation of a Lung Cancer Value-Based Care Framework in a Low and Middle-Income Country Institution. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND The coronavirus disease 2019 [COVID-19] pandemic is affecting lives worldwide. The influence of inflammatory bowel disease [IBD] medication and IBD itself on COVID-19 is controversial. Additionally, IBD-focused guidance is scarce. OBJECTIVE Our aims were to determine COVID-19 prevalence/exposure, perception and information sources, medication compliance, patient behaviour and physician contact among patients with IBD compared with non-IBD controls. METHODS A cross-sectional anonymous survey of patients with IBD [N = 415] at one university IBD clinic and one gastroenterology practice, matched 4:1 with control participants [N = 116], was performed. RESULTS Patients with IBD had a high fear of infection. This was more pronounced in patients taking immunosuppressants and it extended to hospitals, private practices and public places, such as supermarkets. IBD patients reported leaving their homes less frequently than their peers without IBD. A total of 90% of patients with IBD reported washing their hands more frequently. Patients taking immunosuppressants were concerned about interactions between medication and COVID-19, whereas patients taking 5-aminosalicylates were not. Nonetheless, 96.4% of patients adhered to continuing their medication. Patients sought guidance primarily from television and internet news sites. Video consultations were found to be a suitable solution for a subset of patients who are young, have a high level of fear and leave their home less frequently than their peers, whereas overall acceptance of video consultations was limited. CONCLUSION Patients with IBD are significantly more affected by the COVID-19 pandemic than their non-IBD peers, but they continue to adhere to their medication regimens. IBD-focused COVID-19 information should be actively conveyed.
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Affiliation(s)
- P C Grunert
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany ,Corresponding author: Philip C. Grunert, Universitätsklinikum Jena, Klinik für Innere Medizin IV—Gastroenterologie, Hepatologie, Infektiologie, Am Klinikum 1, 07747 Jena, Germany. E-mail:
| | - P A Reuken
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - J Stallhofer
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany
| | - A Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
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4
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Reuken PA, Kruis W, Maaser C, Teich N, Büning J, Preiß JC, Schmelz R, Bruns T, Fichtner-Feigl S, Stallmach A. Microbial Spectrum of Intra-Abdominal Abscesses in Perforating Crohn's Disease: Results from a Prospective German Registry. J Crohns Colitis 2018; 12:695-701. [PMID: 29415186 DOI: 10.1093/ecco-jcc/jjy017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/13/2017] [Accepted: 02/02/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intra-abdominal abscesses [IAAs] are common life-threatening complications in patients with Crohn's disease [CD]. In addition to interventional drainage and surgical therapy, empirical antibiotic therapy represents a cornerstone of treatment, but contemporary data on microbial spectra and antimicrobial resistance are scarce. METHODS We recruited 105 patients with CD and IAAs from nine German centres for a prospective registry in order to characterize the microbiological spectrum, resistance profiles, antibiotic therapy and outcome. RESULTS In 92 of 105 patients, microbial investigations of abscess material revealed pathogenic microorganisms. A total of 174 pathogens were isolated, with a median of 2 pathogens per culture [range: 1-6]. Most frequently isolated pathogens were E. coli [45 patients], Streptococcus spp. [28 patients], Enterococci [27 patients], Candida [13 patients] and anaerobes [12 patients]. Resistance to third-generation cephalosporins, penicillins with beta-lactamase inhibitors and quinolones were observed in 51, 36 and 35 patients, respectively. Seven patients had multiple-drug-resistant bacteria. Thirty patients received inadequate empirical treatment, and this was more frequent in patients receiving steroids or immunosuppression [37%] than in patients without immunosuppression [10%: p = 0.001] and was associated with a longer hospital stay [21 days vs 13 days, p = 0.003]. CONCLUSION Based on antimicrobial resistance profiles, we herein report a high rate of inadequate empirical first-line therapy for IAAs in CD, especially in patients receiving immunosuppression, and this is associated with prolonged hospitalization.
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Affiliation(s)
- P A Reuken
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
| | - W Kruis
- Klinik für Gastroenterologie, Pulmonologie und Allgemeine Innere Medizin, Evangelisches Krankenhaus Köln Kalk, University of Cologne, Cologne, Germany
| | - C Maaser
- Ambulanzzentrum Gastroenterologie, University Teaching Hospital Lüneburg, Lüneburg, Germany
| | - N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany.,Medical Faculty, Friedrich-Schiller University, Jena, Germany
| | - J Büning
- Department of Internal Medicine I [Gastroenterology], University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - J C Preiß
- Department of Medicine I [Gastroenterology, Infectious Diseases, Rheumatology], Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - R Schmelz
- Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - T Bruns
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
| | - S Fichtner-Feigl
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - A Stallmach
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
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5
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Affiliation(s)
- N Teich
- Internistische Gemeinschaftspraxis für Verdauungs-und Stoffwechselkrankheiten, Leipzig, Germany.,Medical Faculty of the Friedrich Schiller University Jena, Jena, Germany
| | - T Bruns
- Medical Faculty of the Friedrich Schiller University Jena, Jena, Germany.,Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - A Stallmach
- Medical Faculty of the Friedrich Schiller University Jena, Jena, Germany.,Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
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6
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Bär F, Kühbacher T, Dietrich NA, Krause T, Stallmach A, Teich N, Schreiber S, Walldorf J, Schmelz R, Büning C, Fellermann K, Büning J, Helwig U. Vedolizumab in the treatment of chronic, antibiotic-dependent or refractory pouchitis. Aliment Pharmacol Ther 2018; 47:581-587. [PMID: 29266360 DOI: 10.1111/apt.14479] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 07/05/2017] [Revised: 07/27/2017] [Accepted: 11/30/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The most common complication after ileal pouch anal anastomosis in up to 50% of patients is an acute pouchitis. The majority of patients respond to antibiotic treatment. However, 10%-15% develops chronic antibiotic-dependent or refractory pouchitis which is usually hard to treat. AIM To evaluate the effectiveness of vedolizumab in patients with chronic pouchitis. METHODS Patients with chronic antibiotic-dependent or refractory pouchitis were treated with vedolizumab (300 mg at week 0, 2, 6 and 10) in 10 IBD centres and retrospectively registered. Data were recorded until week 14 of vedolizumab treatment. In total 20 patients (12 male, median age 43 years) were included for analysis. The effectiveness was measured using the Oresland Score (OS) at week 2, 6, 10 and 14 and the pouch disease activity index (PDAI) at week 0 and 14. RESULTS The mean OS declined from 6.8 (range 2-12) to 3.4 (range 0-11). Concordantly, the mean PDAI after 14 weeks of treatment dropped from 10 (range 5-18) to 3 (range 0-10). Only three patients reported moderate side effects. No serious side effects were recorded. In addition, symptomatic co-medication such as loperamide and tincture of opium could be terminated in 8 out of 12 patients as well as antibiotic treatment could be stopped in 17 out of 19 patients. CONCLUSION Our data indicate that vedolizumab could be an option in the treatment of patients with chronic, antibiotic-dependent or refractory pouchitis.
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Affiliation(s)
- F Bär
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - T Kühbacher
- Asklepios Westklinikum Hamburg, Hamburg, Germany
| | - N A Dietrich
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - T Krause
- Gastroenterology Opernstraße, Kassel, Germany
| | - A Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Jena, Jena, Germany
| | - N Teich
- Practice for Digestive and Metabolic Diseases, Leipzig, Germany
| | - S Schreiber
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Walldorf
- Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - R Schmelz
- Department of Gastroenterology, University Hospital of Dresden, Dresden, Germany
| | - C Büning
- Department of Internal Medicine, Hospital Waldfriede, Berlin, Germany
| | - K Fellermann
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - J Büning
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - U Helwig
- Practice of Internal Medicine, Oldenburg, Germany
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7
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Teich N, Stallmach A. Effective use of ustekinumab for prepouch ileitis without improvement of concomitant pouchitis. Tech Coloproctol 2018; 22:251-252. [PMID: 29423578 DOI: 10.1007/s10151-018-1754-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- N Teich
- Joint Internal Medicine Practice for Digestive and Metabolic Diseases, Leipzig and Schkeuditz, Nordstr. 21, 04105, Leipzig, Germany. .,Faculty of Medicine, Friedrich-Schiller University, Jena, Germany.
| | - A Stallmach
- Internal Medicine Clinic IV, University Clinic, Jena, Germany.,Faculty of Medicine, Friedrich-Schiller University, Jena, Germany
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Allen F, Bobanga ID, Rauhe P, Barkauskas D, Teich N, Tong C, Myers J, Huang AY. CCL3 augments tumor rejection and enhances CD8 + T cell infiltration through NK and CD103 + dendritic cell recruitment via IFNγ. Oncoimmunology 2017; 7:e1393598. [PMID: 29399390 DOI: 10.1080/2162402x.2017.1393598] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 09/06/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 01/08/2023] Open
Abstract
Inflammatory chemokines are critical contributors in attracting relevant immune cells to the tumor microenvironment and driving cellular interactions and molecular signaling cascades that dictate the ultimate outcome of host anti-tumor immune response. Therefore, rational application of chemokines in a spatial-temporal dependent manner may constitute an attractive adjuvant in immunotherapeutic approaches against cancer. Existing data suggest that the macrophage inflammatory protein (MIP)-1 family and related proteins, consisting of CCL3 (MIP-1α), CCL4 (MIP-1β), and CCL5 (RANTES), can be major determinant of immune cellular infiltration in certain tumors through their direct recruitment of antigen presenting cells, including dendritic cells (DCs) to the tumor site. In this study, we examined how CCL3 in a murine colon tumor microenvironment, CT26, enhances antitumor immunity. We identified natural killer (NK) cells as a major lymphocyte subtype that is preferentially recruited to the CCL3-rich tumor site. NK cells contribute to the overall IFNγ content, CD103+ DC accumulation, and augment the production of chemokines CXCL9 and CXCL10 for enhanced T cell recruitment. We further demonstrate that both soluble CCL3 and CCL3-secreting irradiated tumor vaccine can effectively halt the progression of established tumors in a spatial-dependent manner. Our finding implies an important contribution of NK in the CCL3 - CD103+ DC - CXCL9/10 signaling axis in determining tumor immune landscape within the tumor microenvironment.
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Affiliation(s)
- Frederick Allen
- Pathology, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States
| | - Iuliana D Bobanga
- Surgery, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States
| | - Peter Rauhe
- Pediatrics, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States
| | - Deborah Barkauskas
- Pediatrics, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States
| | - Nathan Teich
- Pediatrics, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States
| | - Caryn Tong
- Pediatrics, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States
| | - Jay Myers
- Pediatrics, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States
| | - Alex Y Huang
- Pathology, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States.,Pediatrics, Case Western Reserve University School of Medicine, Wolstein Research Building, Cleveland, Ohio, United States.,Angie Fowler AYA Cancer Institute, UH Rainbow Babies & Children's Hospital, Eulcid Avenue, Cleveland, Ohio, United States
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Baldotto C, Batista M, Lemos F, Padoan M, Carvalho N, Andrade P, Zukin M, Teich N, Araujo L. P1.06-024 Outcome of Non-Small Cell Lung Cancer Patients Treated in the Private Health Care in Brazil. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jansen-Winkeln B, Lyros O, Lachky A, Teich N, Gockel I. [Laparoscopic proctocolectomy technique : Restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis. Video article]. Chirurg 2017; 88:777-784. [PMID: 28812104 DOI: 10.1007/s00104-017-0481-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) constitutes a curative treatment option for therapy-refractory ulcerative colitis. A two-stage procedure with loop ileostomy at the time of IPAA is the most frequent variant of surgery. The aim of the procedure is the complete removal of the colon and rectum with simultaneous restoration of gastrointestinal continuity and preservation of continence functions. Long-term quality of life following laparoscopic proctocolectomy with IPAA is good and comparable with a healthy reference population. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online.
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Affiliation(s)
- B Jansen-Winkeln
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - O Lyros
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Lachky
- Referat Lehre, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Deutschland
| | - I Gockel
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
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11
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Stallmach A, Langbein C, Atreya R, Bruns T, Dignass A, Ende K, Hampe J, Hartmann F, Neurath MF, Maul J, Preiss JC, Schmelz R, Siegmund B, Schulze H, Teich N, von Arnim U, Baumgart DC, Schmidt C. Vedolizumab provides clinical benefit over 1 year in patients with active inflammatory bowel disease - a prospective multicenter observational study. Aliment Pharmacol Ther 2016; 44:1199-1212. [PMID: 27714831 DOI: 10.1111/apt.13813] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [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] [Received: 07/20/2016] [Revised: 08/03/2016] [Accepted: 09/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vedolizumab, a monoclonal antibody targeting the α4β7-integrin, is effective in inducing and maintaining clinical remission in Crohn's disease and ulcerative colitis according to randomised clinical trials. AIM To determine the long-term effectiveness of vedolizumab in a real-world clinical setting. METHODS This observational registry assessed the clinical outcome in patients treated with vedolizumab for clinically active Crohn's disease (n = 67) or ulcerative colitis (n = 60). Primary endpoint was clinical remission (HBI ≤ 4/pMayo ≤ 1) at week 54. Secondary endpoints included clinical response rates (HBI/pMayo score drop ≥3) and steroid-free clinical remission at weeks 30 and 54. RESULTS Vedolizumab was stopped in 69/127 (56%) patients after a median time of 18 weeks (range 2-49) predominantly owing to lack or loss of response. Using nonresponder imputation analysis, clinical remission and steroid-free remission rates were 21% and 15% in Crohn's disease and 25% and 22% in ulcerative colitis, respectively. Lack of clinical remission was associated with prior treatment with anti-TNF or with steroids for more than 3 months in the last 6 months in ulcerative colitis. At week 14, the absence of remission in Crohn's disease or nonresponse in ulcerative colitis indicated a low likelihood of clinical remission at week 54 [2/31 (7%) in Crohn's disease, 4/41 (10%) in ulcerative colitis]. Accordingly, declining C-reactive protein in inflammatory bowel disease and/or lower faecal calprotectin in ulcerative colitis at week 14 predicted remission at week 54. CONCLUSION Among patients who started vedolizumab for active inflammatory bowel disease, clinical remission rates are 21-25% after 54 weeks.
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12
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Gehrmann U, Berger U, Teich N, Bruns T, Stallmach A, Weber M. Motivation of patients with inflammatory bowel disease to participate in a clinical trial. Z Gastroenterol 2016; 54:1123-1129. [PMID: 27723903 DOI: 10.1055/s-0042-105749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Clinical trials are designed to investigate innovative diagnostic and therapeutic strategies for patients. However, factors that influence patients with inflammatory bowel disease (IBD) and willingness to participate in a clinical trial are unknown. Methods: We developed a questionnaire and asked IBD patients about their willingness to hypothetically participate in a clinical trial and their current health-related quality of life by using the IBDQ. Results: Of 201 distributed questionnaires, 166 were returned and included in the analysis. One-hundred-one (61 %) patients declared their willingness to participate in a clinical trial hypothetically offered in their current situation, whereas 65 (39 %) declined. Among all patients, a trustful relationship between patient and doctor was most important for trial participation. The willingness to help others and to support medical progress were other key issues mentioned. In contrast, those patients inclined to refuse trial participation feared impairment of their current health status, potential side effects, medical examinations, and the expenditure of time and effort. Conclusion: In our cohort of IBD patients, approximately two-thirds were willing to participate in a clinical trial. We were able to identify a number of factors that should help physicians to directly address fears and break down barriers in order to increase the number of patients willing to participate in clinical trials.
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Affiliation(s)
- U Gehrmann
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Germany
| | - U Berger
- Institut für Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Germany
| | - N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany
| | - T Bruns
- Gastroenterology, Hepatology and Infectology, Friedrich Schiller University, Jena, Germany
| | - A Stallmach
- Gastroenterology, Hepatology and Infectology, Friedrich Schiller University, Jena, Germany
| | - M Weber
- Gastroenterology, Hepatology and Infectology, Friedrich Schiller University, Jena, Germany
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13
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Teich N. [News on Azathioprine in IBD]. Z Gastroenterol 2013; 51:1195-1196. [PMID: 24122383 DOI: 10.1055/s-0033-1350363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
In 1998, the first TNF-blocker was approved in the USA and a year later in Germany. Treatment with TNF-blocking agents has significantly expanded therapeutic options for patients with chronic inflammatory diseases in rheumatology, dermatology and gastroenterology. However, it is not always possible to achieve a local clinical improvement by systemically administered TNF-blockers. Many approaches to topical therapy with TNF blockers have been published in recent years. The main objective of these off-label applications is the injection of a larger quantity of TNF-blocker in the inflamed tissue than it is achievable with systemic therapy. This summary provides an overview of the variety of topical therapy trials and reports own experiences in patients with Crohn's disease.
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Affiliation(s)
- N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig und Schkeuditz.
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15
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Teich N, Helwig U, Pace A, Dignass AU, Hartmann F, Hüppe D, Schmidt C, Stallmach A, Sturm A, Kruis W, Layer P. [Rational and efficient diagnosis in different stages of Crohn's disease]. Z Gastroenterol 2012; 50:684-693. [PMID: 22760681 DOI: 10.1055/s-0031-1299461] [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: 06/01/2023]
Abstract
The treatment of patients with inflammatory bowel disease has become more complex in recent years through the introduction of various immunosuppressive agents as well as the approval of monoclonal antibodies. Patients receiving such treatment must be carefully monitored. National and international guidelines define a diagnostic and therapeutic context for the practitioner, but can only partially respond to specific questions on the procedure for individual patients. Within the framework of a project initiated by Abbott entitled "IBD ahead" 34 German IBD experts have elaborated concrete proposals for the utility of clinical symptom assessment, endoscopy and the use of laboratory parameters including foecal markers of inflammation. Furthermore, we discuss the significance of conventional X-rays, computed tomography, ultrasound and magnetic resonance tomography. These recommendations are illustrated by case studies from everyday practice in the participating centres.
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Affiliation(s)
- N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig.
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Schmidt C, Dignass A, Hartmann F, Hüppe D, Kruis W, Layer P, Lüers A, Stallmach A, Teich N, Sturm A. [IBD ahead 2010--Answering important questions in Crohn's disease treatment]. Z Gastroenterol 2011; 49:1246-54. [PMID: 21866492 DOI: 10.1055/s-0031-1273416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The treatment of patients with inflammatory bowel disease has become more complex in recent years through the introduction of various immunosuppressive agents as well as the approval of monoclonal antibodies against TNF-α and patients receiving such treatment must be carefully monitored. National and international guidelines define a diagnostic and therapeutic context for the practitioner, but can only partially respond to specific questions on the procedure for individual patients. Within the framework of a project initiated by Abbott entitled "IBD ahead" 38 German IBD experts have elaborated concrete proposals for dealing with corticosteroids, immunosuppressants and TNF-α antibodies on the basis of the published literature and their own personal experience in order to close the gap between these guidelines and daily clinical practice. Statements were developed on the choice of correct timing of initiation, dose and duration of the individual substances and on how to proceed with patients exhibiting treatment failure. Moreover, recommendations are also made on drug combination strategies, safety monitoring and the risks regarding the development of infectious complications and malignancies. These recommendations are illustrated by case studies from everyday practice in participating centres.
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Affiliation(s)
- C Schmidt
- Universitätklinikum Jena, Klinik für Innere Medizin II, Abteilung für Gastroenterologie, Hepatologie und Infektiologie
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Antunes HS, Herchenhorn D, Araujo CM, Cabral E, Ferreira EMDS, Small IA, Rampini MP, Teich N, Rodrigues PC, Silva TGPD, Dias LF, Ferreira CGM. Phase III trial of low-level laser therapy to prevent induced oral mucositis in head and neck cancer patients submitted to concurrent chemoradiation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba5524] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5524 Background: Oral mucositis (OM) remains a limiting factor in in head and neck squamous cell carcinomas (HNSCC) patients (pts) treated with chemoradiation (CRT) leading to pain, dysphagia, and weight loss. Low-level laser therapy (LLLT) emerges as a promising, preventive therapy of CRT-induced OM. Yet, a definitive randomized trial supporting its use is lacking. This study was designed to assess the efficacy of LLLT in reducing the incidence and/or severity of OM. Methods: Assuming OM grade (G3) for placebo 0.4 (P0); LLLT 0.15 (P1) ; β=0.2; α=0.05, sample size was 94 pts. From Jun 2007 to Dec 2010, 47 LLLT and 47 placebo pts bearer of HNSCC of nasopharynx, oropharynx and hipopharynx entered a prospective, randomized, double blind, placebo-controlled, phase III trial. CRT consisted of conventional RT 70.2 Gy (1.8Gy/d, 5 times/wk) + concurrent cisplatin 100 mg/m2 every 3 wks. Main endpoints were OM incidence and severity, RT interruptions due to OM and pain intensity. The LLLT used daily was a diode InGaAlP (660nm-100mW-4J/cm²). OM evaluation was done by WHO and OMAS scale. Results: Mean age was 54.6 and 87.2% of pts were male. Primary site: oropharynx (74 pts), nasopharynx (9 pts), hypopharynx (11 pts). In the LLLT arm the incidence of OM G 3/4 was only 6.4% versus 48% in the placebo arm; HR of 0.13 (IC 95%, p<0.001). Besides in the LLLT arm 51% of pts did not have ulcers versus 17% in placebo arm (p<0.001). LLLT pts had less severe pain (p=0.012), used less narcotic analgesic, HR 0.33 (IC 95%, p<0.001) and required less gastrostomia, HR 0.037 (IC 95%, p= 0.005). No LLLT pts had RT interrupted due to OM. EORTC QLQ-C30 and its specific head and neck module QLQ-H&N35 were applied. Results clearly favored the LLLT arm. In QLQ-C30 benefit was seen in both physical and emotional functioning (p=0.037), fatigue (p=0.011), pain (p=0.043); and in QLQ-H&N35, pain (p=0.007), swallowing (p=0.001) and trouble with social eating (p=0.026). Conclusions: Our results indicate that upfront LLLT in HNSCC pts submitted to CRT is an effective tool in reducing G 3/4 OM, oral pain, use of narcotic and gastrostomia. QoL data supports the efficacy findings. Thereby LLLT should be the new standard of care in this setting.
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Affiliation(s)
- H. S. Antunes
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - D. Herchenhorn
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - C. M. Araujo
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - E. Cabral
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - E. M. d. S. Ferreira
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - I. A. Small
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - M. P. Rampini
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - N. Teich
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - P. C. Rodrigues
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - T. G. P. d. Silva
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - L. F. Dias
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
| | - C. G. M. Ferreira
- Clinical Research Coordination, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil; Department of Nursing, Instituto Nacional de Cancer, Rio de Janeiro, Brazil; Private Clinic, Rio de Janeiro, Brazil; Clinical Research Coordination and Thoracic Oncology Tumor Group, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil; Instituto COI de Educacao
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Vieira FM, Salem JH, De Lima Araujo LH, Helal RC, Zukin M, Gomes TS, Silva CC, Lima MG, Boukai A, Ferreira CGM, Teich N. The influence of triple-negative status on survival of patients with early-stage breast cancer treated in a Brazilian outpatient cancer center. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Antunes HS, Herchenhorn D, Araujo CM, Cabral E, Ferreira EMDS, Small IA, Rampini MP, Teich N, Rodrigues PC, Silva TGPD, Dias LF, Ferreira CGM. Phase III trial of low-level laser therapy to prevent induced oral mucositis in head and neck cancer patients submitted to concurrent chemoradiation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba5524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Teich N, Helal RC, De Lima Araujo LH, Schaum MRA, Victorino APO, Salem JH, Silva BCV, Almeida AN, Corrêa DD, Vieira FM, Ferreira CGM. Epidemiological features of patients with breast cancer treated in a private oncologic center from Brazil. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e12023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Reisner ML, Salmon H, Pavan G, Cavalieri R, Teich N, Vieira FM, Ferreira CGM. Analysis of IMRT and IGRT in coronary sparing in patients with left-sided breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e21164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Rahier JF, Papay P, Salleron J, Sebastian S, Ellul P, Teich N, Fiorino G, Blaha B, Garcia-Sanchez V, Haas T, Van Gossum A, Abitbol V, Yazdanpanah Y, Chaparro MC. Influenza A (H1N1)v infection in patients with inflammatory bowel disease: a case series. Aliment Pharmacol Ther 2011; 33:499-500. [PMID: 21235603 DOI: 10.1111/j.1365-2036.2010.04558.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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23
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Witt L, Osthaus W, Lücke T, Jüttner B, Teich N, Jänisch S, Debertin A, Sümpelmann R. Safety of glucose-containing solutions during accidental hyperinfusion in piglets. Br J Anaesth 2010; 105:635-9. [DOI: 10.1093/bja/aeq204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Teich N, Mössner J. Ernährung bei akuter Pankreatitis. Dtsch Med Wochenschr 2010; 135:1979-81. [DOI: 10.1055/s-0030-1263346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Vieira FM, Teich N, Musacchio JG, Boukai A, Victorino AO, Helal RC, Silva BV, Small IÁ, Corrêa DD, Schaum MR. Prognostic significance of molecular classification of breast-invasive ductal carcinoma in a Brazilian outpatient cancer center. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Teich N, Pepe C, Vieira FM, Teich V, Cintra M, Leibel F, Boukai A, Helal RC, Victorino AO, Musacchio JG. Retrospective cost analysis of breast cancer patients treated in a Brazilian outpatient cancer center (OCC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11026] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Boukai A, Teich N, Vieira FM, Musacchio JG, Helal RC, Victorino AO, Small IÁ, Zukin M, Assiz AN, Corrêa DD. Clinicopathologic features of patients with breast cancer in a private oncology center in Brazil. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Malignancies of the gastrointestinal tract are the most common causes of cancer-related deaths in Germany. They also induce significant morbidity. Despite both surgical and medical therapeutic improvements, advanced stages of these cancers can rarely be cured. Preventive and screening measures are suitable to decrease gastrointestinal cancer-related mortality. Weight reduction and cessation of smoking are effective in preventing esophageal, pancreatic and colorectal cancer. Treatment of infections like chronic viral hepatitis and helicobacter pylori gastritis is able to protect from hepatocellular and gastric cancer, respectively. Colonoscopy is one of the best established screening methods. It allows early detection of colorectal neoplasia. Preneoplastic adenomas can be endoscopically removed during the same session. We here review simple prevention strategies and effective screening methods in gastrointestinal cancers of relevance in daily practice.
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Affiliation(s)
- A Hoffmeister
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Leipzig, AöR, Philipp-Rosenthal Strasse 27, 04103 Leipzig
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Abstract
Acute pancreatitis is potentially fatal. It can be diagnosed based on present history, clinical appearance, and typical findings from laboratory and radiologic investigations. All patients must be admitted to hospital, as the disease course cannot be predicted at initial presentation. Increasing severity demands increasingly individualized therapy. The most important interventions are fast fluid resuscitation and analgesic therapy with opioids. Therapeutic agents specific to pancreatitis have failed to show any advantages so far. The roles of antibiotic therapy and nutritional support in the therapeutic regimen have been profoundly reassessed during recent years. Surgery and endoscopic interventions may be necessary and beneficial in carefully selected patients. In this review we summarize clinically relevant issues of acute pancreatitis.
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Affiliation(s)
- N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselerkrankungen, Funkenburgstrasse 19, Leipzig, Germany.
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Abstract
Nutritional concepts in acute pancreatitis are undergoing a rapid change. An early start of nutrition via nasojejunal tubes is about to replace parenteral nutrition. Yesterday it was believed that the pancreas had to be put at rest. Thus, stimulation of pancreatic secretion by enteral nutrition was believed to be detrimental. However, on comparing the results of enteral with those of parenteral nutrition, the pancreatic infection rates, rate of surgical interventions, days of hospital stay, and costs are found to be significantly reduced. Whether or not enteral nutrition decreases mortality has not been clearly proven. Pancreatitis is associated with the risk of paralytic ileus. Thus, data suggesting that one does not have to feed via a nasojejunal tube but rather via an easier to place nasogastric tube, are provocative. Numerous questions still have to be answered such as composition of tube diet, nutrition in mild to moderate pancreatitis, ways to reduce pain and composition of diet when oral refeeding is started. The nutrition of tomorrow may implicate immunonutrition. There are only a few small studies suggesting beneficial effects by supplementation of tube feeding with MCT/LCT triglycerides, glutamine, arginin, omega-3-fatty acids, nucleotides. So far, these supplements have failed to show efficacy for clinically relevant endpoints. In an recently published study, prebiotics were associated with a high complication rate. In this review, we summarise the current knowledge on nutrition in acute pancreatitis and discuss future developments.
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Affiliation(s)
- J Mössner
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Leipzig
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31
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Dienstmann R, Viola S, Chueke M, Takemoto M, Teich N. Cardiac monitoring and toxicity with adjuvant trastuzumab in breast cancer: Data from clinical practice. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Petros S, Fischer J, Mössner J, Schiefke I, Teich N. Treatment of Massive Cecal Bleeding in a 28-Year-Old Patient with Homozygous Factor V Deficiency with Activated Factor VII. Z Gastroenterol 2008; 46:271-3. [DOI: 10.1055/s-2007-963377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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33
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Wiedmann M, Teich N, Ott R, Eichelkraut S, Mössner J. A man with two pylori. Gut 2008; 57:305, 351. [PMID: 18268053 DOI: 10.1136/gut.2006.114942] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- M Wiedmann
- Department of Internal Medicine II, University of Leipzig, Philipp-Rosenthal-Str. 27, D-04103 Leipzig, Germany.
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Abstract
Ulcerative colitis (UC) has traditionally been considered to be an inflammatory disease limited to the colonic mucosa. However, since it has been shown that UC is frequently accompanied by various extraintestinal disorders, there is increasing evidence that UC may also manifest in the nervous system. The following review focuses particularly on these possible manifestations of UC, both in the peripheral (PNS), and in the central nervous system (CNS). A systematic literature search according to the MEDLINE database was performed for this purpose. Although a reliable differentiation may clinically not always be possible, three major pathogenic entities can be differentiated: (i) cerebrovascular disease as a consequence of thrombosis and thromboembolism; (ii) systemic and cerebral vasculitis; (iii) probably immune mediated neuropathy and cerebral demyelination. With the exception of thromboembolism and sensorineural hearing loss, evidence for a causal relationship relies merely on single case reports or retrospective case series. Considering the CNS-manifestations, similarities between UC-associated disorders of the white matter and acute disseminated encephalomyelitis (ADEM) are obvious. Epileptic seizures, unspecified encephalopathies and confusional states are most likely epiphenomena that have to be regarded symptomatic rather than as own entities. A prospective study on the neurologic aspects of UC would be very welcome.
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Affiliation(s)
- R Scheid
- Day Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany.
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Scheid R, Teich N. Eine schwere neurologische Erkrankung bei einem Patienten mit Colitis ulcerosa und Proteinase-3-positiven atypischen ANCA. Akt Neurol 2007. [DOI: 10.1055/s-2007-970832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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36
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Hoffmeister A, Wittenburg H, Teich N, Bachmann A, Borte G, Mössner J, Achenbach H. [A 32-year-old patient with diarrhoea and acute kidney failure]. Internist (Berl) 2007; 47:1063-7. [PMID: 16953438 DOI: 10.1007/s00108-006-1705-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 32-year-old male patient presented in the emergency department of our hospital with acute vomiting and diarrhoea. He reported occasional non-severe diarrhoea over several years in the past. Furthermore, at the time of presentation the patient had had anuria for several days. A prerenal and postrenal origin of the renal failure was excluded. A renal biopsy was performed and histopathological examination displayed findings consistent with a haemolytic-uraemic syndrome but no signs of glomerulonephritis. MRI examination of the small bowel revealed inflammatory alterations typical for Crohn's disease, even without histological verification. We describe haemolytic-waemic syndrome as manifestation of Crohn's disease for the first time.
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Affiliation(s)
- A Hoffmeister
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Leipzig, Ph.-Rosenthal-Strasse 27, 04103, Leipzig, Germany.
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Abstract
Severe acute pancreatitis leads to a dramatic fluid loss in the intraperitoneal space which may result in circulatory decompensation. Sequestration of fluid can amount up to 40 percent of the circulating blood volume. The amount of fluid and electrolyte replacement is often misjudged leading to a higher rate of complications and a higher mortality rate of the disease. Furthermore, subsequent and adequate fluid resuscitation seems to influence the prognostic course of the disease by improving the perfusion and oxygenation of the pancreas. Otherwise volume overload may cause cardiopulmonary decompensation in the case of synchronous cardiopulmonary comorbidities. Therefore, an important part of treatment relies on careful haemodynamic monitoring, if necessary managed in an intensive care unit. Usually most patients with acute pancreatitis will be treated on a non-intensive medical ward which allows a differentiated and continuous haemodynamic monitoring only to a limited extent. Apart from monitoring circulatory parameters and measuring central venous pressure, there are other clinical methods, laboratory tests and radiological diagnostic procedures to determine the amount of intravascular fluid deficit and the individual volume demand of patients with acute pancreatitis. Prospective clinical trials for evaluation of pancreatitis-specific volume management do not exist so far. The aim of this review is to provide background information on invasive and non-invasive diagnostic methods for detection of circulatory hypovolemia in acute pancreatitis.
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Affiliation(s)
- F Gundling
- II. Medizinische Abteilung für Gastroenterologie, Hepatologie und Gastroenterologische Onkologie, Klinikum Bogenhausen, Städtisches Krankenhaus München GmbH, München.
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38
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Teich N. [First aid regulations: generally unknown in Germany]. Versicherungsmedizin 2006; 58:37-8. [PMID: 16553227] [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] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- N Teich
- Universität Leipzig, Medizinische Klinik und Poliklinik II
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Abstract
BACKGROUND AND OBJECTIVE Sudden cardiac death is a leading cause of death. In Germany, only 10% of patients will survive reanimation. The prognosis is mainly determined by the first-aid skills of accidental witnesses. METHODS The reaction of 1007 German-speaking adults (462 males, 545 females, median age 39 years) was investigated in an emergency scenario with symptoms of sudden cardiac death in an acquaintance. Afterwards a self-assessment of their first-aid skills, such as cardiac compression and mouth-to-mouth ventilation was made. RESULTS 94% of the interviewees would call professional aid at once. Diagnostic skills, as searching for pulse or checking for breath would be done by 26 and 21%, respectively. The most frequently mentioned therapeutic skill was positioning the victim in stable lateral position (37%), but very less frequently cardiac compression (6%) and mouth-to-mouth resuscitation (10%). When asked, 51 (81%) of those interviewed regarded their skills in cardiac compression and mouth-to-mouth resuscitation as adequate. To some extent there were differences in favor of young people and those from East Germany. CONCLUSION These representative data suggest that (a) ABC-like first-aid rules are largely unknown among the population; (b) the value of a stable lateral position is overestimated and (c) first-aid skills of elderly persons are worst. A significant improvement of first-aid skills of the German population is mandatory in order to improve in future the outcome of sudden cardiac death.
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Affiliation(s)
- N Teich
- Medizinische Klinik und Poliklinik II, 04103 Leipzig.
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Abstract
The identification of a specific mutation in the human cationic trypsinogen gene in large kindreds with hereditary pancreatitis was the key to understand the genetic background of chronic pancreatitis. Rapidly, other variants within the same gene were identified-even in small families with a minority of patients. Later, mutations of the most important intrapancreatic trypsin inhibitor SPINK1 were found with high prevalence in patients with idiopathic, tropical and alcoholic chronic pancreatitis. We summarize interesting genetic and biochemical findings, point to clinical features and review recommendations for genetic analysis, follow-up and cancer prevention.
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Affiliation(s)
- N Teich
- Medizinische Klinik und Poliklinik II, Universität Leipzig.
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41
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Schiefke I, Soeder H, Zabel-Langhennig A, Teich N, Neumann S, Borte G, Mössner J, Caca K. Endoluminal gastroplication: what are the predictors of outcome? Scand J Gastroenterol 2004; 39:1296-303. [PMID: 15743010 DOI: 10.1080/00365520410003579] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoluminal gastroplication (EndoCinch) has emerged as an endoscopic anti-reflux therapy, but predictive factors for symptom relief have not been established. The aim of this study was to evaluate the major determinants to predict outcome in patients treated with EndoCinch. METHODS A total of 53 consecutive patients, treated with EndoCinch at a single center were included in this prospective study. Inclusion criteria were symptoms of chronic heartburn, dependency on proton-pump inhibitors, documented pathological esophageal acid exposure, and a hiatal hernia smaller than 3 cm in length. All patients underwent endoscopy, 24-h pH monitoring, esophageal manometry, barium esophagram, and a detailed questionnaire regarding their symptoms before treatment. Patients were stratified into a responder and a non-responder group using a questionnaire at 3-month follow-up. A multivariate analysis was performed. RESULTS The success rate was 64% (34/53 patients). Three variables weresignificantly predictive for successful endoscopic anti-reflux treatment at the multivariate level: presence of typical symptoms (P=0.01), complete symptom relief with acid suppressive therapy (P=0.01), and normal lower esophageal sphincter pressure (P = 0.04). Not predictive of outcome were age, body mass index, esophagitis, other manometric findings, hiatal hernia size, or pathological level of pH <4/24 h. Barium esophagram did not add any additional predictive information. CONCLUSIONS Since no single factor can predict outcome after EndoCinch, a careful patient selection is mandatory to maximize the success rate. The ideal candidate for EndoCinch is a gastroesophageal (GERD) patient with a normal lower esophageal sphincter pressure, whose typical symptoms completely resolved with acid suppressive therapy.
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Affiliation(s)
- I Schiefke
- Depts of Internal Medicine II and Radiology, University of Leipzig, Leipzig, Germany
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Teich N, Tannapfel A, Ammon A, Ruf BR, van der Poel WH, Mössner J, Liebert UG. [Sporadic acute hepatitis E in Germany: an underdiagnosed phenomenon?]. Z Gastroenterol 2003; 41:419-23. [PMID: 12772055 DOI: 10.1055/s-2003-39329] [Citation(s) in RCA: 6] [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: 10/27/2022]
Abstract
Hepatitis E virus infection is the leading cause of enterically transmitted hepatitis worldwide. Case reports of hepatitis E in individuals in Germany so far related to travel to endemic areas. A 33-year-old man presented with painless jaundice. By serology and liver biopsy, no cause of hepatitis could be identified. After discharge transaminases were persistently elevated. Serology (IgG and IgM) confirmed acute hepatitis E. The transaminases declined to normal values within six months. Detailed anamnestic questioning revealed no travel to an endemic region or contact with individuals who had visited such areas. In addition to our patient, a total of 34 cases of acute hepatitis E were reported to the Robert-Koch-Institute (German center of disease control) in 2001. In five of them, the disease had obviously been acquired in Germany. These data indicate that community acquired hepatitis E virus infection may occur sporadically in Germany and should be considered as a cause of seronegative (non-A-non-B-non-C) hepatitis.
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Affiliation(s)
- N Teich
- Medizinische Klinik und Poliklinik II, Universität Leipzig.
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Abstract
BACKGROUND Mutations of the pancreatic serine protease inhibitor, Kazal type 1 (SPINK1), the cationic trypsinogen (PRSS1) and the cystic fibrosis transmembrane conductance regulator (CFTR) were reported to be genetic risk factors of chronic pancreatitis (CP). The aim of this study was to determine the role of genetic variants of the main serum antiproteinases alpha-1-antitrypsin (AAT) and alpha-2-macroglobulin (A2M) for the course of chronic pancreatitis. METHODS 124 patients with non-alcoholic chronic pancreatitis (with PRSS1 or SPINK1 mutations or idiopathic pancreatitis) and 64 healthy controls were investigated for the AAT mutations PiS and PiZ, and the PiM determining variants R101H, V213A, E376D. In 101 subjects, the 'bait region' of A2M was sequenced. A pentanucleotide deletion in the bait region of A2M was analysed in 147 chronic pancreatitis (CP) patients and 87 controls. RESULTS The lowest prevalences of V213A and E376D were found in PRSS1 patients, whereas an increased rate of these mutations was present in the SPINK1 group, and the highest prevalence was found in patients with idiopathic pancreatitis. The prevalence of PiM variants was higher in patients with early onset CP than in late onset (P < 0.05 for E376D). The coding region of the bait region of A2M was of wild type in all investigated subjects. The A2M pentanucleotide deletion showed a homogenous distribution in patients and controls. CONCLUSIONS Our study suggests a moderating, but not predominant, role of AAT variants in the course of chronic non-alcoholic pancreatitis.
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Affiliation(s)
- N Teich
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Leipzig, Germany.
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Abstract
PURPOSE We determined the clinical manifestations of hereditary pancreatitis in nearly 30 families. PATIENTS AND METHODS The two trypsinogen mutations N29I and R122H were identified in a group of 550 patients with chronic pancreatitis of unclear origin. The following criteria were used to characterize the severity of chronic pancreatitis (one point each): calcifications, cysts, dilation of the pancreatic duct, diabetes, hospital treatment, and operation. Stages were defined as stage 0 (no points), stage 1 (one to two points), stage 2 (three to four points), and stage 3 (more than four points). Smoking and drinking habits were also recorded. RESULTS Six families with the N29I mutation (25 subjects with the mutation) and 21 families with the R122H mutation (76 subjects with the mutation) were identified. The median ages for the onset of disease were 11 years in N29I and 10 years in R122H patients. The severity of chronic pancreatitis and symptoms were similar for both mutations. About 26% (n = 26) of the 101 subjects carrying a mutation were asymptomatic, and 42% (n = 42) had mild disease (stage 1). Twenty-nine percent (n = 29) had moderate disease (stage 2), and only 4% (n = 4) had severe disease (stage 3). CONCLUSIONS Symptoms of patients with the N29I or R122H trypsinogen mutation were generally similar. The majority of subjects with trypsinogen mutations had mild disease or was asymptomatic.
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Affiliation(s)
- V Keim
- German Registry of Hereditary Pancreatitis at the Medizinische Klinik und Poliklinik II, Universität Leipzig, Leipzig, Germany
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Abstract
Summary. The understanding of the pathogenesis of chronic pancreatitis is limited. Several theories (i. e. obstruction hypothesis) were suggested in the past but could not be confirmed by experimental data. As a formal description of the course of the disease, the necrosis-fibrosis concept seems to be very attractive. According to this theory, there is no significant difference in the pathogenesis of acute and chronic pancreatitis. A major step was the identification of mutations of the cationic trypsinogen, the secretory trypsin inhibitor (SPINK 1) and the cystic-fibrosis protein (CFTR) in some patients. Investigation of these mutations may significantly contribute to a better understanding of the pathogenesis of chronic pancreatitis.
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Affiliation(s)
- N Teich
- Medizinische Klinik und Poliklinik II, Universität Leipzig, Germany
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Witt H, Luck W, Becker M, Böhmig M, Kage A, Truninger K, Ammann RW, O'Reilly D, Kingsnorth A, Schulz HU, Halangk W, Kielstein V, Knoefel WT, Teich N, Keim V. Mutation in the SPINK1 trypsin inhibitor gene, alcohol use, and chronic pancreatitis. JAMA 2001; 285:2716-7. [PMID: 11386926 DOI: 10.1001/jama.285.21.2716-a] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Teich N, Keim V. [Pancreatic stellate cells and chronic alcoholic pancreatitis]. Z Gastroenterol 2001; 39:333-4. [PMID: 11367983 DOI: 10.1055/s-2001-12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- N Teich
- Medizinische Klinik und Poliklinik II, Universität Leipzig.
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Teich N, Ockenga J, Hoffmeister A, Manns M, Mössner J, Keim V. Chronic pancreatitis associated with an activation peptide mutation that facilitates trypsin activation. Gastroenterology 2000; 119:461-5. [PMID: 10930381 DOI: 10.1053/gast.2000.9312] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.3] [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: 12/15/2022]
Abstract
BACKGROUND & AIMS Mutations of the cationic trypsinogen have been described in hereditary pancreatitis. We report a new trypsinogen mutation in the activation peptide of the proenzyme in a family with chronic pancreatitis. METHODS The coding region of the cationic trypsinogen gene was sequenced after polymerase chain reaction amplification. The following peptides homologous to the N-terminal end of cationic trypsinogen were synthesized (one-letter code, mutated amino acid underlined): wild-type peptide, APFDDDDKIVGG; pD22G, APFDDDGKIVGG; pK23R, APFDDDDRIVGG. The sequences of pD22G and pK23R correspond to the recently identified mutation K23R and to the mutation described here (D22G). To mimic trypsinogen activation, these peptides were digested with trypsin for 30 minutes at pH 5.0-8. 0, and the fragments were analyzed by high-performance liquid chromatography. RESULTS In a family with clinical evidence of hereditary chronic pancreatitis, a missense mutation of codon 22 (GAC-->GGC) of the cationic trypsinogen was found. This mutation results in a substitution of aspartic acid by glycine; therefore, the mutation was called D22G. Chromatographic analysis of tryptic digests of the peptides pD22G and pK23R showed hydrolysis rates of 22% and 75%, respectively, whereas the wild-type peptide was hydrolyzed at only 6%. The cleavage rates were reduced at lower pH, and no hydrolysis occurred without trypsin. CONCLUSIONS The activation peptides of the trypsinogen variants D22G and K23R could be released at a higher rate than in wild-type trypsinogen, resulting in increased amounts of trypsin in the pancreas, which could initiate pancreatitis.
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Affiliation(s)
- N Teich
- Medizinische Klinik II, Universität Leipzig, Leipzig, Germany
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Ockenga J, Stuhrmann M, Ballmann M, Teich N, Keim V, Dörk T, Manns MP. Mutations of the cystic fibrosis gene, but not cationic trypsinogen gene, are associated with recurrent or chronic idiopathic pancreatitis. Am J Gastroenterol 2000; 95:2061-7. [PMID: 10950058 DOI: 10.1111/j.1572-0241.2000.02228.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [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: 12/11/2022]
Abstract
OBJECTIVE We investigated whether mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene and cationic trypsinogen gene are associated with recurrent acute, or chronic idiopathic pancreatitis. METHODS Twenty patients with idiopathic pancreatitis (11 women, nine men; mean age, 30 yr) were studied for the presence of a CFTR mutation by screening the genomic DNA for more than 30 mutations and variants in the CFTR gene. Selected mutations of the cationic trypsinogen gene were screened by Afl III restriction digestion or by a mutation-specific polymerase chain reaction (PCR). In each patient exons 1, 2, and 3 of the cationic trypsinogen gene were sequenced. Patients with a CFTR mutation underwent evaluation of further functional electrophysiological test (intestinal current measurement). RESULTS No mutation of the cationic trypsinogen gene was detected. A CFTR mutation was detected in 6/20 (30.0%) patients. Three patients (15.0%) had a cystic fibrosis (CF) mutation on one chromosome (deltaF508, I336K, Y1092X), which is known to cause phenotypical severe cystic fibrosis. One patient was heterozygous for the 5T allele. In addition, two possibly predisposing CFTR variants (R75Q, 1716G-->A) were detected on four patients, one of these being a compound heterozygous for the missense mutation I336K and R75Q. No other family member (maternal I336K; paternal R75Q; sister I1336K) developed pancreatitis. An intestinal current measurement in rectum samples of patients with a CFTR mutation revealed no CF-typical constellations. CONCLUSIONS CFTR mutations are associated with recurrent acute, or chronic idiopathic pancreatitis, whereas mutations of the cationic trypsinogen mutation do not appear to be a frequent pathogenetic factor.
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Affiliation(s)
- J Ockenga
- Department of Gastroenterology and Hepatology, Human Genetics, Paediatric Pulmonology, Medical School of Hannover, Germany
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Abstract
Hereditary pancreatitis (OMIM 167800) is thought to be associated with a mutation of the exon 3 of cationic trypsinogen (Nature Genet (1996): 14:141-145). This paper reports sequence data of two independent families suffering from this disease. PCR amplificates from leukocyte or buccal swab DNA showed no mutation of exon 3 of cationic trypsinogen. Instead, in exon 2, an A-to-T tranversion was found that led to the substitution of Asn by Ile in the sixth amino acid of the active trypsin. In exons 4 and 5, silent mutations were found. In the other expressed trypsinogens, several homozygous alterations not associated to hereditary pancreatitis were identified. As a model of pathogenesis, we hypothesize that mutation of trypsinogen in exon 2 could lead to premature cleavage of the activation peptide of trypsinogen or to altered intracellular transport.
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Affiliation(s)
- N Teich
- Medizinische Klinik und Poliklinik II, Universität Leipzig, Germany
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